Rehabilitation after proximal femur fracture surgery in the oldest old

Objective: To assess the course and results of rehabilitation after proximal femur fracture (PFF) in patients 85 years of age or older, compared with younger elderly patients, with an emphasis on functional status. Design: Prospective cohort study. Setting: A rehabilitation geriatric ward in a tertiary university hospital in southern Israel. Participants: The study group included 127 elderly patients 85 years of age or older who were hospitalized for rehabilitation following surgery for PFF. The comparison group was comprised of 297 patients aged 75 to 84 years who were hospitalized for the same indication in the same time period. Interventions: Not applicable. Main Outcome Measures: Functional studies by FIMTM instrument, mental status by the Folstein Mini-Mental State Examination, Geriatric Depression Screening (GDS) scale, length of rehabilitation, and complications and mortality during rehabilitation. Results: Compared with patients aged 75 to 84 years, the older study group was in a worse mental state (P=.00005), even though the groups did not differ in their GDS scores. There were no significant differences between the groups in rehabilitation length of stay, in the rate of most postoperative complications, or in death rates during rehabilitation. FIM values before PFF, at the beginning of rehabilitation and at its end, and the difference between the beginning and end of rehabilitation were lower in the older group (P<.00001 for all tests). Conclusions: From the functional standpoint, rehabilitation after PFF surgery is much less successful in the 85 + age group than in the 75-to-84 age group but did not differ in its duration, rates of most complications, or mortality. Nonetheless, a significant percentage of patients in this age group have successful rehabilitation so they should not be deprived the chance.