Supplementary Online Content Neuman MD, Silber JH, Magaziner JS, Passarella MA, Mehta S, Werner RM. Survival and functional outcomes after hip fracture among nursing home residents [published online June 23, 2014]. JAMA Intern Med. doi:10.1001/jamainternmed.2014.2362 etable 1. ICD-9-CM Procedure Codes for Internal Fixation, Hemiarthroplasty, or Total Hip Arthroplasty etable 2. Definitions of Activity of Daily Living (ADL) Self-Performance Items Examined in the Present Study etable 3. Minimum Data Set (MDS) ADL Self-Performance Grading System etable 4. Baseline Characteristics of the Study Sample, by Sex etable 5. Predictors of Mortality at 180 Days Among Long-term Nursing Home Residents With Fracture efigure. 180-Day Outcomes: Survival and Post-Fracture Self-Performance in Six ADLs (Dressing, Personal Hygiene, Toileting, and Eating), by Pre-Fracture ADL Functional Category This supplementary material has been provided by the authors to give readers additional information about their work.
etable1: ICD-9-CM codes for internal fixation, hemiarthroplasty, and total hip arthroplasty used in the present study. Internal fixation a 78.55 79.15 79.25 79.35 79.55 79.65 79.85 79.95 Hemiarthroplasty 81.52 Total hip arthroplasty 00.70 00.71 00.72 00.73 00.74 00.75 00.76 00.77 00.85 00.86 00.87 81.40 81.51 81.53 81.69 a. Includes codes for open reduction procedures etable 2: Definitions of activity of daily living self-performance items examined in the present study a Bed mobility How resident moves to and from lying position, turns side to side, and positions body while in bed Transferring How resident moves between surfaces to/from: bed, chair, wheelchair, standing position (excluding movement to/from bath/toilet) Locomotion on unit How resident moves between locations in his/her room and adjacent corridor on same floor. If in wheelchair, self-sufficiency once in chair Dressing How resident puts on, fastens, and takes off all items of street clothing, including donning/removing prosthesis Eating How resident eats and drinks (regardless of skill). Includes intake of nourishment by other means (e.g., tube feeding, total parenteral nutrition) Toileting How resident uses the toilet room (or commode, bedpan, urinal); transfer on/off toilet, cleanses, changes pad, manages ostomy or catheter, adjusts clothes Personal hygiene How resident maintains personal hygiene, including combing hair, brushing teeth, shaving, applying makeup, washing/drying face, hands, and perineum (excluding baths and showers) a. Center for Medicare and Medicaid Services Revised Long-Term Care Resident Assessment Instrument, Version 2.0. etable 3: Minimum Data Set (MDS) ADL self-performance grading system a. Categories correspond to degree of self-performance for a given ADL over the preceding 7 days. In No help or oversight or help/oversight provided only 1 or 2 times during last 7 days. Supervision Oversight, encouragement or cueing provided 3 or more times during last 7 days or (3 or more times) plus physical provided only 1 or 2 times during last 7 days. Limited Extensive Total dependence Activity did not occur b Resident highly involved in activity; received physical help in guided maneuvering of limbs or other non-weight bearing 3 or more times, or had more help provided only 1 or 2 times during last 7 days. While resident performed part of activity, over last 7-day period, help of the following type(s) was provided 3 or more times: (a) weight-bearing support or (b) full staff performance during part (but not all) of last 7 days. Full staff performance of activity during entire 7 days. Activity did not occur during entire 7 days. a. Center for Medicare and Medicaid Services Revised Long-Term Care Resident Assessment Instrument, Version 2.0. b. For the present study, patients for whom a particular ADL did not occur over the seven-day observation period were considered to be totally in that domain.
etable 4: Baseline characteristics and acute fracture management, by sex Women (%) N=45,345 Men (%) N=14,766 P Age 75 or younger 4,060 (8.95) 2,602 (17.62) <0.001 76-80 5,818 (12.83) 2,590 (17.54) 81-85 10,642 (23.43) 3,719 (25.19) 86-90 12,453 (27.46) 3,477 (23.55) 91 or older 12,390 (27.32) 2,378 (16.10) Race White 42,049 (92.73) 13,192 (89.34) <0.001 Black 2,244 (4.95) 1,091 (7.39) Other 1,052 (2.32) 483 (3.27) Charlson score 0 4,176 (9.21) 791 (5.36) <0.001 1 12,438 (27.43) 2,790 (18.89) 2 10,875 (23.98) 3,043 (20.61) 3 7,386 (16.29) 2,641 (17.89) 4 4,537 (10.01) 2,014 (13.64) 5 or more 5,933 (13.08) 3,487 (23.62) Baseline cognitive performance Intact 4,192 (9.24) 1,394 (9.44) <0.001 Borderline intact 4,213 (9.29) 1,387 (9.39) Mild impairment 7,592 (16.74) 2,528 (16.74) Moderate impairment 19,075 (42.07) 6,221 (42.13) Moderate-severe impairment 4,701 (10.37) 1,639 (11.10) Severe impairment 4,555 (10.05) 1,334 (9.03) Very severe impairment 1,017 (2.24) 263 (1.78) Baseline dependence in locomotion In 13,514 (29.80) 5,124 (34.70) <0.001 Requires 9,026 (19.91) 2,996 (20.29) Requires limited 9,633 (21.24) 2,864 (19.40) Requires 7,563 (16.68) 2,321 (15.72) Total dependence 5,609 (12.37) 1,461 (9.89) Number out of 6 non-locomotion ADL s with functional independence 6 2,705 (5.97) 789 (5.40) <0.001 4-5 4,281 (9.44) 1,462 (9.90) 2-3 8,389 (18.50) 2,874 (19.46) 0-1 29,970 (66.09) 9,632 (65.23) Fracture location Femoral neck 20,836 (45.95) 7,544 (51.09) <0.001 Intertrochanteric 19,839 (43.75) 5,696 (38.58) Subtrochanteric 1,675 (3.69) 413 (2.80) Multiple locations 2,995 (6.60) 1,113 (7.54) Acute fracture management Hemiarthroplasty 13,850 (30.54) 4,910 (33.25) <0.001 Internal fixation 25,622 (56.50) 7,651 (51.81) Total hip arthroplasty 710 (1.57) 299 (2.02) Non-operative management 5,163 (11.39) 1,906 (12.91)
etable 5: Predictors of death at 180 days among 60,111 nursing home residents with hip fracture Death at 180 days: Adjusted Relative Risk P Sex Female Male 1.42 (1.39,1.45) <0.001 Age 75 or younger 76-80 1.19 (1.12, 1.27) <0.001 81-85 1.44 (1.36, 1.52) <0.001 86-90 1.75 (1.66, 1.84) <0.001 91 or older 2.38 (2.26, 2.51) <0.001 Race White Black 0.82 (0.78,0.86) <0.001 Other 0.75 (0.70,0.81) <0.001 Charlson score 0 1 1.08 (1.03,1.13) 0.003 2 1.19 (1.13,1.24) <0.001 3 1.29 (1.23,1.35) <0.001 4 1.33 (1.26,1.40) <0.001 5 or more 1.53 (1.46,1.60) <0.001 Baseline cognitive performance Intact Borderline intact 1.02 (0.96,1.07) 0.563 Mild impairment 1.08 (1.03,1.13) 0.001 Moderate impairment 1.12 (1.07,1.16) <0.001 Moderate-severe impairment 1.17 (1.12,1.23) <0.001 Severe impairment 1.22 (1.16,1.28) <0.001 Very severe impairment 1.12 (1.04,1.21) 0.004 Baseline dependence in locomotion In Requires 1.01 (0.97,1.04) 0.675 Requires limited 1.06 (1.02,1.09) 0.002 Requires 1.12 (1.08,1.16) <0.001 Total dependence 1.11 (1.06,1.15) <0.001 Number out of 6 non-locomotion activities of daily living with functional independence at a 6 4-5 1.12 (1.05,1.2) 0.001 2-3 1.21 (1.14,1.29) <0.001 0-1 1.21 (1.14,1.28) <0.001 Fracture location Femoral neck Intertrochanteric 1.11 (1.08,1.14) <0.001 Subtrochanteric 1.13 (1.07,1.21) <0.001 Multiple locations 1.16 (1.12,1.21) <0.001 Acute fracture management Internal fixation Total hip arthroplasty 1.17 (1.07,1.27) <0.001 Hemiarthroplasty 1.16 (1.12,1.2) <0.001 Non-operative management 1.82 (1.78,1.87) <0.001 Notes: a. Activities assessed include: bed mobility, transferring, dressing, personal hygiene, eating, and toileting.
efigure. 180-day survival and within-subjects changes in self-performance for six activities of daily living (ADLs) among 59,749 nursing home residents hospitalized with hip fractures between July 1, 2005 and June 30, 2009. For individuals within a given category of ADL self-performance, the corresponding horizontal bar within each graph shows the fraction of patients who died within 180 days, along with the distribution of post-fracture ADL self-performance scores at the last available assessment within 180 days among survivors. The bold vertical line intersecting each bar demarcates the fraction of individuals within a self-performance category for a given ADL who both survived to 180 days and regained or exceeded their level of self-performance in that ADL at the latest available assessment within 180 days after fracture.
39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 efigure 1 A. Getting in and out of bed Totally at Required at Required limited at B. Dressing Required at In at Totally at Required at Required limited at Required at In at limited in limited in 7
83 84 85 86 efigure 1 (Continued) C. Eating Totally at Required at Required limited at Required at In at limited in D. Using the toilet Totally at Required at Required limited at Required at In at limited in 8
87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 efigure 1 (Continued) E. Transferring between surfaces Totally at Required at Required limited at Required at In at F. Personal hygiene Totally at Required at Required limited at Required at In at limited in limited in 9