Session VI - Geriatrics

Friday, October 13, 2000 Session VI, Paper #36, 10:29 am

Effect of Depression on Functional Recovery following Hip Fracture

Kimberly Cusimano, PhD; Philip Wolinsky, MD; Gina Aharonoff, MPH; Joseph Zuckerman, MD; Kenneth Koval, MD, Hospital for Joint Diseases, New York, NY

Depression is a common condition among the elderly recovering from hip fracture surgery, and several studies have suggested that it has an effect on recovery following major surgery.

Purpose: This study was undertaken to assess the role of depression on outcome after hip fracture in an elderly, previously home-dwelling and ambulatory population.

Methods: Data were collected on all hip fractures admitted to the hospital between 1987 and 1997. The predictor variable was the presence of depression as determined by the Geriatric Depression Scale. Patients were classified as being not depressed (scores of 0-10), mildly depressed (scores of 11-19), or having severe depression (scores of 20+). Outcome variables were one-year mortality, postoperative medical complications, recovery of basic and instrumental activities of daily living (BADLs, IADLs) and recovery of previous ambulatory levels.

Results: Four hundred twenty-two patients had a baseline assessment for depression. Of those, 327 (77.5%) were not depressed, 72 (17.1%) had mild depression, and 23 (5%) were severely depressed. At one- year follow up, 10.4% of the patients had died, and 28.5% had a decline of one or more levels of BADL function (47% of those with depression versus 23% of those who were not depressed). Patients with depression were more likely to have declined from their pre-fracture BADL level (P =. 001, OR = 2.9, C.I. = 1.7-4.9). This relationship remained after controlling for potential confounders (age, sex, co-morbidities, etc). There were however, no differences in mortality, IADL, or ambulatory recovery between patients classified as not depressed, mildly depressed, or having severe depression.

Conclusion: This study suggests that patients with mild to severe depression are less likely to recover to their prefracture level of basic activities of daily living. The data, howeer, do not show that depression has an effect on instrumental activities of daily living, ambulation or mortality one year following hip fracture.