Hip fractures and daily functioning in old age: when does the decline start and how can it be measured?

Abstract

Hip fractures are common in old age and have a significant impact, both on the older patients as on society in general.

This thesis shows that daily functioning of older people with a hip fracture already deteriorates before their fracture, with a larger pre-fracture decline in and lower

pre-fracture level of daily functioning as compared to age-related peers. Picking up the decline in daily functioning before a hip fracture for individual patients is not possible yet, as it is not measured routinely in clinical practice and, as this thesis show, there is currently also no other way to extract daily functioning from routine care data. However, the last pre-fracture daily functioning level, which can often be reconstructed at the time of fracture, is informative on its own for post-fracture recovery potential. In any case, a hip fracture is a signal of ongoing decline, which can warn clinicians that their patient is in a trajectory of decline and thus expectations of recovery should be adjusted correspondingly. When measuring this recovery in daily functioning, researchers and clinicians should be aware that (I)ADL questionnaires hardly correspond with self-perceived functioning of older people and are not so sensitive to small but (for older people) relevant changes. Thus, (I)ADL questionnaires alone are not enough to measure post-fracture recovery.