Depressive symptoms are associated with reduced neutrophil function in hip fracture patients

ABSTRACTBackground: The effects of depression and cognitive impairment on hip fracture rehabilitation outcomes are not well established. We aimed to evaluate the associations of depressive symptoms and cognitive impairment (individually and combined) with ambulatory, living activities and quality of life outcomes in hip fracture rehabilitation patients.Methods: A cohort of 146 patients were assessed on depressive symptoms (Geriatric Depression Scale, GDS ≥ 5), cognitive impairment (Mini-mental State Examination, MMSE ≤ 23), and other variables at baseline, and on ambulatory status, Modified Barthel Index (MBI), and SF-12 PCS and MCS quality of life on follow ups at discharge, 6 months and 12 months post fracture.Results: In these patients (mean age 70.8 years, SD 10.8), 7.5% had depressive symptoms alone, 28.8% had cognitive impairment alone, 50% had both, and 13.7% had neither (reference). Ambulatory status showed improvement over time in all mood and cognition groups ((β = 0.008, P = 0.0001). Patients who had cognitive impairment alone (β = −0.060, P = 0.001) and patients who had combined cognitive impairment with depressive symptoms β = −0.62, P = 0.0003), showed significantly less improvement in ambulatory status than reference patients. In the latter group, the relative differences in ambulatory scores from the reference group were disproportionately greater over time (β = −0.003, SE = 0.001, P = 0.021). Patients with combined depressive symptoms and cognitive impairment also showed a significantly lower MBI score, (β = −10.92, SE = 4.01, P = 0.007) and SF-12 MCS (β = −8.35, SE = 2.37, P = 0.0006). Mood and cognition status did not significantly predict mortality during the follow-up.Conclusion: Depression and cognitive impairment comorbidity is common in hip fracture rehabilitation patients and significantly predicts poor functional and quality of life outcomes.

Download Full-text

Prognostic factors of depression and depressive symptoms after hip fracture surgery: systematic review

BMC Geriatrics ◽

10.1186/s12877-021-02514-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

R. Milton-Cole ◽

S. Ayis ◽

K. Lambe ◽

M. D. L. O’Connell ◽

C. Sackley ◽

...

Keyword(s):

Prognostic Factors ◽

Depressive Symptoms ◽

Hip Fracture ◽

Data Extraction ◽

High Quality Research ◽

Hip Fracture Surgery ◽

Modelling Studies ◽

Underlying Mechanisms ◽

Fracture Surgery

Abstract Background Patients with hip fracture and depression are less likely to recover functional ability. This review sought to identify prognostic factors of depression or depressive symptoms up to 1 year after hip fracture surgery in adults. This review also sought to describe proposed underlying mechanisms for their association with depression or depressive symptoms. Methods We searched for published (MEDLINE, Embase, PsychInfo, CINAHL and Web of Science Core Collection) and unpublished (OpenGrey, Greynet, BASE, conference proceedings) studies. We did not impose any date, geographical, or language limitations. Screening (Covidence), extraction (Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies, adapted for use with prognostic factors studies Checklist), and quality appraisal (Quality in Prognosis Studies tool) were completed in duplicate. Results were summarised narratively. Results In total, 37 prognostic factors were identified from 12 studies included in this review. The quality of the underlying evidence was poor, with all studies at high risk of bias in at least one domain. Most factors did not have a proposed mechanism for the association. Where factors were investigated by more than one study, the evidence was often conflicting. Conclusion Due to conflicting and low quality of available evidence it is not possible to make clinical recommendations based on factors prognostic of depression or depressive symptoms after hip fracture. Further high-quality research investigating prognostic factors is warranted to inform future intervention and/or stratified approaches to care after hip fracture. Trial registration Prospero registration: CRD42019138690.

Download Full-text

Effects of Prefracture Depressive Illness and Postfracture Depressive Symptoms on Physical Performance After Hip Fracture

Journal of the American Geriatrics Society ◽

10.1111/jgs.14487 ◽

2016 ◽

Vol 64 (11) ◽

pp. e171-e176 ◽

Cited By ~ 6

Author(s):

Alan M. Rathbun ◽

Michelle Shardell ◽

Denise Orwig ◽

Ann L. Gruber-Baldini ◽

Glenn Ostir ◽

...

Keyword(s):

Depressive Symptoms ◽

Hip Fracture ◽

Physical Performance ◽

Depressive Illness

Download Full-text

Trajectories of depressive symptoms after hip fracture

Psychological Medicine ◽

10.1017/s0033291715002974 ◽

2016 ◽

Vol 46 (7) ◽

pp. 1413-1425 ◽

Cited By ~ 20

Author(s):

P. Cristancho ◽

E. J. Lenze ◽

M. S. Avidan ◽

K. S. Rawson

Keyword(s):

Depressive Symptoms ◽

Hip Fracture ◽

Functional Recovery ◽

Functional Outcomes ◽

Stressful Life Events ◽

Rating Scale ◽

Fracture Repair ◽

Walking Ability ◽

Psychosocial Variables ◽

Antidepressant Use

BackgroundHip fracture is often complicated by depressive symptoms in older adults. We sought to characterize trajectories of depressive symptoms arising after hip fracture and examine their relationship with functional outcomes and walking ability. We also investigated clinical and psychosocial predictors of these trajectories.MethodWe enrolled 482 inpatients, aged ⩾60 years, who were admitted for hip fracture repair at eight St Louis, MO area hospitals between 2008 and 2012. Participants with current depression diagnosis and/or notable cognitive impairment were excluded. Depressive symptoms and functional recovery were assessed with the Montgomery–Asberg Depression Rating Scale and Functional Recovery Score, respectively, for 52 weeks after fracture. Health, cognitive, and psychosocial variables were gathered at baseline. We modeled depressive symptoms using group-based trajectory analysis and subsequently identified correlates of trajectory group membership.ResultsThree trajectories emerged according to the course of depressive symptoms, which we termed ‘resilient’, ‘distressed’, and ‘depressed’. The depressed trajectory (10% of participants) experienced a persistently high level of depressive symptoms and a slower time to recover mobility than the other trajectory groups. Stressful life events prior to the fracture, current smoking, higher anxiety, less social support, antidepressant use, past depression, and type of implant predicted membership of the depressed trajectory.ConclusionsDepressive symptoms arising after hip fracture are associated with poorer functional status. Clinical and psychosocial variables predicted membership of the depression trajectory. Early identification and intervention of patients in a depressive trajectory may improve functional outcomes after hip fracture.

Download Full-text

Development of depressive symptoms post hip fracture is associated with altered immunosuppressive phenotype in regulatory T and B lymphocytes

Biogerontology ◽

10.1007/s10522-015-9587-7 ◽

2015 ◽

Vol 17 (1) ◽

pp. 229-239 ◽

Cited By ~ 8

Author(s):

Niharika Arora Duggal ◽

Jane Upton ◽

Anna C. Phillips ◽

Janet M. Lord

Keyword(s):

Depressive Symptoms ◽

Hip Fracture ◽

B Lymphocytes ◽

T And B Lymphocytes

Download Full-text

Depressive symptoms in hip fracture patients are associated with reduced monocyte superoxide production

Experimental Gerontology ◽

10.1016/j.exger.2014.01.028 ◽

2014 ◽

Vol 54 ◽

pp. 27-34 ◽

Cited By ~ 16

Author(s):

Niharika Arora Duggal ◽

Amy Beswetherick ◽

Jane Upton ◽

Peter Hampson ◽

Anna C. Phillips ◽

...

Keyword(s):

Depressive Symptoms ◽

Hip Fracture ◽

Superoxide Production

Download Full-text

Affective functioning after delirium in elderly hip fracture patients

International Psychogeriatrics ◽

10.1017/s1041610212001962 ◽

2012 ◽

Vol 25 (3) ◽

pp. 445-455 ◽

Cited By ~ 13

Author(s):

Chantal J. Slor ◽

Joost Witlox ◽

René W. M. M. Jansen ◽

Dimitrios Adamis ◽

David J. Meagher ◽

...

Keyword(s):

Cognitive Impairment ◽

Depressive Symptoms ◽

Hip Fracture ◽

Elderly Patients ◽

Cognitive Functioning ◽

Fracture Repair ◽

Living Situation ◽

Affective Functioning ◽

Baseline Characteristics

ABSTRACTBackground: Delirium in elderly patients is associated with various long-term sequelae that include cognitive impairment and affective disturbances, although the latter is understudied.Methods: For a prospective cohort study of elderly patients undergoing hip fracture surgery, baseline characteristics and affective and cognitive functioning were assessed preoperatively. During hospital admission, presence of delirium was assessed daily. Three months after hospital discharge, affective and global cognitive functioning was evaluated again in patients free from delirium at the time of this follow-up. This study compared baseline characteristics and affective functioning between patients with and without in-hospital delirium. We investigated whether in-hospital delirium is associated with increased anxiety and depressive levels, and post-traumatic stress disorder (PTSD) symptoms three months after discharge.Results: Among 53 eligible patients, 23 (43.4%) patients experienced in-hospital delirium after hip fracture repair. Patients who had experienced in-hospital delirium showed more depressive symptoms at follow-up after three months compared to the 30 patients without in-hospital delirium. This association persisted in a multivariate model controlling for age, baseline cognition, baseline depressive symptoms, and living situation. The level of anxiety and symptoms of PTSD at follow-up did not differ between both groups.Conclusion: This study suggests that in-hospital delirium is associated with an increased burden of depressive symptoms three months after discharge in elderly patients who were admitted to the hospital for surgical repair of hip fracture. Symptoms of depression in patients with previous in-hospital delirium cannot be fully explained by persistent (sub)syndromal delirium or baseline cognitive impairment.Trial name: The Effect of Taurine on Morbidity and Mortality in the Elderly Hip Fracture Patient. URL: http://clinicaltrials.gov/ct2/show/NCT00497978?term=taurine+hip+fracture&rank=1. Registration number: NCT00497978.

Download Full-text