Perioperative Depression in Older Patients after Hip Fracture

Aim: Depression in patients after hip fracture has adverse effects on patient outcomes. This study aimed to identify the prevalence of perioperative depression and the risk factors which predispose patients undergoing emergency hip surgery to perioperative depression. Methods: A cross-sectional study was conducted in hip fracture survivors in an orthogeriatric unit in Western Australia, from 2005 to 2008. Patients were categorized as depressed if Geriatric Depression Scale (GDS) score was five or above. Linear regression was used to analyze the association between age and GDS. Modifying effect of dementia was examined using likelihood ratio test. Results: Depression was present in 18.3% of 1127 patients within two weeks after hip fracture. Mean age was 81.2 years. Prevalence of perioperative depression was highest in the old-old (24.1%) and in patients with pre-existing dementia (64.8%). Advancing age, prefracture institutionalization, use of gait aids, poor physical status, and dementia were associated with higher GDS scores, but not gender or perioperative delirium. The association between increasing depressive symptoms and advancing age was significant in patients without dementia but not in patients with dementia. Conclusions: Depressive symptoms were common during perioperative care for emergency hip surgery. Depression was highly prevalent in patients with dementia after hip fracture regardless of their age. Pre-morbid patient factors may help to identify those patients at risk for depression and should be addressed to optimize rehabilitation participation and outcomes.