Recovery of physical function after limb injuries in independent older people living at home

Objectives: to describe changes in physical functioning after fall-related injuries to the limbs in independently living older people. Design: prospective cohort study, including a pre-injury assessment and post-injury assessments at 8 weeks and 5 and 12 months. Setting: the study is part of the larger, population-based prospective and longitudinal Groningen Longitudinal Aging Study on the determinants of health-related quality of life of people aged 57 and over, who are living independently in the north of the Netherlands. Subjects: 171 patients who sustained injuries at various sites on the limbs and who had completed all four assessments (66% of the eligible population). Patients were grouped according to injury site, Outcome measure: self-reported grades of difficulties with performing basic and instrumental activities of daily living as measured by the Groningen Activity Restriction Scale. Results: 1 year after the injury, pre-injury (mean) levels of functioning were not regained in any of the groups studied. However, only those with fractures of the wrist or hip experienced a substantial decrease in ability to perform basic and instrumental activities of daily living between baseline and the final assessment. Furthermore, of the 44 subjects with wrist fractures, seven (15.9%) needed help with at least one relevant activity at baseline and 18 (40.9%) at 12 months. Of the 34 subjects with hip fractures, four (11.8%) needed help with at least one activity at baseline and 18 (52.9%) at 12 months. Practically no changes were found in any of the groups after 5 months post-injury. Conclusions: not only hip fractures, but also wrist fractures may reduce older people's chances of remaining independent. Prospects of further recovery are minimal 5-6 months after the injury.