Title page for ETD etd-05112000-15470008

Type of Document Dissertation
Author Dawson, Donna Kay
URN etd-05112000-15470008
Title Determinants of Nonrecovery Following Hip Fracture in Older Adults: a Chronic Disease Trajectory Analysis
Degree PhD
Department Human Development
Advisory Committee
Advisor Name Title
Roberto, Karen A. Committee Chair
Blieszner, Rosemary Committee Member
Hutchinson, Susan R. Committee Member
Schlenker, Eleanor D. Committee Member
Teaster, Pamela B. Committee Member
  • mobility
  • older adult
  • functional recovery
  • chronic disease
  • hip fracture
Date of Defense 2000-05-05
Availability unrestricted

Hip fracture in older adults may be the sentinel event leading to functional

decline, long-term disability, and death. For the substantial number of older persons who

fracture a hip each year, the chances of full functional recovery remains relatively low.

The purpose of this study was to examine the differences between older persons with hip

fracture who recover fully and those individuals who do not fully recover. A chronic

disease trajectory framework guided the theoretical design of the research. Data were

collected from the medical records of 102 persons aged 60 years and older who sustained

a proximal hip fracture from 1993 to 1998 at a medical center in North Carolina. Data

included personal characteristics, prefracture health status, hospital factors, rehabilitation

features, and functional outcomes. The analysis consisted of a two-step hierarchical

logistic regression model with the control variables of age, prefracture ambulation status,

and prefracture cognitive status entered first and the variables of type of therapy program,

frequency of therapy, number of therapy provider organizations, and location of therapy

at 4 weeks entered second. Significance of the final model was observed, Chi-Square(7, n = 99)=

43.55, p < .05. Significant individual predictors (p < .05) in the model were prefracture

ambulation status (43.56 odds ratio) and cognitive status (6.44 odds ratio). Post-hoc

analysis of the cases revealed a substantial lack of stability in ambulation status from

three months post-fracture to the six-month and one-year follow-up. Findings support

other research studies that indicate prefracture personal characteristics of older persons

who fracture a hip are the most influential factors in predicting successful recovery.

Linkage of the findings to the chronic disease trajectory model suggests that intervention

efforts should focus on prevention, health promotion, and policies that extend the ability

of health care providers to assist older persons with hip fracture in managing their


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