A Follow-up Study On The Ability Of Daily Living In Elderly Patients With Osteoporotic Fractures

Objective:The purpose of this study was to follow up the elderly patients with osteoporotic fracture in the Department of Orthopedics of The Second Affiliated Hospital of Dalian Medical University,to understand their refracture rate,mortality rate,self-care ability in life,and identify their related risk factors.In order to provide basis for the refracture prevention,death reduction and self-care ability improvement of patients with osteoporotic fracture.Methods:A total of 775 elderly patients with osteoporotic fractures who were hospitalized in the Department of Orthopedics of The Second Affiliated Hospital of Dalian Medical University from January 2015 to December 2016.Collect general information(age,gender,blood pressure,body mass index(BMI),fracture site,etc.),laboratory indicators(hemoglobin,serum albumin,serum creatinine,etc.),complications and ability of daily living according to medical record inquiry system.The incidence of death(time of death,cause of death)and the incidence of refracture(rate of refracture,cause of refracture),and ability of daily living were collected by face-to-face interview and telephone follow-up from October to December 2020.The Activity of Daily Living(ADL)and Instrument Activity of Daily Living(IADL)were used to evaluate the self-care ability of patients.Cox risk regression analysis was used to determine independent factors for survival of patients with osteoporotic fracture,and multivariate Logistic regression analysis was used to screen out factors related to death and self-care ability.Result:1.Baseline of patients: A total of 775 elderly patients with osteoporotic fracture were included,and 645 of them were followed up effectively 4 years later,with an effective follow-up rate of 83.2%.480 patients(74.4%)survived and 165 patients(25.6%)died.The mean age of 645 patients was 74.38±9.20 years old.There were 477 cases in females(74.0%)and 168 cases in males(26.0%).The number of osteoporotic fractures was significantly higher in women than in men.The ADL results of the pre-fracture assessment of 645 patients with effective follow-up showed that the degree of assistance required,from highest to lowest was: bathing,walking stairs,movement,transfer,grooming,toilet use,dressing,urine control,stool control,and feeding.There were 364cases(56.4%),353 cases(54.7%),251 cases(38.9%),187 cases(29.0%),145 cases(22.5%),137 cases(21.2%),131 cases(20.3%),99 cases(15.3%),89 cases(13.8%),83cases(12.9%).The IADL results showed that the need for help,in descending order,was:using a car,shopping,cooking,housework,laundry,financial management,taking medication,and using the telephone.There were 458 cases(71.0%),430 cases(66.7%),405 cases(62.8%),369 cases(57.2%),343 cases(53.2%),322 cases(49.9%),301 cases(46.7%)and 224 cases(34.7%).2.Follow-up mortality: Among the 645 patients followed up,165(25.6%)died.The mean age of the patients who died was 81.01±8.47 years old.There were 89 cases in females(53.9%)and 76 cases in males(46.1%).86 cases(52.1%)hip fractures lead to the highest number of deaths(P<0.05).Cox risk regression analysis showed that gender,age,alkaline phosphatase,albumin and blood glucose had significant influence on the survival rate of osteoporotic fracture in the elderly.Before fracture,the ADL and IADL of the dead patients were generally in high need of help,and the help rate was more than 80%.The items included walking up and down stairs,taking a bath,cooking,doing housework,laundry and financial management.3.Survival patients refracture and medication status: 480 patients(74.4%)survived,65 patients(13.5%)had refracture.Among them,vertebral fracture rate was the highest(P < 0.05).there were 21 vertebral fractures(32.3%),15 hip fractures(23.1%),12 other fractures(18.5%),9 upper limb fractures(13.8%)and 8 lower limb fractures(12.3%).Of the patients with refracture,60(92.0%)were refracture due to fall.After discharge,206 cases(42.9%)were treated with calcium,and 112 cases(23.3%)were treated with anti-osteoporosis drugs.4.Impaired ability of daily living:(1)According to the ADL(Barthel Index)evaluation scale,81 patients(16.9%)were completely self-care in daily life.Basic self-care 231cases(48.1%);62 cases(12.9%)needed some help;40 cases(8.3%)had obvious dependence on others;66 cases(13.8%)were completely dependent on others.Hip fracture and fracture patients with basic diseases were more likely to lead to decreased self-care ability in life,and the difference was statistically significant(P<0.05).More projects in need of help than before fracture after discharge for bathing,up and down the stairs,activities,transfer,dress,decorate,go to the toilet,eating(P<0.05).(2)IADL assessment results: more than before fracture after discharge project in need of help for the use of vehicles,shopping,doing housework,cooking,financial management,medicine,use the telephone(P<0.05).(3)Logistic regression analysis showed that age and serum creatinine value were the main influencing factors of self-care ability in life.Patients with older age and low creatinine value were more likely to lead to the decline of self-care ability in life.Conclusion:1.Among the elderly patients with osteoporotic fractures,females are significantly more than males,and the incidence of vertebral refracture is the highest.2.Hip fracture has the highest mortality rate;Gender,age,alkaline phosphatase,albumin and blood glucose had significant effects on survival.3.Patients with hip fracture and underlying diseases are more likely to suffer from reduced self-care ability.Aging and low serum creatinine were the main factors affecting patients’ self-care ability.4.After 4 years of fracture,the patient’s ability to live independently decreased significantly.