Apathy as a Predictor of Functional Recovery in Older Adults With Hip Fracture: A Multicentre Prospective Study

BACKGROUND: In older patients with hip fractures, delirium and behavioural and psychological symptoms of dementia (BPSD) during hospitalisation have been reported to impede recovery of activities of daily living (ADL). As delirium and BPSD may fluctuate throughout hospitalisation, improving ADL requires longitudinal assessment of these symptoms and clarification of factors influencing functional recovery. This study aimed to evaluate delirium and BPSD longitudinally during hospitalisation in older patients with hip fractures and identify factors associated with improvement in ADL. METHODS: This prospective cohort study included 65 patients aged ≥ 65 years who underwent surgery for hip fracture. ADL were assessed using the Functional Independence Measure (FIM) at two time points: post-operatively and prior to discharge. BPSD were assessed using the Neuropsychiatric Inventory, delirium was assessed using the Confusion Assessment Method, and daily rehabilitation time and number of prescribed medications were recorded post-operatively and after transfer to the ward. Changes in the Total FIM score were analysed using a paired t-test. Multiple regression analysis identified factors associated with improvement in ADL, with FIM gain as the dependent variable. RESULTS: The mean age of participants was 83.34 ± 9.45 years. Total FIM score increased significantly from the post-operative assessment to pre-discharge (FIM gain; p = 0.001). Multiple regression analysis revealed that age (β = -0.308, p = 0.025) and severity of apathy at post-transfer (β = -0.483, p = 0.002) were significantly negatively associated with FIM gain. In contrast, length of hospital stay (β = 0.309, p = 0.012) was significantly positively associated with FIM gain. CONCLUSIONS: Greater severity of apathy following ward transfer was associated with poorer recovery of ADL during hospitalisation. These findings underscore the importance of early identification and management of apathy within hospital medicine and rehabilitation settings to optimise functional recovery in older patients with hip fractures.