Open Access

ARTICLE

Trajectories of Functional Ability and Quality of Life among Older Adults after Hip Fracture with and without Cognition Impairment: A Three-Month Longitudinal Study

Tri Laksono^1,2, Yu-Pin Chen^3,4, Yi-Jung Chen¹, Kah-Ying Yap¹, Fang-Wen Hu^5,6,7, Chi Hsien Huang^8,9,10,*, Lien-Chen Wu^3,4,11, Yi-Jie Kuo^3,4,11, Mark D. Griffiths¹², Chung-Ying Lin^{1,5,13,14,15,*}
1 Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2 Department of Physiotherapy, Faculty of Health Science, Universitas ‘Aisyiyah Yogyakarta, Sleman, Indonesia
3 Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
4 Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
5 School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
6 Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan
7 Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
8 Department of Family Medicine and Community Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
9 School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
10 College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
11 Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
12 Psychology Department, Nottingham Trent University, Nottingham, UK
13 Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
14 Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
15 Department of Occupational Therapy, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
* Corresponding Author: Chi Hsien Huang. Email: , ; Chung-Ying Lin. Email:

International Journal of Mental Health Promotion https://doi.org/10.32604/ijmhp.2026.082706

Received 20 March 2026; Accepted 22 June 2026; Published online 07 July 2026

Abstract

Background: Hip fractures among older adults lead to significant morbidity and mortality, often complicated by pre-existing cognitive impairment. Understanding the longitudinal trajectories of functional ability and quality of life (QoL) among this specific population is crucial for customized interventions development. The present study compared the three-month trajectories of functional ability and QoL among older adults after hip fracture, specifically differentiating between those with and without cognitive impairment. Methods: A three-month longitudinal comparison analysis was conducted with 647 older adults following hip fracture. Participants were stratified by cognitive status (intact [n = 377] vs. impaired [n = 270]). Repeated measures analysis of variance (RM-ANOVA) and generalized estimating equations (GEEs) were employed to compare the trajectories of the functional ability, functional mobility and QoL utility score. Results: RM-ANOVA showed significant changes over time for functional ability, functional mobility, and QoL. A significant interaction between time and cognitive status was found for functional ability (p < 0.001, ω² = 0.011) and functional mobility (p < 0.001, ω² = 0.013), suggesting differing recovery patterns based on cognitive status. GEE analyses confirmed that the cognition-intact group experienced a notable deterioration in QoL over time. However, the pace of QoL decrease was not statistically different between the two groups. Moreover, the group with cognitive impairment showed a significantly faster decline in both functional ability and mobility (p < 0.001) over three-month follow-up. Conclusions: Cognitive impairment among older adults after hip fracture is associated with a significantly poorer baseline condition and, critically, an accelerated decline in functional ability and mobility over the initial three-month recovery period. These findings underscore the need for early identification and tailored support strategies for cognitively impaired individuals to mitigate functional decline and improve post-fracture outcomes.

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Keywords

Hip fracture; older adults; cognition; quality of life; functional recovery; EQ-5D-3L; Barthel Index

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