DOS 2020

DOS Kongressen 2020 · 181 Living settings and cognitive impairment are stronger predictors of nursing home admission after hip fracture surgery than physical comorbidities Liv Riisager Wahlsten, Stig Brorson, Henrik Palm Orthopedic department , Herlev and Gentofte University Hospital; Orthopedic department , Zealand University Hospital; Orthopedic department, Bispebjerg University Hospital Background: Sustaining a hip fracture is a life changing event for many elder- lies. While doctors and researchers tend to be preoccupied with mortality and complication rates, patients are more concerned by other aspects e.g. loss of independence and ability to remain in their own home. Purpose / Aim of Study: This study aimed to i) determine age-stratified one stratified one-year event rates of admission to nursing home after discharge, and ii) identify risk factors associated with nursing home admission. Materials and Methods: Community dwelling patients aged 60-100 years undergoing their first hip fracture surgery in 2005 100 years undergoing their first hip fracture surgery in 2005 - 2015 were identified in nationwide admin- istrative registries. Outcome was admission to nursing home within one year of discharge. To assess risk factors, we performed age-stratified cumulative inci- dence curves and multivariate cause specific cox regression models adjusted for age, sex, social factors, and comorbidities. Findings / Results: A total of 53,157 patients were included. One-year risk in- creased with advancing age from 3.2% of patients aged 60 to 69, up to 22.4% in the eldest group aged 90-100 years. Living alone and dementia were strong risk factors HR 9.22 [95% CI 5.60-15.18, p = <0.0001] and HR 6.73 [95% CI 4.80 15.18, p = <0.0001] and HR 6.73 [95% CI 4.80- 9.44, p = 0.0001] respectively for patients aged 60 to 69 years, the effect decreased with higher age down to HR 2.75 [95% CI 2.12- 3.57, p = <0.0001] and HR 2.15 [95% CI 1.88- 2.46, p = <0.0001] for patients ≥ 90 years. Other important risk factors were pre 2.46, p = <0.0001] for patients ≥ 90 years. Other important risk fac- tors were pre-injury home care, Parkinson’s disease and depression. Surprisingly, physical comorbidities i.e. kidney disease, chronic obstructive pulmonary dis- ease, diabetes and cancer did not increase the risk of nursing home admission. Conclusions: Future initiatives aimed to reduce loss of independence and nurs- ing home admission, among patients with first time hip fracture, should devote attention to living settings and cognitive impairment rather than physical co- morbidity. 160.