Walking Recovery After Hip Fracture in Patients with Exceptional Longevity: Predictors and Association with Short- and Long-Term Survival

Background: There are very few studies on walking recovery, its predictors and impact on survival in oldest-old patients after a hip fracture. Methods: This study is a retrospective review which included all patients older than 95 years admitted with a fragility hip fracture between December 2009 and September 2015 in a tertiary university hospital in Barcelona. Walking ability was assessed using the Functional Ambulation Classification (FAC) prior to admission and 6 months after discharge. The objective of our study is to assess walking recovery and its predictors in oldest-old patients at 6 months after discharge, and to determine whether there was a relationship with short and long-term survival. Results: One hundred and fifty-two patients were included in the study. Prior to the fracture, 78.3% of patients could walk independently, 36.8% after the fracture. A higher previous FAC score (p < 0.001, OR 3.658), absence of delirium during admission (p = 0.010, OR 3.45), and being able to carry out full weight-bearing (p = 0.026, OR 12.705) were associated with better walking recovery. The area under the ROC curve was 0.819 (p < 0.001). Mean survival after discharge was 2.24 years (SD 1.185). Patients with a post-fracture FAC ≥ 3 showed better survival. Conclusions: Predictors of walking recovery in patients with exceptional longevity were a higher previous FAC score, being able to carry out full weight-bearing, and absence of delirium. Patients able to walk unaided within six months of discharge showed better survival. These findings highlight the importance of functional outcomes when assessing prognosis in the oldest-old.