Is There an Association between Norton Scale and Cognitive Impairment in Hip Fractured Elderly Patients?

Nadya Kagansky, Ilia Stambler, Eliyahu Hayim Mizrahi

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Introduction: Geriatric assessment as an integrative part of assessment is a composite of a large number of scales. Sometimes it is difficult to transfer all of them. The Norton Scale Score (NSS) assesses the degree of risk to develop bedsores. In previous studies, a correlation between Norton Scale and function was found. A correlation between Norton Scale and cognitive assessments was not evaluated yet. The aim of this study was to determine if there is an association between Norton Scale Score and cognitive impairment. This association can further facilitate geriatric assessment in frail older patients, especially in older patients with communicative difficulties. Methods: We have performed an observational cohort study which included hip fractured older patients consecutively admitted to the rehabilitation ward of the Shmuel Harofe Geriatric Medical Center. The collected data included demographic data and data on chronic illnesses. Results of cognitive status assessment (Mini-Mental State Examination - MMSE) and Norton Scale assessment were received from the computerized patients' charts. We evaluated the association between these 2 scales. Results: The study included 224 consecutive hip fracture patients with a mean age of 81.78 ± 7.19 years. Norton scores at admission, age, education, and previous stroke emerged as the only statistically significant parameters differing between those with cognitive decline and those without it. After adjusting for confounding variables, lower Norton scores at admission (OR 1.303, CI: 1.097-1.548, p = 0.003) were associated with an increased risk finding for cognitive impairment. Conclusion: Our findings suggest that there is an association between Norton Scale Scores and cognitive impairment. Norton score parameters, under certain circumstances, such as speech and other communication difficulties, can be used as a proxy measure for MMSE to indicate cognitive impairment. These findings can be even more helpful in the present time of "COVID-19,"when we have to evaluate older patients with facial masks and other defensive suits.

Original languageEnglish
Pages (from-to)535-540
Number of pages6
JournalDementia and Geriatric Cognitive Disorders
Issue number6
StatePublished - 1 Mar 2022
Externally publishedYes

Bibliographical note

Funding Information:
There was no financial support for this study.

Publisher Copyright:
© 2021 The Author(s).


  • Cognition
  • Hip fracture
  • Mini-Mental State Examination
  • Norton Scale Scores
  • Older persons


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