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Background <p>Hip fracture and cognitive impairment often coexist in later life, but whether cognitive disadvantage precedes the fracture-report index, worsens afterward, or both remains unclear. We examined pre- and post-index cognitive trajectories among older adults with reported incident hip fracture and matched controls.</p> Methods <p>We used Health and Retirement Study (HRS) data from 1996–2016. From 5,833 eligible US adults aged ≥ 65&#xa0;years without baseline hip fracture, 543 incident hip fracture cases were matched to 1,538 controls using exact age/sex matching and propensity-score matching on sociodemographic, cognitive, and depressive-symptom measures. Incident hip fracture was reported at biennial interviews; cases were indexed at the age of first reported fracture, and matched controls were assigned the same index age. Global cognition was the primary out- come; mental status and memory were secondary outcomes. Event-centered piecewise linear mixed-effects models estimated pre-index slopes, index differences, and post-index slope differences, with covariate adjustment for residual imbalance. Sensitivity analyses examined raw-score outcomes, event-time assumptions, and post-index follow-up completeness.</p> Results <p>Of 558 eligible incident hip fracture cases, 543 were matched to 1,538 controls across 543 matched sets; the maximum absolute standardized mean difference was 0.055. For the primary outcome, global cognition was similar eight years before the index, lower by the index interview, and further separated eight years after the index. The post-index slope difference indicated additional worsening for global cognition (-0.022 (95% confidence interval [CI] -0.042 to -0.002)). Among secondary outcomes, mental status showed a similar adverse post-index slope difference (-0.030 (95% CI -0.052 to -0.007)), whereas memory did not (-0.009 (95% CI -0.028 to 0.009)).</p> Conclusions <p>In this matched longitudinal analysis of US adults aged 65&#xa0;years or older, reported hip fracture marked a more adverse trajectory of cognitive aging. Cognitive vulnerability was evident before the fracture-report index, cognition was lower by the index interview, and additional post-index divergence was most apparent for global cognition and mental status.</p>

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Cognitive trajectories before and after geriatric hip fracture: a matched longitudinal analysis of the Health and Retirement Study, 1996–2016

  • 期刊论文

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  • 发表日期：

    2026年6月22日

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  • Haiyan Hu,
  • Fangfang Deng,
  • Zhenbing Chen,
  • Bo Chen

摘要

Background

Hip fracture and cognitive impairment often coexist in later life, but whether cognitive disadvantage precedes the fracture-report index, worsens afterward, or both remains unclear. We examined pre- and post-index cognitive trajectories among older adults with reported incident hip fracture and matched controls.

Methods

We used Health and Retirement Study (HRS) data from 1996–2016. From 5,833 eligible US adults aged ≥ 65 years without baseline hip fracture, 543 incident hip fracture cases were matched to 1,538 controls using exact age/sex matching and propensity-score matching on sociodemographic, cognitive, and depressive-symptom measures. Incident hip fracture was reported at biennial interviews; cases were indexed at the age of first reported fracture, and matched controls were assigned the same index age. Global cognition was the primary out- come; mental status and memory were secondary outcomes. Event-centered piecewise linear mixed-effects models estimated pre-index slopes, index differences, and post-index slope differences, with covariate adjustment for residual imbalance. Sensitivity analyses examined raw-score outcomes, event-time assumptions, and post-index follow-up completeness.

Results

Of 558 eligible incident hip fracture cases, 543 were matched to 1,538 controls across 543 matched sets; the maximum absolute standardized mean difference was 0.055. For the primary outcome, global cognition was similar eight years before the index, lower by the index interview, and further separated eight years after the index. The post-index slope difference indicated additional worsening for global cognition (-0.022 (95% confidence interval [CI] -0.042 to -0.002)). Among secondary outcomes, mental status showed a similar adverse post-index slope difference (-0.030 (95% CI -0.052 to -0.007)), whereas memory did not (-0.009 (95% CI -0.028 to 0.009)).

Conclusions

In this matched longitudinal analysis of US adults aged 65 years or older, reported hip fracture marked a more adverse trajectory of cognitive aging. Cognitive vulnerability was evident before the fracture-report index, cognition was lower by the index interview, and additional post-index divergence was most apparent for global cognition and mental status.