A 2-Minute Cognitive Screener for Predicting 1-Year Functional Recovery and Survival in Older Adults After Hip Fracture Repair

Abstract

Abstract Background Implementing cognitive assessment in older people admitted to hospital with hip fracture—lying in bed, experiencing pain—is challenging. We investigated the value of a quick and easy-to-administer 10-point Cognitive Screener (10-CS) in predicting 1-year functional recovery and survival after hip surgery. Methods Prospective cohort study comprising 304 older patients (mean age = 80.3 ± 9.1 years; women = 72%) with hip fracture consecutively admitted to a specialized academic medical center that supports secondary hospitals in Sao Paulo Metropolitan Area, Brazil. The 10-CS, a 2-minute bedside tool including temporal orientation, verbal fluency, and three-word recall, classified patients as having normal cognition, possible cognitive impairment, or probable cognitive impairment on admission. Outcomes were time-to-recovery activities of daily living (ADLs; Katz index) and mobility (New Mobility Score), and survival during 1-year after hip surgery. Hazard models, considering death as a competing risk, were used to associate the 10-CS categories with outcomes after adjusting for sociodemographic and clinical measures. Results On admission, 144 (47%) patients had probable cognitive impairment. Compared to those cognitively normal, patients with probable cognitive impairment presented less postsurgical recovery of ADLs (77% vs 40%; adjusted sub-hazard ratio [HR] = 0.44; 95% confidence interval [CI] = 0.32–0.62) and mobility (50% vs 30%; adjusted sub-HR = 0.52; 95% CI = 0.34–0.79), and higher risk of death (15% vs 40%; adjusted HR = 2.08; 95% CI = 1.03–4.20) over 1-year follow-up. Conclusions The 10-CS is a strong predictor of functional recovery and survival after hip fracture repair. Cognitive assessment using quick and easy-to-administer screening tools like 10-CS can help clinicians make better decisions and offer tailored care for older patients admitted with hip fracture.