Journal of Advanced Nursing, 1998, 27, 59–67 Postoperative variation in neurocognitive and functional status in elderly hip fracture patients Koen Milisen MSN RN Research Associate, Centre for Health Services and Nursing Research, Catholic University of Leuven and Clinical Nurse, Division of Traumatology, University Hospitals of Leuven, Leuven Ivo L. Abraham PhD RN FAAN Professor of Nursing, Associate Professor of Psychiatric Medicine, Co-Director, Centre on Aging and Health, University of Virginia, Charlottesville, Virginia, USA and Professor, Centre for Health Services and Nursing Research, Catholic University of Leuven, Leuven and Paul L. O. Broos MD PhD Professor of Surgery and Chairman, Department of Traumatology and Emergency Medicine, Catholic University of Leuven, Leuven, Belgium Accepted for publication 9 January 1997 MILISEN K., ABRAHAM I.L. & BROOS P.L.O. (1998) Journal of Advanced Nursing 27, 59–67 Postoperative variation in neurocognitive and functional status in elderly hip fracture patients Regaining independence in the performance of activities of daily living (ADL) is a nursing priority in the postoperative care of hip fracture patients, though often impeded by a temporary yet reversible decrease in cognitive status postoperatively. This study investigated the incidence and evolution of decreased cognitive status in geriatric hip fracture patients from admission through to the fifth postoperative day, and the relationship between cognitive abilities and functional (ADL) status. Twenty-six elderly hip fracture patients (f: 21, m: 5) with a mean age of 79·5 years (SD=8·2) admitted to the emergency room of an academic medical centre were monitored longitudinally from admission until the fifth postoperative day regarding neurocognitive status and ADL status, as measured by the mini-mental state exam (MMSE; including subscales of memory, linguistic ability, concentration and psychomotor executive skills) and an adapted version of the Katz ADL-scale, respectively. Patients were categorized on the basis of cognitive status as follows: no cognitive impairment (MMSE≥24), moderate (MMSE≤23 but ≥18) and severe impairment (MMSE≤17). Nineteen of the 26 patients (73·1%) showed cognitive impairment (MMSE≤23) at some point in time before and/or after surgery. Some improvement in cognitive status was observed yet only selectively across patient cohorts and neurocognitive dimensions. Cognitive status, especially memorial ability and psychomotor executive skills, seemed to be most Correspondence: Koen Milisen, Centre for Health Services and Nursing Research, Catholic University of Leuven, Kapucijnenvoer 35/4, B-3000 Leuven, Belgium. 59 © 1998 Blackwell Science Ltd