Abstract:
The prevalence of cognitive impairment (CI) increases with advancing age and it is a leading cause of falls and fractures among older adults. This study assessed the prevalence and factors associated with CI among hip fracture (HF) patients admitted to National Hospital, Galle, Sri Lanka. A total of 209 consecutive patients with incident HF admitted between May 2023 and May 2024, aged 40 years or more were studied. CI was evaluated soon after the admission using the Sinhala version of Mini Mental State Examination tool (MMSE). Pre-fracture physical function, frailty, sarcopenia, nutritional status were assessed using the locally validated Barthel Index, Frail Non-Disabled (FiND) questionnaire, SARC-F tool and Mini Nutritional Assessment (MNA) tool respectively. Independent t- test and One way ANOVA test were used to identify the associated factors. Ethical approval was obtained from Ethical Review Committee of Faculty of Medicine, University of Ruhuna. Among 209 subjects, 151 (72%) were females while 150 (71.8%) were married. The mean age (±SD) of HF patients was 73.8 (11.3) years. Of 209 patients, 113 (54.1%) had CI at the time of admission. Of those with impaired cognition, 23% and 26.8% had mild (MMSE score 21 - 24 and moderate (MMSE score 10 - 20) CI respectively while 4.3% had severe CI (MMSE score 0 - 9). Female gender (p = 0.035), advanced age (p < 0.001), poor living arrangement (p = 0.025), poor nutritional status (p = 0.038), disability (p = 0.001), and physical dependence (p = 0.01) having higher risk of developing CI. Further, pre-fracture sarcopenia and frailty also associated with CI (p < 0.001) among HF patients. Previous fractures and ASA scoring did not show associations with CI (p > 0.05). This study reveals that cognitive impairment is prevalent among HF patients. Advanced age, female gender, poor nutritional status, physical function, frailty, and sarcopenia were significantly associated with CI. These findings highlights the importance of early identification and targeted interventions to address risk factors, which can help to reduce the risk of developing CI.
