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Abstract Number: 2326

Outcomes One Year after Hip Fracture Repair in the Elderly: Does Social Isolation Matter?

Lisa A. Mandl1, Serena Lian1, Jackie Szymonifka2, Kirsten Grueter3, Aidan Hadad3 and Joseph Lane3, 1Rheumatology, Hospital for Special Surgery, New York, NY, 2Hospital for Special Surgery, New York, NY, 3Orthopaedic Surgery, Hospital for Special Surgery, New York, NY

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: fractures, Hip, osteoporosis, outcomes and social support

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Session Information

Date: Tuesday, October 23, 2018

Session Title: Osteoporosis and Metabolic Bone Disease – Basic and Clinical Science Poster

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Hip fractures are a serious public health issue with a significant population burden, especially among those over age 65. Social isolation—how integrated a patient is in their community—is a novel and potentially modifiable risk factor for poor health outcomes after low energy hip fracture. This study evaluates the association of pre-operative social isolation with death, adverse events, and patient-reported outcomes in elderly patients 1 year after surgical repair of low energy hip fracture.

Methods:

The Lubben Social Networks Scale-18 (LSNS-18), a validated instrument specifically designed to measure social isolation in the elderly; PROMIS-29, which measures a variety of important patient-reported domains; and the Lower Extremity Activity Scale (LEAS), which measures physical function, were administered to cognitively intact patients ≥ age 65 with no active cancer, 2-4 days after surgical repair of hip fracture. Patients were specifically instructed to answer based on their pre-fracture status. Patients were contacted at 4 weeks, 3 months, and 1 year after surgery. The LSNS-18, PROMIS-29, and LEAS were re-administered at 1 year. Data were analyzed using t-tests, chi-square tests, Wilcoxon rank-sum tests and Spearman correlations.

Results:

203 patients enrolled: 71.9% female, 91.6% white, 78.7% college educated, with a median age of 81.8 [74.1, 87.3] years. 36% were socially isolated. Of the 9 known deaths within 1 year, 6/9 (67%) were socially isolated, a much higher percentage than the overall cohort, though not statistically significant (p=0.095).

73/99 (74%) of subjects who were 1-year post-fracture repair completed 1-year questionnaires (20 withdrew consent/were lost to follow-up, and 6 were mentally/physically unable to participate). There was no statistically significant difference in number of adverse events/severe adverse events between socially isolated and non-socially isolated subjects. There was also no difference in LEAS score or any PROMIS-29 domain between isolated and non-isolated subjects 1 year after surgery. However, socially isolated patients were more likely to improve their LSNS-18 score than those who were not socially isolated prior to fracture repair (Δ6.1 ±13.3 vs. Δ-1.2 ±13.7; p=0.03).

Conclusion:

There is a trend suggesting social isolation may be associated with 1-year mortality in cognitively intact elderly patients undergoing surgical repair of low energy hip fracture. Although there was no association between pre-fracture social isolation and adverse events or self-reported patient reported outcomes, on average socially isolated patients were less isolated 1 year after fracture repair than pre-fracture. Whether the magnitude of improvement in social isolation is associated with improved health status will be evaluated as this study continues to recruit.


Disclosure: L. A. Mandl, None; S. Lian, None; J. Szymonifka, None; K. Grueter, None; A. Hadad, None; J. Lane, None.

To cite this abstract in AMA style:

Mandl LA, Lian S, Szymonifka J, Grueter K, Hadad A, Lane J. Outcomes One Year after Hip Fracture Repair in the Elderly: Does Social Isolation Matter? [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/outcomes-one-year-after-hip-fracture-repair-in-the-elderly-does-social-isolation-matter/. Accessed April 16, 2021.
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