Social Isolation Leads to Worse Outcomes Following Low-Trauma Hip Fracture

Robyn Lipschultz

Avoiding social isolation after a low-trauma hip fracture operation is crucial in avoiding negative outcomes.

A team, led by Robyn Lipschultz, Hospital for Special Surgery, evaluated the association of pre-operative social isolation with patient-reported functional recovery in elderly patients 1 year after surgical repair of low-trauma hip fracture.

The data was presented during the 2022 American College of Rheumatology Convergence Meeting in Philadelphia.

The Burden

Hip fractures put a significant burden on the older population. One potential modifiable risk factor for poor health outcomes following low trauma hip fractures is social isolation.

In the study, the investigators examined 320 patients at least 65 years old at a single center. Each patient underwent surgical repair of a low trauma hip fracture, but were excluded if they had active cancer, dementia, previous or bilateral hip fracture, or a non-US address. The mean age of the patient population was 81 years and 70.9% of the participants were female.

At the time of fracture 31.6% of the participants were socially isolated.

Patient Repoorted Outcomes

The investigators collected patient reported outcomes, including the Lubben Social Networks Scale, a validated instrument designed to measure social isolation in the elderly, PROMIS-29, and the Lower Extremity Activity Scale (LEAS), 2-4 days following the operation to assess pre-fracture status. The outcomes were also asked a year later.

The investigators defined social isolation as a Lubben score of 36 and used multivariable exact logistic regression to generate estimates of association between pre-operative social isolation and outcomes at 1 year.

Finally, they performed multivariable linear models, controlling for age, sex, education, and BMI separately for each outcome of interest.

At year 1, 90.9% (n = 291) of the participants were confurmed alive, while 20 died and 9 were lost to follow-up. Of the confirmed alive patkents, 29 withdrew, 31 could not be reached at home/assisted living, 9 were too cognitively impaired to respond.

Ultimately, 76.2% (n = 222) provided 1-year patient report outcome measures.

Individuals who were socially isolated at time of fracture had significantly worse function, (β= -3.83 p= 0.0012) ability to participate in social roles (β= -4.84 p= 0.0002) and depression (β= 2.32 p= 0.0.461) at time of fracture, after controlling for age, sex, education, and BMI.

Being socially isolated was significantly associated with clinically meaningfully worse function (β= -8.02 p= 0.0003) and ability to participate in social roles (β= -9.79 p= 0.0002) at 1 year from similar multivariate models.

“Being socially isolated at the time of first low trauma hip fracture is associated with worse function and social participation 1 year later,” the authors wrote. “Given the dearth of modifiable risk factors in elderly hip fracture patients, future studies are needed to evaluate whether improving social connections could improve outcomes in this rapidly growing demographic.”

The study, “The Effect of Social Isolation on 1-Year Outcomes After Surgical Repair of Low Trauma Hip Fracture,” was published online by ACR Convergence.