BACKGROUND Hip fractures are associated with mortality, disability, and loss of independence in older adults. While several risk factors associated with poor outcomes following a hip fracture have been identified, the effect of frailty status prior to hip fracture is not well established. AIM To examine the associations of frailty with mortality, change in activities of daily living (ADL) limitations, and transition to permanent residential aged care in older people following a hip fracture. METHODS A retrospective cohort study was conducted on people aged 65 years and older with a surgically treated hip fracture between 2003 and 2015. Frailty was estimated using a cumulative deficit-based frailty index and categorized into quartiles. Cox multivariable regression, logistic regression, and Fine-Gray multivariable regression models estimated associations of frailty with mortality, ADL limitations, and entry into permanent residential aged care, respectively. Hazard ratios (HR), odds ratios (OR), subdistribution hazard ratios (SHR), and 95% confidence intervals (95%CI) are reported. RESULTS Out of 4771 individuals with hip fractures, 75.6% were female and the median age was 86 (interquartile range 82-90) years old. The two-year survival of patients following hip fracture was 43.7% (95%CI 40.9-46.7%) in those in the highest quartile of frailty, compared to 54.4% (95%CI 51.8-57.2%) for those in the lowest quartile (HR = 1.25, 95%CI 1.11-1.41, p < 0.001). No associations between pre-fracture frailty and post-fracture ADL limitations were observed. Additionally, no association of frailty with transition to permanent residential aged care for patients living in the community (n = 1361) was observed (SHR = 0.98, 95%CI 0.81-1.18, p = 1.000). CONCLUSIONS Older patients with the highest level of frailty had an increased risk of mortality after hip fracture. Consideration for appropriate clinical interventions, including fall and frailty prevention measures, may be appropriate for this identified group of vulnerable individuals.

中文翻译：

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虚弱对老年人髋部骨折手术治疗结果的影响

背景髋部骨折与老年人的死亡率、残疾和丧失独立性有关。虽然已经确定了与髋部骨折后不良结果相关的几个风险因素，但尚未确定髋部骨折前虚弱状态的影响。目的 研究老年人髋部骨折后虚弱与死亡率、日常生活活动 (ADL) 限制的变化以及过渡到永久性住宅老年护理之间的关联。方法 对 2003 年至 2015 年间接受手术治疗的髋部骨折的 65 岁及以上人群进行了一项回顾性队列研究。使用基于累积缺陷的衰弱指数估计衰弱，并将其分类为四分位数。Cox 多变量回归、逻辑回归、和 Fine-Gray 多变量回归模型分别估计了虚弱与死亡率、ADL 限制和进入永久性住宅老年护理之间的关联。报告了风险比 (HR)、优势比 (OR)、亚分布风险比 (SHR) 和 95% 置信区间 (95%CI)。结果 4771 名髋部骨折患者中，75.6% 为女性，中位年龄为 86 岁（四分位距 82-90）。髋部骨折患者的两年生存率在体弱程度最高的四分位数中为 43.7% (95%CI 40.9-46.7%)，而在体弱程度最低的四分位数中为 54.4% (95%CI 51.8-57.2%) (HR = 1.25, 95% CI 1.11-1.41, p < 0.001)。未观察到骨折前虚弱和骨折后 ADL 限制之间存在关联。此外，没有观察到体弱与社区患者（n = 1361）过渡到永久住所老年护理之间的关联（SHR = 0.98，95% CI 0.81-1.18，p = 1.000）。结论 体弱程度最高的老年患者髋部骨折后死亡风险增加。考虑适当的临床干预措施，包括预防跌倒和虚弱的措施，可能适合这一已确定的弱势群体。