***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE To evaluate the role of delirium in the natural history of functional recovery after hip fracture surgery , independent of prefracture status . DESIGN Prospect i ve cohort study . SETTING Orthopedic surgery service at a large academic tertiary hospital , with follow-up extending into rehabilitation hospitals , nursing homes , and the community . PARTICIPANTS One hundred twenty-six consenting subjects older than 65 years ( mean age 79 + /- 8 years , 79 % women ) admitted emergently for surgical repair of hip fracture . MEASUREMENTS Detailed assessment at enrollment to ascertain prefracture status through interviews with the patient and design ated proxy and review of the medical record . Interviews included administration of st and ardized instruments ( Activities of Daily Living ( ADL ) Scale , Blessed Dementia Rating Scale , Delirium Symptom Interview ) and assessment of ambulation , and prefracture living situation . Medical comorbidity , the nature of the hip fracture , and the surgical repair were obtained from the medical record . All subjects underwent daily interviews for the duration of the hospitalization , including the  Mini-Mental State Examination and Delirium Symptom Interview  , and delirium was diagnosed using the  Confusion Assessment Methods algorithm . Patients and proxies were recontacted 1 and 6 months after fracture , and underwent interviews similar to those at enrollment to determine death , persistent delirium , decline in ADL function , decline in ambulation , or new nursing home placement . RESULTS Delirium occurred in 52/126 ( 41 % ) of patients , and persisted in 20/52 ( 39 % ) at hospital discharge , 15/52 ( 32 % ) at 1 month , and 3/52 ( 6 % ) at 6 months . Patients aged 80 years or older , and those with prefracture cognitive impairment , ADL functional impairment , and high medical comorbidity were more likely to develop delirium . However , after adjusting for these factors , delirium was still significantly associated with outcomes indicative of poor functional recovery 1 month after hip fracture : ADL decline ( odds ratio ( OR ) = 2.6 ; 95 % confidence interval ( 95 % CI ) , 1.1- 6.1 ) , decline in ambulation ( OR = 2.6 ; 95 % CI , 1.03 - 6.5 ) , and death or new nursing home placement ( OR = 3.0 ; 95 % CI , 1.1 - 8.4 ) . Patients whose delirium persisted at 1 month had worse outcomes than those whose delirium had resolved . CONCLUSIONS Delirium is common , persistent , and independently associated with poor functional recovery 1 month after hip fracture even after adjusting for prefracture frailty . Further research is necessary to identify the mechanisms by which delirium contributes to poor functional recovery , and to determine whether interventions design ed to prevent or reduce delirium can improve recovery after hip fracture Objectives To assess the impact of a specifically design ed model of orthopedic-geriatric cocare on hip fracture ( HF ) outcomes . Setting Tertiary teaching hospital ( level I trauma center ) . Design Prospect i ve observational study with a retrospective ( historical ) control . Data on 951 consecutive patients 60 years of age or older admitted to the authors ' institution with a nonpathologic HF over a 7-year period ( 1995 to 2002 ) were analyzed . Between 1995 and 1997 , medical problems were managed by a geriatric medicine ( GM ) consultation-only service ( retrospective audit ) . In 1998 , a GM registrar began overseeing daily medical care with weekly geriatrician consultant review ( prospect i ve study ) . Outcomes for 2 time periods were compared : a 3-year period before ( no GM ; 504 patients ) and a 4-year period after ( GM ; 447 patients ) the introduction of GM cocare . Main Outcome Measurements Postoperative medical complications , mortality , length of stay , discharge destination , use of thromboprophylaxis , and antiosteoporotic treatment . Results While comparing 2 periods ( GM and no GM ) , significant reductions in postoperative medical complications and comorbid conditions ( in total 49.5 % vs. 71.0 % , P<0.001 ) and mortality ( 4.7 % vs. 7.7 % , P<0.01 ) occurred and rehospitalization to medical wards within 6 months decreased ( 28 % vs. 7.6 % ) . However , no differences were observed in median length of hospital stay ( 10.8 vs. 11.0 days ) or in discharge destination . Antiosteoporotic treatment ( 12 % to 69 % ) and specific thromboprophylaxis ( 63 % to 94 % ) increased in the GM period . Conclusions Orthopedic-geriatric cocare for the older patients with HF was associated with significant reductions in morbidity and mortality , and increases in optimal postoperative care . Options for further improvement of orthopedic-GM cocare need to be investigated OBJECTIVE To investigate the short- and long-term effects of a multidisciplinary postoperative rehabilitation programme in patients with femoral neck fracture . DESIGN AND SUBJECTS A r and omized controlled trial in patients ( n = 199 ) with femoral neck fracture , aged > or= 70 years . METHODS The primary outcomes were : living conditions , walking ability and activities of daily living performance on discharge , 4 and 12 months postoperatively . The intervention consisted of staff education , individualized care planning and rehabilitation , active prevention , detection and treatment of postoperative complications . The staff worked in teams to apply comprehensive geriatric assessment , management and rehabilitation . A geriatric team assessed those in the intervention group 4 months postoperatively , in order to detect and treat any complications . The control group followed conventional postoperative routines . RESULTS Despite shorter hospitalization , significantly more people from the intervention group had regained independence in personal activities of daily living performance at the 4- and 12-month follow-ups ; odds ratios ( 95 % confidence interval ( CI ) ) 2.51 ( 1.00 - 6.30 ) and 3.49 ( 1.31 - 9.23 ) , respectively . More patients in the intervention group had also regained the ability to walk independently indoors without walking aids by the end of the study period , odds ratio ( 95 % confidence interval ) 3.01 ( 1.18 - 7.61 ) . CONCLUSION A multidisciplinary postoperative intervention programme enhances activities of daily living performance and mobility after hip fracture , from both a short-term and long-term perspective BACKGROUND This report describes changes in eight areas of functioning after a hip fracture , identifies the point at which maximal levels of recovery are reached in each area , and evaluates the sequence of recuperation across multiple functional domains . METHODS . Community-residing hip fracture patients ( n = 674 ) admitted to eight hospitals in Baltimore , Maryl and , 1990 - 1991 were followed prospect ively for 2 years from the time of hospitalization . Eight areas of function ( i.e. , upper and lower extremity physical and instrumental activities of daily living ; gait and balance ; social , cognitive , and affective function ) were measured by personal interview and direct observation during hospitalization at 2 , 6 , 12 , 18 , and 24 months . Levels of recovery are described in each area , and time to reach maximal recovery was estimated using Generalized Estimating Equations and longitudinal data . RESULTS Most areas of functioning showed progressive lessening of dependence over the first postfracture year , with different levels of recovery and time to maximum levels observed for each area . New dependency in physical and instrumental tasks for those not requiring equipment or human assistance prefracture ranged from as low as 20.3 % for putting on pants to as high as 89.9 % for climbing five stairs . Recuperation times were specific to area of function , ranging from approximately 4 months for depressive symptoms ( 3.9 months ) , upper extremity function ( 4.3 months ) , and cognition ( 4.4 months ) to almost a year for lower extremity function ( 11.2 months ) . CONCLUSIONS Functional disability following hip fracture is significant , patterns of recovery differ by area of function , and there appears to be an orderly sequence by which areas of function reach their maximal levels OBJECTIVE --To study the mortality and morbidity associated with proximal femoral fractures with reference to fracture type ( intracapsular and extracapsular )  . DESIGN --Consecutive prospect i ve study with 12 month follow ups . SETTING --Two British trauma receiving centres . PATIENTS --1000 consecutive acute proximal femoral fractures ( fractured necks of femur ) in 972 patients . RESULTS --Significantly higher mortality at one year was seen in patients with extracapsular fractures ( 188/490 ; 38 % ) than in those with intracapsular fractures ( 147/510 ; 29 % ; p < 0.01 ) . Greater morbidity was experienced during the study period by patients with extracapsular fractures , who were less mobile and less independent at the time of their injury . CONCLUSIONS --The rise in average age of presentation with proximal femoral fracture is associated with a persistently high mortality ( 33 % ) and morbidity , greater in patients with an extracapsular fracture . Comparison with other studies , principally from outside Britain , is difficult , but despite advancing st and ards of care the mortality and morbidity of femoral neck fractures remains high , placing an ever increasing burden on the health service The purpose of the current study was to evaluate the effectiveness of a multidisciplinary Hip Fracture Service in the treatment of hip fractures in elderly patients . Baseline information and hospital outcomes were compared for 510 patients over the age of 65 with hip fracture treated before and after the institution of the Hip Fracture Service .  Data included basic demographic data , admission laboratory results , surgical information , number of comorbidities , mortality , medical complications , discharge information , time to surgery , and length of stay in hospital . The demographics of the two groups of patients were similar . Patients treated as part of the Hip Fracture Service had fewer medical complications ( 36 % vs. 51 % ) , more often had surgery within 24 hours ( 63 % vs. 35 % ) , and had shorter hospital stays ( mean , 5.7 days vs. 8.1 days ) than patients treated before the Hip Fracture Service . These findings provide the rationale for a prospect i ve , r and omized trial of the service OBJECTIVES Delirium ( or acute confusional state ) affects 35 % to 65 % of patients after hip-fracture repair , and has been independently associated with poor functional recovery . We performed a r and omized trial in an orthopedic surgery service at an academic hospital to determine whether proactive geriatrics consultation can reduce delirium after hip fracture . DESIGN Prospect i ve , r and omized , blinded . SETTING Inpatient academic tertiary medical center . PARTICIPANTS 126 consenting patients 65 and older ( mean age 79 + /- 8 years , 79 % women ) admitted emergently for surgical repair of hip fracture . MEASUREMENTS Detailed assessment through interviews with patients and design ated proxies and review of medical records was performed at enrollment to ascertain prefracture status . Subjects were then r and omized to proactive geriatrics consultation , which began preoperatively or within 24 hours of surgery , or " usual care . " A geriatrician made daily visits for the duration of the hospitalization and made targeted recommendations based on a structured protocol . To ascertain study outcomes , all subjects underwent daily , blinded interviews for the duration of their hospitalization , including the Mini-Mental State Examination ( MMSE ) , the Delirium Symptom Interview ( DSI ) , and the Memorial Delirium Assessment Scale ( MDAS ) . Delirium was diagnosed using the Confusion Assessment Method ( CAM ) algorithm . RESULTS The 62 patients r and omized to geriatrics consultation were not significantly different ( P>.1 ) from the 64 usual-care patients in terms of age , gender , prefracture dementia , comorbidity , type of hip fracture , or type of surgical repair . Sixty-one percent of geriatrics consultation patients were seen preoperatively and all were seen within 24 hours postoperatively . A mean of 10 recommendations were made throughout the duration of the hospitalization , with 77 % adherence by the orthopedics team . Delirium occurred in 20 /62 ( 32 % ) intervention patients , versus 32 / 64 ( 50 % ) usual-care patients ( P = .04 ) , representing a relative risk of 0.64 ( 95 % confidence interval ( CI ) = 0.37 - 0.98 ) for the consultation group . One case of delirium was prevented for every 5.6 patients in the geriatrics consultation group . There was an even greater reduction in cases of severe delirium , occurring in 7/ 60 ( 12 % ) of intervention patients and 18 / 62 ( 29 % ) of usual-care patients , with a relative risk of 0.40 ( 95 % CI = 0.18 - 0.89 ) . Despite this reduction in delirium , length of stay did not significantly differ between intervention and usual-care groups ( median + /- interquartile range = 5 + /- 2 days in both groups ) , likely because protocol s and pathways predetermined length of stay . In subgroup analyses , geriatrics consultation was most effective in reducing 
    Output:
    
This meta- analysis supports orthogeriatric collaboration to improve mortality after hip repair .