The influence of fracture on activity, social participation and quality of life among older adults. Results from the population study Good Ageing in Skåne.

The aims of this thesis where the target population has been older adults suffering from osteoporosis related fractures were firstly to study the association between functional impairment due to pain, and activity expressed as walking speed (WS) and Timed Get up and-Go (TUG), and to examine the associations between functional impairment and social participation (SP) and quality of life (QoL). Secondly, to study the association between activity and SP and QoL. Thirdly, to study the effect of informal and/or formal support on SP. In study I activity 3 years after trauma and stratified for pain was examined. For fractured, both with and without pain, higher WS was noted for subjects with the last fracture more than 3 years ago compared to subjects fractured less than 3 years ago. The median time for fractured in pain and a trauma more than 3 years ago walking 15m at a self selected speed was 14 s compared to 20 s (p = 0.04) for subjects in pain and fractured less than 3 years ago. Both fracture and pain independently explained levels of WS. In study II the association between functional impairment and SP and QoL was investigated. QoL included Life satisfaction index A (LSI- A) and SF-12 consisting of a mental component (MCS) and a physical component (PCS). Fractured with and without pain were compared to non-fractured controls and in 12 out of 21 activities fewer fractured in pain took part compared to controls. Regarding QoL, fractured in pain scored lower for MCS, PCS and LSI-A, compared to controls. In study III the association between WS, TUG and QoL and SP was examined. In a logistic regression model adjusting for confounders, significant associations remained between SP and WS, TUG where an increased probability of taking part increased with a faster performance. In study IV the extent of SP due to formal and/or informal care was examined. Adjusted odds ratios for SP using non support as a reference, showed that subjects with informal support did not have a lower probability for participating while subjects with informal and/or formal support had a significant lower probability for SP. In conclusion, fractured had a limitation in activity. For both fractured with and without pain a limitation in WS was observed up to three years after trauma suggesting that there is rehabilitation potential the first years after fracture. A health condition with fracture and a functional impairment due to pain, or a deterioration WS or TUG are associated with a restriction in SP and a lowered QoL. The results also substantiate the influence of informal support i.e. care given by relatives and friends have decisive influence to maintain SP and thereby an active lifestyle