Depressive symptoms combined with dementia affect 12-months survival in elderly patients after rehabilitation post-hip fracture surgery

Objectives: To assess whether the association of depression and dementia affects 12-month survival of elderly patients after rehabilitation post-hip fracture (HF) surgery. Methods: Two hundred eleven inpatients admitted to a Rehabilitation and Aged Care Unit (RACU) following surgery for HF were screened for depression with the 15-item Geriatric Depression Scale (GDS) and stratified into four groups according to dementia (n=40), depressive symptoms (n=54, GDS score>7/15), both (n=27), and neither conditions (n=90). The 12-months survival after discharge was assessed among groups with Kaplan Meyer analysis and compared with Cox proportional hazard regression models adjusted for covariates. Subjects with neither depression nor dementia were the reference group. Results: Survival of patients with depression and dementia was significantly lower than the other 3 groups: after adjustment for age, gender, comorbidity (Charlson Index), use of antidepressants, and Barthel Index at discharge, their Hazard Ratio (HR) was 8.7 (95% CI 1.5-48.5; p=0.01); in the same Cox regression model, the HR of patients with dementia alone was 3.4 (95% CI 0.5-24.0; p=0.20) while the HR of patients with depressive symptoms but no dementia was 5.0 (95% CI 0.8-28.3; p=0.07). Conclusions: The co-occurrence of depression and dementia significantly increases the 12-months risk of dying in elderly patients after rehabilitation post-HF surgery.