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Cognitive Improvement in Older Adults in the Year After Hip Fracture: Implications for Brain Resilience in Advanced Aging.

ABSTRACT: OBJECTIVE:We examined cognitive function in nondemented, nondelirious older adults 1 year post hip fracture. DESIGN:Prospective observational study. SETTING AND PARTICIPANTS:Three hundred eighty-six hip fracture patients aged 60 years and older with no history of cognitive impairment, such as clinical dementia or persistent delirium, recruited from eight area hospitals 2-3 days after hip surgery (week 0), and 101 older adults with no recent acute medical events for control comparison. METHODS:Cognitive function was examined with the Repeatable Battery for the Assessment of Neuropsychological Status and the Short Blessed Test (SBT) at weeks 0 (SBT only), 4, and 52 using a repeated measures mixed model analysis. Baseline predictor variables included demographics, personality, genetic factors, and depressive symptom level. RESULTS:Hip fracture participants had lower cognitive scores than healthy comparisons. Cognitive scores improved in the hip fracture group relative to healthy comparison participants from week 4-52. The only significant predictor of cognitive improvement after hip fracture was education: individuals with college education showed cognitive improvement by week 52, while those with high school or less did not. CONCLUSION:Nondemented, nondelirious older adults suffering hip fracture have poorer cognitive function immediately after the fracture but then exhibit cognitive improvement over the ensuing year, especially among those with high education. This demonstrates brain resilience in older adults even in the context of advanced age, medical illness, and frailty.

SUBMITTER: Oughli HA

PROVIDER: S-EPMC6251311 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Cognitive Improvement in Older Adults in the Year After Hip Fracture: Implications for Brain Resilience in Advanced Aging.

Oughli Hanadi Ajam HA Chen Gengsheng G Philip Miller J J Nicol Ginger G Butters Meryl A MA Avidan Michael M Stark Susan S Lenze Eric J EJ

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry 20181101 11

<h4>Objective</h4>We examined cognitive function in nondemented, nondelirious older adults 1 year post hip fracture.<h4>Design</h4>Prospective observational study.<h4>Setting and participants</h4>Three hundred eighty-six hip fracture patients aged 60 years and older with no history of cognitive impairment, such as clinical dementia or persistent delirium, recruited from eight area hospitals 2-3 days after hip surgery (week 0), and 101 older adults with no recent acute medical events for control ...[more]

PMID: 30454790

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Project description:ObjectivesDefining common patterns of recovery after an acute health stressor (resiliency groups) has both clinical and research implications. We sought to identify groups of patients with similar recovery patterns across 10 outcomes following hip fracture (stressor) and to determine the most important predictors of resiliency group membership.DesignSecondary analysis of three prospective cohort studies.SettingParticipants were recruited from various hospitals in the Baltimore Hip Studies network and followed for up to 1 year in their residence (home or facility).ParticipantsCommunity-dwelling adults aged 65 years or older with recent surgical repair of a hip fracture (n = 541).MeasurementsSelf-reported physical function and activity measures using validated scales were collected at baseline (within 15-22 d of fracture), 2, 6, and 12 months. Physical performance tests were administered at all follow-up visits. Stressor characteristics, comorbidities, and psychosocial and environmental factors were collected at baseline via participant report and chart abstraction. Latent class profile analysis was used to identify resiliency groups based on recovery trajectories across 10 outcome measures and logistic regression models to identify factors associated with those groups.ResultsLatent profile analysis identified three resiliency groups that had similar patterns across the 10 outcome measures and were defined as "high resilience" (n = 163 [30.1%]), "medium resilience" (n = 242 [44.7%]), and "low resilience" (n = 136 [25.2%]). Recovery trajectories for the outcome measures are presented for each resiliency group. Comparing highest with the medium- and low-resilience groups, self-reported pre-fracture function was by far the strongest predictor of high-resilience group membership with area under the curve (AUC) of .84. Demographic factors, comorbidities, stressor characteristics, environmental factors, and psychosocial characteristics were less predictive, but several factors remained significant in a multivariable model (AUC = .88).ConclusionThese three resiliency groups following hip fracture may be useful for understanding mediators of physical resilience. They may provide a more detailed description of recovery patterns in multiple outcomes for use in clinical decision making. J Am Geriatr Soc 67:2519-2527, 2019.

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Cognitive Improvement in Older Adults in the Year After Hip Fracture: Implications for Brain Resilience in Advanced Aging.

Publications

Cognitive Improvement in Older Adults in the Year After Hip Fracture: Implications for Brain Resilience in Advanced Aging.

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