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Men who fracture hips more susceptible to cognitive impairment, death
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Men with fractured hips performed worse on several mental assessment tests and had higher mortality rates than women with fractured hips, according to research recently published in the Journal of the American Geriatrics Society.
“While men make up only about 25% of all hip fractures, the number of men who fracture their hip is increasing and we know men are more likely to die than women after a hip fracture,” Ann L. Gruber-Baldini, PhD, department of mathematics and statistics, University of Maryland School of Medicine, said in a press release.
For their prospective cohort study, researchers administered the Modified Mini Mental State Examination (and derived MMSE score), Hooper Visual Organization test and Trail-Making test) on 339 patients within 22 days of being admitted to the hospital. The patients (168 men) were all aged 65 and older and still living in the community at the time of fracture. Mortality of patients was reported after 6 months.
The researchers reported that men had more impaired cognitive scores on the mental status assessments (P < .05) at baseline. Even after controlling for pre-fracture dementia, in-hospital delirium, age, education, race, and comorbidity, statistically significant differences between men and women remained on the MMSE and Hooper Visual Organization test. Men had higher 6-month mortality rates (HR = 4.4, P < .001). Cognitive measures were also significantly associated with mortality, including Modified MMSE, Hooper Visual Organization test and Trail Making test B. Among the cognitive measures, higher Modified MMSE was most predictive for mortality (HR = 0.98, P < .001), both unadjusted and adjusted for other cognitive scales, comorbidity, delirium, and pre-existing dementia. The highest mortality was among men with Modified MMSE scores of less than 78, with 26.3% dying within 6 months.
The study should put into motion several steps for clinicians treating these patients, Gruber-Baldini told Healio Family Medicine.
“Men who are cognitively impaired are particularly vulnerable and in need of special attention to improve their likelihood of surviving. It may be valuable for clinicians to monitor hip fracture patients after hospital discharge, especially men, to see if they are still experiencing cognitive impairment and effects of delirium. Interventions to reduce delirium, such as evaluation of medications, nutrition, infections and comorbidities may be needed. It is also important that those with cognitive impairment get rehabilitation to help improve their mobility.” Gruber-Baldini said. “Clinicians should try and let patients and their families know that changes in ‘memory and thinking’ or attention … happen after a hip fracture and surgery for many patients. It is important to know about these changes so that the underlying cause of the problems can be treated. It is also useful for patients to try and improve their ability to walk and get around as it helps both their body [in areas such as] muscle atrophy and their mind in cognition and depression.”
Previously published research has suggested hip fracture contributes to long-, short-term excess mortality. Another study suggested patients who underwent hip fracture surgery had a higher chance of in-hospital mortality after adjustment for age, sex and comorbidities than patients who underwent elective total hip replacement. – by Janel Miller
Disclosure: Gruber-Baldini reports no relevant financial disclosures. Please see the study for a full list of the other researchers’ relevant financial disclosures.