Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people

• Published in: Psychological medicine Vol. 36; no. 11; p. 1635
• Main Authors: Oude Voshaar, Richard C, Banerjee, Sube, Horan, Mike, Baldwin, Robert, Pendleton, Neil, Proctor, Rebekah, Tarrier, Nicholas, Woodward, Yvonne, Burns, Alistair
• Format: Journal Article
• Language: English
• Published: England 01-11-2006
• Subjects: Accidental Falls - prevention & control; Activities of Daily Living - classification; Activities of Daily Living - psychology; Aged; Aged, 80 and over; Antidepressive Agents - therapeutic use; Cognition Disorders - diagnosis; Cognition Disorders - psychology; Cognitive Therapy; Combined Modality Therapy; Convalescence - psychology; Depressive Disorder - diagnosis; Depressive Disorder - prevention & control; Depressive Disorder - psychology; Depressive Disorder - therapy; England; Fear; Female; Follow-Up Studies; Geriatric Assessment; Hip Fractures - psychology; Hip Fractures - surgery; Humans; Male; Neuropsychological Tests; Pain, Postoperative - diagnosis; Pain, Postoperative - drug therapy; Pain, Postoperative - psychology; Personality Inventory; Postoperative Complications - psychology; Randomized Controlled Trials as Topic; Sickness Impact Profile; England
• ISSN: 0033-2917
• DOI: 10.1017/S0033291706008270

Depression and cognitive functioning have a negative impact on functional recovery after hip fracture surgery in older people, and the same has been suggested for pain and fear of falling. These variables, however, have never been studied together, nor has the timing of psychiatric assessment been taken into account.
Two parallel, randomized controlled trials were undertaken aiming to prevent and treat depression after hip fracture surgery in older people. Multiple logistic regression analyses corrected for age and pre-morbid level of functioning were performed to evaluate the effect of depressive symptoms (15-item Geriatric Depression Scale, GDS), pain (Wong-Baker pain scale), cognitive functioning (Mini-mental State Examination, MMSE) and fear of falling (Modified Falls Efficacy Scale, MFES) within 2 weeks after surgery and 6 weeks later on functional recovery at 6 months. Main outcome measures were performance-based measures (up-and-go test, gait test, functional reach) and the self-report Sickness Impact Profile (SIP) questionnaire to assess the impact of the hip fracture on activities of daily living (ADL).
Two hundred and ninety-one patients participated and outcome measures for 187 (64%) patients were available at 6 months. All mental health variables interfered with functional recovery. However, in the final multivariate model, cognitive functioning and fear of falling assessed 6 weeks after surgery consistently predicted functional recovery, whereas pain and depressive symptoms were no longer significant.
Fear of falling and cognitive functioning may be more important than pain and depression to predict functional recovery after hip fracture surgery. Rehabilitation strategies should take this into account.