Trajectories in postoperative recovery of elderly hip-fracture patients at risk for depression: A follow-up study

Objectives: This secondary-analysis study aimed to identify distinct developmental depressivesymptom trajectories among elderly hip-fracture patients at risk for depression, examine the associations of trajectories with potential risk factors and care models, and explore the effect of trajectory membership on recovery outcomes. Method: Longitudinal data were obtained for 179 patients in a randomized controlled trial. These patients were included if their Geriatric Depression Scale short form scores were ≥ 5 before discharge or 1, 3, 6, or 12 months following discharge. Individuals who followed similar developmental depressive-symptom trajectories were identified by group-based trajectory modeling. Associations between trajectory-group membership and postoperative outcomes over the 12 months following discharge were evaluated by the generalized estimating equations method. Results: We identified a progressively lower-risk group and a fluctuating higher-risk group. Patients' membership in the progressively lower-risk group was associated with receiving a comprehensive care model featuring psychological and physical interventions. Membership in this group was associated with better postoperative outcomes and fewer emergency department visits or hospital readmissions. Patients were more likely to belong to the fluctuating higher-risk group if they had more comorbidities or worse prefracture mobility. Patients in the fluctuating higher-risk group not only had higher levels of depressive symptoms, but also a greater likelihood of poor postoperative recovery outcomes. Conclusions: Depressive symptoms in elderly hip-fracture patients may be alleviated by postoperative comprehensive care that features both psychological and physical interventions. Patients with increasing depressive status should be targeted for early interventions.