Original articleRelationship between dementia degree and gait ability after surgery of proximal femoral fracture: Review from Clinical Pathway with Regional Alliance data of rural region in Japan
Introduction
The incidence of proximal femoral fracture (PFF) has been steadily increasing year by year in Japan in recent decades [1]. As the elderly population expands in Japan, fractures due to bone fragility have become a big social issue and health burden [2], [3], [4], [5]. One report showed 32.8% mortality within one year of PFF in the elderly over ninety years of age [6]. Not only does PFF undermine function and threaten lives, however its burgeoning incidence is fast becoming one of the most serious problems in progressed countries [1], [3], [4], [5], [6], [7]. The Clinical Pathway with Regional Alliance (CPRA) system has been implemented since 2006 with the aim of reducing health care costs in Japan. This system is built for regional medical institutions within the alliance, where patients have been treated in a systemic way. However, despite these efforts, a majority of patients are unable to return home or walk because of insufficient recovery in gait, as reported before CPRA [8], [9].
Dementia is also severe social problem in developed countries. It is well known that dementia is associated with sarcopenia and loss of ambulatory ability. Relationship between PFF and dementia is also widely established. However, little has been published whether dementia degree affect recovery after surgery for PFF. In this study, we investigated CPRA data for our region, and evaluated the influence of dementia, its severity, and other factors on functional recovery in activities of daily living (ADL) and gait function after surgery for PFF.
Section snippets
Methods
Of the approximately 100,000 people residing in the study region, 33% are elderly (i.e., above the age of 65). Within this region, the core hospital (i.e. the acute institution; AI) is the only institution, and the majority of PFF patients are referred to and treated and operated in it. Between April 2006 and March 2014, surgeries on 1316 fractures were performed in the AI within the CPRA, constituted approximately 99% of PFF patients in this area. Clinical data from the CPRA were also been
Results
Parameters that showed significant correlation with FIM at RI were FIM at AI, HDS-R at AI, HDS-R at RI, MR at RI, GM at AI, GM at RI, QF at AI, QF at RI, FL at RI, AB at RI, GS at AI, and GS at RI (P < 0.01). Neither PS at AI nor at RI demonstrated a significant correlation with FIM at RI (Table 2). FIM and HDS-R showed a significant strong correlation in both AI (R = 0.6517, P < 0.0001) and RI (R = 0.6934, P < 0.0001).
All HDS-R score groups were significantly different from each other in terms
Discussion
Fractures caused by bone fragility such as PFF and vertebral body fractures now constitute a major health problem in Japan [1], [2], [3], [4], [5]. Underlying issue of PFF is osteoporosis that causes not only in unilateral side, but also contralateral side PFF [14], [15]. Not only functional prognosis, but life expand is shorten because of comorbidity and immobility [4], [5], [6], [7], [8], [16], [17], [18].
Regional cohort studies of such fractures provide meaningful data for implementing
Conclusions
From these results, we conclude that ADL after surgery to treat proximal femoral fractures is very closely correlated with dementia, and that the severity of dementia influences patient motivation for undergoing rehabilitation, and therefore influences gait ability. During rehabilitation, patients make progress in terms of their gait ability when their dementia improves. However, if dementia does not improve, patients are expected to gain very little in terms of gait ability. Therefore,
Conflict of interest
None of the authors and their family have share income or property with any person.
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