Men Experience Greater Cognitive Impairment After Hip Fracture

Men could be at higher risk than women of cognitive impairment and, ultimately, death, after hip fracture, according to a new study.

Noting the lack of research on cognition and its relationship to mortality after hip fracture among men in comparison to women, investigators set out to compare men and women who fractured their hip on cognition after hospital discharge, as well as examining the impact of cognition on the differential risk of 6-month mortality between men and women after experiencing a hip fracture.
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The authors performed a prospective cohort study that matched 168 male and 171 female hip fracture patients, all age 65 or older, living in the community before fracture. The researchers assessed cognition by Modified Mini-Mental State Examination (3MS, and derived MMSE score, Hooper Visual Organization test (HVOT), and Trailmaking test (Trails A & B) within 22 days of hospital admission, and 6-month mortality.

Overall, men had more impaired cognitive scores on 3MS, MMSE, HVOT, and Trails A at baseline, according to the authors, who add that these statistically significant differences between male and female participants remained on MMSE and HVOT after controlling for pre-fracture dementia, in-hospital delirium, age, education, race, and comorbidity. In addition, men had higher 6-month mortality rates, and cognitive measures were significantly associated with mortality, including 3MS, HVOT, and Trails B. Among the cognitive measures, higher 3MS was most protective for mortality, both unadjusted and adjusted for other cognitive scales, comorbidity, delirium, and pre-existing dementia.

Ultimately, the men taking part in the study displayed greater levels of cognitive impairment within the first 22 days of hip fracture than women, with the authors finding that cognitive limitations increase the risk of mortality in both men and women.

These results "suggest that men who are cognitively impaired are particularly vulnerable and in need of special attention to improve their likelihood of surviving," said lead study author Ann Gruber-Baldini, PhD, a professor in the division of gerontology at the University of Maryland School of Medicine.

"It [might] be important to monitor the cognition of these patients after hospital discharge," added Gruber-Baldini, "to be sure they are not experiencing continued effects of delirium and are getting appropriate medical and rehabilitative care."

—Mark McGraw

Reference

Gruber-Baldini A L, Hosseini M, Orwig D, et al. Cognitive differences between men and women who fracture their hip and impact on six-month survival [published online January 2017]. Journal of American Geriatrics Society. doi:10.1111/jgs.14674.