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Chanthanapodi P, Tammata N, Laoruengthana A, Jarusriwanna A. Independent Walking Disability After Fragility Hip Fractures: A Prognostic Factors Analysis. Geriatr Orthop Surg Rehabil 2024; 15:21514593241278963. [PMID: 39184134 PMCID: PMC11344254 DOI: 10.1177/21514593241278963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/03/2024] [Accepted: 08/04/2024] [Indexed: 08/27/2024] Open
Abstract
Introduction Up to one-third of patients with fragility hip fractures are totally dependent in the year following the injury which leads to later morbidity and mortality. Understanding the related factors that affect patients' ambulation helps health care providers prepare for the treatment plans to improve their functional outcomes. This study aimed to evaluate the factors associated with independent walking disability in the early postoperative period after fragility hip fractures. Material and methods This retrospective cohort study involved 394 patients with fragility hip fractures with either intertrochanteric, subtrochanteric, or femoral neck fractures from January 2018 to June 2023. The related factors including preoperative demographics, perioperative, and postoperative factors, were collected and analyzed. The endpoint was the independent walking disability of patients at 6 weeks after surgery. Results 110 patients (27.9%) were disabled, whereas 284 patients (72.1%) could walk independently at postoperative 6 weeks. The multivariable risk ratio regression analysis showed that patients with age ≥80 years (RR 1.65; 95% CI 1.21-2.25; P = 0.001), pre-fracture walking with the gait aid (RR 2.03; 95% CI 1.53-2.69; P < 0.001), having ≥2 underlying comorbidities (RR 1.63; 95% CI 1.19-2.23; P = 0.002), preoperative hypoalbuminemia (RR 1.74; 95% CI 1.32-2.29; P < 0.001), and presence of the postoperative medical complication (RR 2.04; 95% CI 1.37-3.02; P < 0.001) were significantly associated with independent walking disability at the early postoperative period of 6 weeks. Conclusions Post-hip fracture surgery patients with the presence of postoperative medical complication have the highest risk of independent walking disability. Health care providers should concentrate on high-risk patients, correct the modifiable factors, and minimize any postoperative complications to improve functional recovery and decrease morbidity related to non-ambulation after fragility hip fractures.
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Affiliation(s)
| | - Netnapha Tammata
- Department of Rehabilitation Medicine and Physical Therapy, Somdejphrajaotaksin Maharaj Hospital, Tak, Thailand
| | - Artit Laoruengthana
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Atthakorn Jarusriwanna
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
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Kamimura T, Kobayashi Y, Tamaki S, Koinuma M. Impact of Prefracture Cognitive Impairment and Postoperative Delirium on Recovery after Hip Fracture Surgery. J Am Med Dir Assoc 2024; 25:104961. [PMID: 38428834 DOI: 10.1016/j.jamda.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES This study aimed to examine the impact of prefracture cognitive impairment (CI) severity and postoperative delirium on recovery after hip fracture surgery in older patients. DESIGN Prospective study with a 1-year follow-up. SETTING AND PARTICIPANTS We included 355 patients aged ≥80 years from 2 acute hospitals in Japan. METHODS Barthel Index (BI) ambulation scores were assessed prefracture and at 1, 3, 6, and 12 months postoperatively. The score at each time point minus the prefracture score was used as the ambulation recovery variable. The 21-item Dementia Assessment Sheet for the Community-based Care System (DASC-21) and Confusion Assessment Method were used to assess CI severity and delirium, respectively. The impacts of CI severity and delirium on recovery at 1 month and by 12 months postoperatively were examined. Linear multiple regression and linear mixed effects models were used. RESULTS BI ambulation scores remained the same or improved from prefracture levels in 26.8%, 34.4%, 33.0%, and 30.4% of patients at 1, 3, 6, and 12 months, respectively. Ten patients (2.8%) had fall-related hip fractures, 20 (5.6%) were rehospitalized, and 43 (12.1%) died during this period. Although DASC-21 CI severity significantly affected the recovery both at 1 month and by 12 months postoperatively [standardized β (Stdβ) = -0.39, P < .0001, and Stdβ = -0.37, P < .0001, respectively], delirium did not. Other variables affecting recovery by 12 months postoperatively included prefracture BI ambulation scores, Mini Mental State Examination scores, age, fracture type, place of residence, and time. CONCLUSIONS AND IMPLICATIONS Postoperative ambulation recovery, excluding the effect of death and other poor outcomes, is influenced by prefracture CI severity, and the presence of delirium itself may not be the moderating variable. These results emphasize the importance of treatment planning based on prefracture CI severity and indicate that assessments such as the DASC-21 may be useful in implementing such a plan.
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Affiliation(s)
- Tomoko Kamimura
- Department of Medical Sciences, Shinshu University, Matsumoto, Nagano, Japan.
| | - Yuya Kobayashi
- Department of Rehabilitation, Aizawa Hospital, Matsumoto, Nagano, Japan
| | - Satoshi Tamaki
- Department of Rehabilitation, Kamiiida-Daiichi General Hospital, Nagoya, Aichi, Japan
| | - Masayoshi Koinuma
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan
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Romero Pisonero E, Mora-Fernández J, Queipo Matas R, González Montalvo JI, Neira Álvarez M, Ojeda Thies C, Sáez López P, Malafarina V. Demographic, functional and clinical characteristics in hip fracture patients according to mental status of the Spanish National Hip Fracture Registry. Rev Esp Geriatr Gerontol 2024; 59:101450. [PMID: 38159499 DOI: 10.1016/j.regg.2023.101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To describe the differences according to mental status at admission on the care process and 30-day outcomes in hip fracture patients, mainly regarding the use of rehabilitation resources and anti-osteoporotic medication, by analysing data from the Spanish National Hip Fracture Registry (RNFC, "Registro Nacional de Fracturas de Cadera" in Spanish). METHODS We analysed prospectively collected data from a cohort of patients admitted participating in the Spanish National Hip Fracture Registry (RNFC) in 76 Spanish hospitals between 2017 and 2019. We classified participants using Short Portable Mental Status Questionnaire (SPMSQ), defining two groups: patients with ≤2 SPMSQ score and patients with >2 SPMSQ score. RESULTS Of 21,254 patients was recorded SPMSQ in 17,242 patients, 9052 were >2 SPMSQ score (52.6%). These were older (87.7 vs. 85.3 years; p<0.001), had worse mobility (no-independent walking ability 26.0% vs. 4.5%; p<0.001) and were more likely to be living in nursing homes (35.3% vs. 9.6%; p<0.001). They were more likely to be treated nonoperatively (3.8% vs. 1.5%; p>0.001), less early mobilisation (57.5% vs. 68.9%; p<0.001) and suffered higher in-hospital mortality (5.2% vs. 2.7%; p<0.001). At discharge, they received less anti-osteoporotic medication (37.9% vs. 48.9%; p<0.001) and returned home less often (29.8%% vs. 51.2%; p<0.001). One month after fracture, patients with >2 SPMSQ score had poorer mobility (no-independent walking ability 44.4% vs. 24.9%; p<0.001) and were newly institutionalised in a nursing home more (12.6% vs. 12.0%; p<0.001) and were more likely to die by one-month post-fracture (9.5% vs. 4.6%; p<0.001). CONCLUSION RNFC patients with >2 SPMSQ score were more vulnerable and had poorer outcomes than patients with ≤2 SPMSQ score, suggesting that they need specialised care in-hospital and in the recovery phase.
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Affiliation(s)
| | - Jesús Mora-Fernández
- Department of Geriatrics, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University, Madrid, Spain
| | - Rocío Queipo Matas
- Europea University, Madrid, Spain; La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Juan Ignacio González Montalvo
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain; Department of Geriatrics, La Paz University Hospital, Madrid, Spain; Department of Medicine, Faculty of Medicine, Autonoma University, Madrid, Spain
| | | | - Cristina Ojeda Thies
- Department of Traumatology and Orthopaedic Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Pilar Sáez López
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain; Geriatrics Unit, Fundación Alcorcón University Hospital, Alcorcón, Madrid, Spain
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Noeske KE, Snowdon DA, Ekegren CL, Harding KE, Prendergast LA, Peiris CL, Shields N, O'Halloran PD, Porter J, Watts JJ, Taylor NF. Walking self-confidence and lower levels of anxiety are associated with meeting recommended levels of physical activity after hip fracture: a cross-sectional study. Disabil Rehabil 2024:1-7. [PMID: 38635302 DOI: 10.1080/09638288.2024.2338195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE To explore whether psychological factors are associated with ability to meet recommended physical activity thresholds after hip fracture. MATERIALS AND METHODS Cross-sectional observational study of 216 community-dwelling adults aged ≥65 years after hip fracture (mean age 79 SD 7 years, 70% female). Multiple ordinal regression analysis determined factors associated with meeting physical activity thresholds related to positive health outcomes: 4,400 and 7,100 daily steps. Explanatory variables were: walking self-confidence; falls self-efficacy; depression; anxiety; co-morbidities; previous gait aid use; nutritional status; age; and gender. RESULTS Forty-three participants (20%) met the lower threshold of ≥4,400 to <7,100 steps and thirty participants (14%) met the upper threshold of ≥7,100 steps. Walking self-confidence was positively associated with meeting higher physical activity thresholds (adjusted odds ratio [AOR] 1.32: 95% CI 1.11 to 1.57, p = 0.002). Age (AOR 0.93: 95% CI 0.89 to 0.98, p = 0.003), DASS-21 anxiety score (AOR 0.81: 95% CI 0.69 to 0.94, p = 0.008) and comorbidity index score (AOR 0.52: 95% CI 0.36 to 0.72, p < 0.001) were negatively associated with meeting higher physical activity thresholds. CONCLUSION Walking self-confidence and anxiety are potentially modifiable factors associated with meeting physical activity thresholds related to positive health outcomes after hip fracture.
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Affiliation(s)
- Kate E Noeske
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - David A Snowdon
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- National Centre for Healthy Ageing (NCHA), Melbourne, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
- Academic Unit, Peninsula Health, Melbourne, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Katherine E Harding
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Luke A Prendergast
- School of Computing, Engineering and Mathematical Sciences, La Trobe University, Bundoora, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
- The Royal Melbourne Hospital, Allied Health, Parkville, Australia
| | - Nora Shields
- Olga Tennison Autism Research Centre, La Trobe University, Bundoora, Australia
| | - Paul D O'Halloran
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Judi Porter
- Institute for Physical Activity and Nutrition (IPAN), Deakin University School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Jennifer J Watts
- School of Health & Social Development, Faculty of Health, Deakin University, Burwood, Australia
| | - Nicholas F Taylor
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
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Kitcharanant N, Atthakomol P, Khorana J, Phinyo P, Unnanuntana A. Prognostic Factors for Functional Recovery at 1-Year Following Fragility Hip Fractures. Clin Orthop Surg 2024; 16:7-15. [PMID: 38304218 PMCID: PMC10825251 DOI: 10.4055/cios23177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/30/2023] [Accepted: 09/08/2023] [Indexed: 02/03/2024] Open
Abstract
Background The main objective of treating fragility hip fractures is to maximize the patients' ability to return to their basic activities of daily living (ADL) levels. This study explored prognostic factors associated with the ability to recover pre-fracture ADL levels at 1 year after fragility hip fractures. Methods We retrospectively recruited patients admitted with fragility hip fractures between July 2016 and September 2018. Details of the following were extracted from electronic medical records: age, sex, body mass index; pre-fracture Charlson Comorbidity Index (CCI), Barthel index, and EuroQol-Visual Analog Scale (EQ-VAS) scores; pre-fracture ambulatory status; and fracture type and treatment. The primary endpoint was the ability to return to the pre-fracture ADL status at 1 year. Multivariable logistic regression analysis assessed the prognostic ability of predictors. Results Of 405 patients, 284 (70.1%) managed to return to their pre-fracture ADL status. Multivariable logistic regression analysis demonstrated that the predictor with the most apparent effect size was pre-fracture EQ-VAS scores ≥ 65 (multivariable odds ratio [mOR], 12.90; p = 0.03). Other influential predictors were CCI scores < 5 (mOR, 1.96; p = 0.01) and surgical treatment for the hip fracture. Conclusions Three prognostic factors can predict a hip fracture patient's ability to return to the pre-fracture ambulatory status at 1 year. They are the patient's CCI score, operative treatment for the hip fracture, and the pre-fracture EQ-VAS score. This information could be used to develop a clinical prediction model based on the prognostic factors.
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Affiliation(s)
- Nitchanant Kitcharanant
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pichitchai Atthakomol
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jiraporn Khorana
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Musculoskeletal Science and Translational Research (MSTR), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Aasis Unnanuntana
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Sioutis S, Zikopoulos A, Karampikas V, Mitsiokapa E, Tsatsaragkou A, Katsanos S, Mastrokalos D, Koulalis D, Mavrogenis AF. Hip Fractures in Patients with Dementia: An Emerging Orthopedic Concern. J Long Term Eff Med Implants 2024; 34:85-93. [PMID: 37938210 DOI: 10.1615/jlongtermeffmedimplants.2023046658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Hip fractures are a very common injury in the elderly population associated with an increased mortality rate. Currently, more and more elderly patients are diagnosed with dementia. Demented patients are more prone to falls and hip fractures compared to the general population because of conditions related to their disease such as instability, osteoporosis, poor muscle control and weakness. The coexistence of dementia and hip fractures is a difficult situation for both the patients and the treating physicians because of postoperative complications in this frail subgroup of patients and their inability to stand up and walk. To enhance the literature, we reviewed published studies of hip fracture patients suffering from dementia to discuss why they have more frequent hip fractures, to review their associated in-hospital complications, and to emphasize on their postoperative management to be able to reach the pre-injury activity level and optimal quality of life.
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Affiliation(s)
- Spyridon Sioutis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, University Medical School, Athens, Greece
| | - Alexandros Zikopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Karampikas
- First Department of Orthopedics, National and Kapodistrian University of Athens, ATTIKON University General Hospital, Athens, Greece
| | - Evanthia Mitsiokapa
- Department of Physical and Rehabilitation Medicine, Thoracic Diseases General Hospital Sotiria, Athens, Greece
| | | | - Spyridon Katsanos
- Department of Emergency Medicine and Cardiology, National and Kapodistrian University of Athens
| | - Dimitrios Mastrokalos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Koulalis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
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Phruetthiphat OA, Pinijprapa P, Satravaha Y, Kitcharanant N, Pongchaiyakul C. An innovative scoring system for predicting an excellent Harris hip score after proximal femoral nail anti-rotation in elderly patients with intertrochanteric fracture. Sci Rep 2022; 12:19939. [PMID: 36402794 PMCID: PMC9675850 DOI: 10.1038/s41598-022-24177-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022] Open
Abstract
Typically, intramedullary and extramedullary devices are used to treat elderly with intertrochanteric fractures. The majority of previous research has focused on the association between surgical factors and mechanical failure after internal fixation. There is, however, limited evidence to demonstrate the association between functional outcomes after proximal femoral nail anti-rotation (PFNA) fixation and the non-surgical factors such as patient's comorbidities. The aim of this study is to determine the predictive factors associated with excellent outcome, as well as to develop an integrated scoring system to predict the outcome after PFNA fixation in elderly patients with an intertrochanteric fracture. A retrospective study was conducted between January 2012 and December 2018. Elderly patients with low-energy intertrochanteric fractures who underwent PFNA fixation and at least a year of follow-up were recruited. Demographics, comorbidities, cognitive status, time to operation, and surgical parameters of the patients were all identified. Excellent and non-excellent outcomes were assessed by Harris Hip Score (HHS) after a one-year follow up. Regression analysis was used to determine the predictors for an excellent functional outcome. A new integrated scoring system (ISSI; Integrate Scoring System in elderly patients with Intertrochanteric fracture) was developed and validated. 450 elderly patients were randomly divided into two cohorts: a development (N = 225) and validation cohorts (N = 225). In this study, age < 85 years, normal weight/overweight, Charlson comorbidity index (CCI) < 6, no cognitive impairment, a modified AO/OTA 31A1.3, time to operation < 6 days, and Tip Apex Distance between 20 and 30 mm were significantly associated with an excellent outcome after PFNA fixation. The range of ISSI score was between 0 to 16 and the cut-off score of 13 was found to have the highest discriminatory power to determine the excellent functional outcome where the area of ROC was 0.85. In regards to the validation cohort, the sensitivity and specificity of ISSI score was 69% and 87%, respectively, and the AUC was 0.81. The ISSI score is effortless and practical for orthopedic surgeons for predicting an outcome after PFNA fixation in elderly patients with an intertrochanteric fracture.
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Affiliation(s)
- Ong-art Phruetthiphat
- grid.414965.b0000 0004 0576 1212Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Ratchvidhi Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400 Thailand
| | - Panukorn Pinijprapa
- grid.414965.b0000 0004 0576 1212Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, 315 Ratchvidhi Rd, Thung Phaya Thai, Ratchathewi, Bangkok, 10400 Thailand
| | - Yodhathai Satravaha
- grid.10223.320000 0004 1937 0490Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Nitchanant Kitcharanant
- grid.7132.70000 0000 9039 7662Department of Orthopaedics, Chiang Mai University, Chiang Mai, Thailand
| | - Chatlert Pongchaiyakul
- grid.9786.00000 0004 0470 0856Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Garmendia Prieto B, Sánchez Del Corral Usaola F, Avilés Maroto P, Ramírez Real L, Fernández Rodríguez AMª, Gómez Pavón J. [Evolution of the profile of patients attended by a hospital Geriatric Home Care Unit in the last 20 years]. Rev Esp Geriatr Gerontol 2022; 57:291-297. [PMID: 36396509 DOI: 10.1016/j.regg.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/01/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the evolution of the profile of patients attended by a Geriatric Home Care (GHC) Unit and its care activity in the last two decades. METHODS Data on the historical activity of the AGD Unit from 2001 to 2020, grouped into 5-year periods, were recorded. Sociodemographic, clinical, functional (Functional Red Cross Scale and Barthel index) and mental (Mental Red Cross Scale) variables were collected, baseline and at inclusion to AGD. Also the waiting time until first visit, mean follow-up, origin of referral, destination at the end of the intervention, reason for consultation and cause of functional dependence were also included. A descriptive analysis was performed with the SPSSv.23 program. RESULTS Ten thousand six hundred fifty-four patients attended in AGD (1 January 2001 to 31 December 2020). A progressive increase in age and in the number of geriatric syndromes was observed. Patients presented higher functional and cognitive decline, and the number of patients living alone and in need of private assistance increased. The duration of the intervention decreases and Primary Care remains the main source and destination at the end of the intervention, with dementia standing out as the main cause for functional dependence. CONCLUSION The vulnerability of the populations in need of specialised geriatric care is increasing: patients are older, and have more geriatric syndromes, high functional and cognitive decline, and suffer social frailty; more work is needed to address the role of these support units in the community, as well as their coordination with Primary Care teams.
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Affiliation(s)
- Blanca Garmendia Prieto
- Servicio de Geriatría, Hospital Universitario Central de la Cruz Roja San José y Santa Adela, Madrid, España.
| | | | - Pilar Avilés Maroto
- Servicio de Geriatría, Hospital Universitario Central de la Cruz Roja San José y Santa Adela, Madrid, España
| | - Luís Ramírez Real
- Servicio de Geriatría, Hospital Universitario Central de la Cruz Roja San José y Santa Adela, Madrid, España
| | - Ana M ª Fernández Rodríguez
- Servicio de Geriatría, Hospital Universitario Central de la Cruz Roja San José y Santa Adela, Madrid, España
| | - Javier Gómez Pavón
- Servicio de Geriatría, Hospital Universitario Central de la Cruz Roja San José y Santa Adela, Madrid, España
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Kobayashi H, Inoue T, Ogawa M, Abe T, Tanaka T, Kakiuchi M. Malnutrition diagnosed by the Global Leadership Initiative on Malnutrition criteria as a predictor of gait ability in patients with hip fracture. Injury 2022; 53:3394-3400. [PMID: 35948508 DOI: 10.1016/j.injury.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 07/27/2022] [Accepted: 08/01/2022] [Indexed: 02/02/2023]
Abstract
AIM Malnutrition is common in patients with hip fractures and is associated with poor clinical outcomes. The Global Leadership Initiative on Malnutrition (GLIM) and the European Society for Clinical Nutrition and Metabolism (ESPEN) criteria are widely used to diagnose malnutrition. However, the criteria regarding the prediction of gait ability in patients with hip fractures during the acute phase remain unclear. We aimed to determine whether GLIM or ESPEN criteria were more appropriate for predicting gait ability at discharge from an acute hospital. METHODS This retrospective observational study included hip fracture patients aged ≥ 65 years. Patients were classified as malnourished or non-malnourished according to the GLIM and ESPEN criteria at admission. The primary outcome was gait ability, which was evaluated using functional ambulation categories (FAC) at discharge. We categorized into those with (FAC score ≥ 3 points) and without (< 3 points) improved gait ability. Logistic regression analysis for FAC was performed to determine whether GLIM or ESPEN was predictive of gait ability at discharge. RESULTS Overall 157 patients were included; the median age was 84 years, and 75.3% were female. The prevalence of malnutrition was 73.9% and 25.5% according to the GLIM and ESPEN criteria, respectively. Logistic regression analysis showed that malnutrition evaluated using the GLIM criteria were predictive of lower FAC at discharge (odds ratio, 0.394; 95% CI, 0.164-0.946), while ESPEN criteria did not show statistically significant differences (odds ratio, 0.625; 95% CI, 0.292-1.335). CONCLUSION GLIM criteria are useful for predicting gait ability at discharge during acute hospitalization in patients with hip fractures.
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Affiliation(s)
- Hikaru Kobayashi
- Department of Rehabilitation, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kouzidai, Nisi-Ku, Kobe, Hyogo 651-2273, Japan
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-ku, Niigata city 950-3198, Japan.
| | - Masato Ogawa
- Division of Rehabilitation Medicine, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Takafumi Abe
- Department of Rehabilitation, Uonuma Kikan Hospital, 4132 Urasa, Minamionuma, Niigana 949-7302, Japan
| | - Toshiaki Tanaka
- Department of Rehabilitation, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kouzidai, Nisi-Ku, Kobe, Hyogo 651-2273, Japan
| | - Masayoshi Kakiuchi
- Department of Rehabilitation, Kobe City Nishi-Kobe Medical Center, 5-7-1 Kouzidai, Nisi-Ku, Kobe, Hyogo 651-2273, Japan
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Determinants of Lack of Recovery from Dependency and Walking Ability Six Months after Hip Fracture in a Population of People Aged 65 Years and Over. J Clin Med 2022; 11:jcm11154467. [PMID: 35956084 PMCID: PMC9369508 DOI: 10.3390/jcm11154467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Hip fracture in the elderly means that between a quarter and a half of patients do not regain the levels of independence and walking ability that they previously had, according to the literature, after the fracture. Material and methods: Retrospective study of 537 patients aged ≥65 years who survived at the sixth month after fracturing their hip, of which the age, sex, type of fracture, surgical risk, independence (BI), walking ability, cognitive level (PS), comorbidities, indicated drugs, complications, surgical delay, hospital stay, and surgical technique are known. Using Pearson’s χ2 test, all the variables were contrasted with respect to the limitation or not, at the sixth month of the recovery of both independence and pre-admission walking ability. Multivariate analysis provides the necessary adjustment to the previous contrast. Results: We have found that age and PS ≥ 5 at admission limit recovery from both dependency and walking ability. Surgical risk, independence (BI) upon admission, anemia, and constipation during the hospital stay limit the recovery of the BI. Worsening of walking ability during the hospital stay and the type of extra-articular fracture, which was surgically treated by osteosynthesis, limit the recovery of walking ability. Conclusions: The factors previously exposed, and perhaps the fact that patients with hip fractures are not routinely referred to rehabilitation, explain the high proportion of patients who do not recover their previous independency (36%) or walking ability (45%) to the fact of fracturing.
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11
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Bronheim RS, Cotter E, Skolasky RL. Cognitive impairment is associated with greater preoperative symptoms, worse health-related quality of life, and reduced likelihood of recovery after cervical and lumbar spine surgery. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 10:100128. [PMID: 35706693 PMCID: PMC9189192 DOI: 10.1016/j.xnsj.2022.100128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 02/03/2023]
Abstract
Background Cognitive impairment (CI) is associated with prolonged hospital stays and increased complications; however, its role in symptom severity and health-related quality of life (HRQoL) among spine patients is unknown. We determined 1) prevalence of preoperative CI; 2) associations between CI and preoperative pain, disability, and HRQoL; and 3) association between CI and postoperative improvements in HRQoL. Methods This is a prospective cohort study of 453 consecutive adult spine surgery patients between October 2019 and March 2021. We compared pain (Numeric Rating Scale, NRS), pain-related disability (Oswestry/Neck Disability Index, O/NDI), and HRQoL (PROMIS-29 profile, version 2.0) among participants having severe (PROMIS-29 Cognitive Abilities score ≤30), moderate (31-35), or mild CI (36-40) or who were unimpaired (score >40), using analysis of variance. Likelihood of clinical improvement given the presence of any CI was estimated using logistic regression. All comparisons were adjusted for age, gender, comorbidity, and use of opioid medication during the last 30 days. Alpha=.05. Results Eighty-five respondents endorsed CI (38 mild; 27 moderate; 20 severe). Preoperatively, those with CI had more severe back pain (p=.005) and neck pain (p=.025) but no differences in leg or arm pain. Those with CI had greater disability on ODI (p<.001) and NDI (p<.001) and worse HRQoL in all domains (all, p<.001). At 6 and 12 months postoperatively, those with CI were less likely to experience clinical improvement in disability and HRQoL (anxiety, pain interference, physical function, and satisfaction with ability to participant in social roles) (all, p<.05). Conclusions CI was present in nearly 20% of spine patients before surgery and was independently associated with worse preoperative back and neck pain, disability, and HRQoL. Those with CI had approximately one-half the likelihood of achieving meaningful clinical improvement postoperatively. These results indicate a need to evaluate spine patients' cognitive impairment prior to surgery. Level of Evidence III.
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Affiliation(s)
- Rachel S Bronheim
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Emma Cotter
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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12
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Yoo JI, Ha YC, Cha Y. Nutrition and Exercise Treatment of Sarcopenia in Hip Fracture Patients: Systematic Review. J Bone Metab 2022; 29:63-73. [PMID: 35718923 PMCID: PMC9208903 DOI: 10.11005/jbm.2022.29.2.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/03/2022] [Indexed: 11/11/2022] Open
Abstract
Background This study aimed to investigate nutritional or rehabilitation intervention protocols for hip fracture patients with sarcopenia and to analyze the effect of these protocols through a systematic review of studies that reported clinical results. Methods Studies were selected based on the following criteria: (1) study design: randomized controlled trials or non-randomized comparative studies; (2) study population: patients with hip fracture; (3) intervention: nutritional or rehabilitation; and (4) reporting the clinical outcomes and definition of sarcopenia. Results Of the 247 references initially identified from the selected databases, 5 randomized controlled studies and 2 comparative studies were selected for further investigation. The total number of patients was 497. We found 2 specific rehabilitation interventions, one medication intervention using erythropoietin, and 4 nutritional interventions using amino-acid or protein. Among the studies included in this systematic review, 2 studies did not find a clear statistical difference in assessment tools compared to controls after intervention. On the other hand, the rest of the studies positively interpreted the results for intervention. The most frequently used assessment tool for intervention was handgrip strength. Conclusions Although mainstream methods of intervention for sarcopenia include nutritional, exercise, and drug interventions, the validity of these interventions in elderly hip fractures has not been clearly proven. In addition, as most studies only reported short-term results, there is no consensus on the optimal long-term treatment.
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Affiliation(s)
- Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongang National University Hospital, Gyeongsang National University, Jinju, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
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13
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Ashkenazi I, Rotman D, Amzalleg N, Graif N, Amal Khoury, Ben-Tov T, Steinberg E. Efficacy of Oral Nutritional Supplements in Patients Undergoing Surgical Intervention for Hip Fracture. Geriatr Orthop Surg Rehabil 2022; 13:21514593221102252. [PMID: 35615598 PMCID: PMC9125056 DOI: 10.1177/21514593221102252] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/29/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: Malnutrition is considered a risk factor among geriatric individuals with hip fracture, affecting functional healing and recovery, increasing healthcare spending, and associated with high mortality. In this study, we sought to evaluate the clinical efficacy of oral nutritional supplements in geriatric patients undergoing surgery for hip fracture. Material and Methods: We retrospectively analyzed data of 1625 consecutive patients who underwent fixation or arthroplasty for hip fracture in a tertiary medical center between 2017 and 2020. Patients who had no available albumin or body mass index levels were excluded. The study group is of patients who received an advanced formula in the form of an oral nutritional supplement (ONS), and the control group of patients that received no ONS. Peri- and postoperative complications, readmissions, short-term mortality, and albumin levels were compared between the 2 groups. Results: The final cohort included 1123 patients, 298 in the study group and 825 controls, with a follow-up of at least 1-year. Provision of the advanced enriched formula was not associated with 30-day, 90-day, or 1-year mortality (P = .62, P = .52, and P = .72, respectively) or any perioperative complications, such as 30-day or 90-day readmission (P = .37 and P = .1, respectively), revision surgery of any cause (P = .35), and postoperative infection rates (P = .73). Albumin levels on admission and the minimum albumin levels during hospitalization were similar between the groups, but they were significantly higher in the study group before discharge (33.42 g/L vs. 32.79 g/L, P = .01). Discussion: The use of an ONS was not associated with reduced perioperative complications or mortality, although it did affect nutritional status, as indicated by increased albumin levels, a known marker of nutritional status. Conclusions. While current findings do not support ONS use to minimize major postoperative complication after hip fracture surgery, further long-term study is warranted to evaluate subjective and functional outcomes associated with improved nutritional status.
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Affiliation(s)
- Itay Ashkenazi
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dani Rotman
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nissan Amzalleg
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nadav Graif
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amal Khoury
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Ben-Tov
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ely Steinberg
- Division of Orthopedics, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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14
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Costa V, Ramirez O, Perea L, Velasquez A, Otero A, Rocon E, Raya R. Development and clinical validation of a rehabilitation platform for hip fracture in elderly population. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1340-1349. [PMID: 35580104 DOI: 10.1109/tnsre.2022.3175688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hip fracture is one of the most common traumatisms associated with falls in the elderly, severely affecting the patient's mobility and independence. In recent years, the use of robotic technology has proven to be effective in gait rehabilitation, especially for neurological disorders. However, there is a lack of research validating these devices for hip fracture in elderly patients. This paper presents the design and evaluation of a novel assistive platform for hip rehabilitation, SWalker, aimed at improving the rehabilitation of this condition. Functional validation of the SWalker platform was carried out with five healthy elderly subjects and two physiotherapists. Clinical validation was conducted with 34 patients with hip fracture. The control group (n=24, age=86.38±6.16 years, 75% female) followed conventional therapy, while the intervention group (n=10, age=86.80±6.32 years, 90% female) was rehabilitated using SWalker. The functional validation of the device reported good acceptability (System Usability Scale >85). In the clinical validation, the control group required 68.09±27.38 rehabilitation sessions compared to 22.60±16.75 in the intervention group (p<0.001). Patients in the control group needed 120.33±53.64 days to reach ambulation, while patients rehabilitated with SWalker achieved that stage in 67.11±51.07 days (p=0.021). FAC and Tinetti indexes presented a larger improvement in the intervention group when compared with the control group (p=0.007 and p=0.01, respectively). The SWalker platform can be considered an effective tool to enhance autonomous gait and shorten rehabilitation therapy in elderly hip fracture patients. This result encourages further research on robotic rehabilitation platforms for hip fracture.
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15
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Yoshitaka T, Shimaoka Y, Yamanaka I, Tanida A, Tanimoto J, Toda N, Akimori T, Hamawaki J. Cognitive Impairment as the Principal Factor Correlated with the Activities of Daily Living Following Hip Fracture in Elderly People. Prog Rehabil Med 2022; 7:20220026. [PMID: 35633759 PMCID: PMC9110876 DOI: 10.2490/prm.20220026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: Hip fracture is a common injury occurring in elderly people and often impairs their
activities of daily living (ADL). This study aimed to identify and analyze factors
associated with ADL following hip fracture treatment. Methods: A total of 371 consecutive patients with hip fractures who were surgically treated in
our hospital were enrolled. Among these, 103 patients who underwent acute- to
recovery-phase postoperative rehabilitation at our hospital and whose motor scale of the
functional independence measure (mFIM) score was ≥70 before the fracture were finally
included in this study. Single and multiple regression analyses were performed to
identify the factors correlated with ADL. The mFIM at hospital discharge was set as the
outcome variable, and various clinical factors, such as fracture type, surgical
technique, serum and biological data, mini-mental state examination (MMSE) score, and
serial mFIM scores, were used as explanatory variables. Results: Only MMSE and preinjury mFIM scores were significantly correlated with mFIM at
discharge, and MMSE had the larger effect on the outcome. Receiver operating
characteristic curve analysis revealed an MMSE cutoff value of 20/21. Patients with an
MMSE score of ≤20 showed a relatively poor recovery of mFIM from 2–3 weeks
postoperatively compared with those with an MMSE score of ≥21. Conclusion: Cognitive impairment and the preinjury ADL level were correlated with short-term ADL
outcomes following hip fracture. Cognitive impairment was the most important factor
affecting ADL; treatment and postoperative rehabilitation should be carefully considered
for cognitively disturbed patients from the acute phase after hip fracture.
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Affiliation(s)
- Teruhito Yoshitaka
- Department of Orthopedic Surgery, Hiroshima City Rehabilitation Hospital, Hiroshima, Japan
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16
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Cartei A, Mossello E, Ceccofiglio A, Rubbieri G, Polidori G, Ranalli C, Cammilli A, Curcio M, Cavallini MC, Mannarino GM, Ungar A, Toccafondi G, Peris A, Marchionni N, Rostagno C. Independent, Differential Effects of Delirium on Disability and Mortality Risk After Hip Fracture. J Am Med Dir Assoc 2021; 23:654-659.e1. [PMID: 34861226 DOI: 10.1016/j.jamda.2021.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To assess the independent effect of delirium on mortality and disability after 1 year of follow-up, in consecutive older patients with hip fracture hospitalized for surgical repair. DESIGN This is a prospective observational study. SETTING AND PARTICIPANTS Patients aged older than 65 years consecutively admitted for hip fracture to the Trauma and Orthopedics Centre of a third-level hospital, between March and October 2014. METHODS Patients were evaluated by a multidisciplinary team. A comprehensive geriatric assessment was performed on admission. Delirium was assessed before and after surgical repair according to the Confusion Assessment Method. Mortality and disability status were collected at 3 months and 1 year after hospital discharge. RESULTS Of 411 patients with hip fracture, 387 (mean age 82 years, female 72%) were enrolled. Delirium was assessed in 50% of the enrolled population. Patients with delirium were older, frequently affected by dementia, severe prefracture disability, history of falls, and polypharmacy. One-year mortality was 19% in all populations, and higher in patients with delirium, although delirium did not show an independent association with mortality, in multivariable analysis. Conversely, delirium was identified as an independent prognostic factor of long-term disability (B-1.605, SE 0.211, P < .001). CONCLUSION AND IMPLICATIONS This study identifies delirium as an independent long-term disability generator, regardless of associated clinical conditions and premorbid cognitive and functional status. This emphasises the importance of delirium prevention through a multidisciplinary approach and the potential role of systematic treatment of risk factors in reducing functional decline, even in subjects with preexistent disability and dementia. Moreover, these data call for research on rehabilitation interventions specifically targeted to these complex patients, with the aim of identifying approaches effective in reducing long-term disability. Conversely, a high level of clinical alertness is required in patients with delirium, as an appropriate treatment of acute diseases should reduce their high mortality risk.
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Affiliation(s)
- Alessandro Cartei
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy.
| | - Enrico Mossello
- Division of Geriatric Medicine and Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Alice Ceccofiglio
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Gaia Rubbieri
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Gianluca Polidori
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Claudia Ranalli
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Alessandra Cammilli
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Massimo Curcio
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Maria Chiara Cavallini
- Agency for Postdischarge Continuity of Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulio Maria Mannarino
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Andrea Ungar
- Division of Geriatric Medicine and Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Giulio Toccafondi
- Clinical Risk Management and Patient Safety Centre, Tuscany Region, Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Centre Emergency Department Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Niccolò Marchionni
- Division of Geriatric Medicine and Cardiology, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
| | - Carlo Rostagno
- Division of Internal and Post-Surgical Medicine, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy
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17
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Gleich J, Fleischhacker E, Rascher K, Friess T, Kammerlander C, Böcker W, Bücking B, Liener U, Drey M, Höfer C, Neuerburg C. Increased Geriatric Treatment Frequency Improves Mobility and Secondary Fracture Prevention in Older Adult Hip Fracture Patients-An Observational Cohort Study of 23,828 Patients from the Registry for Geriatric Trauma (ATR-DGU). J Clin Med 2021; 10:jcm10235489. [PMID: 34884190 PMCID: PMC8658325 DOI: 10.3390/jcm10235489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/15/2021] [Accepted: 11/21/2021] [Indexed: 12/11/2022] Open
Abstract
Interdisciplinary orthogeriatric care of older adult hip fracture patients is of growing importance due to an ageing population, yet there is ongoing disagreement about the most effective model of care. This study aimed to compare different forms of orthogeriatric treatment, with focus on their impact on postoperative mobilization, mobility and secondary fracture prevention. In this observational cohort study, patients aged 70 years and older with a proximal femur fracture requiring surgery, were included from 1 January 2016 to 31 December 2019. Data were recorded from hospital stay to 120-day follow-up in the Registry for Geriatric Trauma (ATR-DGU), a specific designed registry for older adult hip fracture patients. Of 23,828 included patients from 95 different hospitals, 72% were female, median age was 85 (IQR 80–89) years. Increased involvement of geriatricians had a significant impact on mobilization on the first day (OR 1.1, CI 1.1–1.2) and mobility seven days after surgery (OR 1.1, CI 1.1–1.2), initiation of an osteoporosis treatment during in-hospital stay (OR 2.5, CI 2.4–2.7) and of an early complex geriatric rehabilitation treatment (OR 1.3, CI 1.2–1.4). These findings were persistent after 120 days of follow-up. Interdisciplinary treatment of orthogeriatric patients is beneficial and especially during in-patient stay increased involvement of geriatricians is decisive for early mobilization, mobility and initiation of osteoporosis treatment. Standardized treatment pathways in certified geriatric trauma departments with structured data collection in specific registries improve outcome monitoring and interpretation.
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Affiliation(s)
- Johannes Gleich
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (J.G.); (E.F.); (W.B.)
| | - Evi Fleischhacker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (J.G.); (E.F.); (W.B.)
| | - Katherine Rascher
- AUC—Academy for Trauma Surgery, 80538 Munich, Germany; (K.R.); (T.F.); (C.H.)
| | - Thomas Friess
- AUC—Academy for Trauma Surgery, 80538 Munich, Germany; (K.R.); (T.F.); (C.H.)
| | | | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (J.G.); (E.F.); (W.B.)
| | - Benjamin Bücking
- Center for Orthopedics and Trauma Surgery, DRK-Kliniken Nordhessen, 34121 Kassel, Germany;
| | - Ulrich Liener
- Department of Orthopedics and Trauma Surgery, Marienhospital, 70199 Stuttgart, Germany;
| | - Michael Drey
- Department of Medicine IV, University Hospital, LMU Munich, 80336 Munich, Germany;
| | - Christine Höfer
- AUC—Academy for Trauma Surgery, 80538 Munich, Germany; (K.R.); (T.F.); (C.H.)
| | - Carl Neuerburg
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (J.G.); (E.F.); (W.B.)
- Correspondence: ; Tel.: +49-89-4400-73500
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18
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Inui T, Watanabe Y, Kurata Y, Suzuki T, Matsui K, Ishii K, Kurozumi T, Kawano H. Early postoperative Barthel index score and long-term walking ability in patients with trochanteric fractures walking independently before injury: a retrospective cohort study. Arch Orthop Trauma Surg 2021; 141:1283-1290. [PMID: 32705380 DOI: 10.1007/s00402-020-03548-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Trochanteric fractures are one of the most common fragility fractures, and the number of the patients is increasing worldwide. Identifying prognostic factors is important to manage and minimize the social losses caused by postoperative walking impairment. The purpose of this retrospective study is to clarify the association between early postoperative Barthel index score and postoperative long-term walking ability among patients with trochanteric fractures who could walk independently before injury. MATERIALS AND METHODS Consecutive patients with trochanteric fractures aged ≥ 65 years who were walking independently before injury were included. Patients were divided into two groups according to the Barthel index score measured within 1 week after surgery; the cut-off value was set at 20 points. The prevalence of walking impairment after 1 year was compared between these two groups after adjusting for confounding factors in a complete case analysis and using the data introduced by the multiple imputation method. RESULTS Among the 758 eligible patients, 254 patients (34%) had their walking ability evaluated after 1 year from injury. The patients in the lower Barthel index group showed a significantly impaired walking ability in both analyses (adjusted odds ratio 5.5 and 2.4, 95% confidence intervals 2.4-13 and 1.5-3.8, respectively). CONCLUSIONS The present results suggested that the Barthel index score measured in the early postoperative period after trochanteric fractures was associated with the level of long-term walking impairment in patients who could walk independently before injury.
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Affiliation(s)
- Takahiro Inui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan. .,Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan.
| | - Yoshinobu Watanabe
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan.,Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| | - Yoshiaki Kurata
- Division of Orthopaedic Trauma, Sapporo Tokushukai Hospital, 1-1-1 Oyachi-higashi, Atsubetsu-ku, Sapporo, Hokkaido, Japan
| | - Takashi Suzuki
- Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| | - Kentaro Matsui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan.,Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| | - Keisuke Ishii
- Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| | - Taketo Kurozumi
- Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
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A bibliometric analysis of orthogeriatric care: top 50 articles. Eur J Trauma Emerg Surg 2021; 48:1673-1682. [PMID: 34114053 PMCID: PMC9192394 DOI: 10.1007/s00068-021-01715-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/26/2021] [Indexed: 11/22/2022]
Abstract
Background Population is ageing and orthogeriatric care is an emerging research topic. Purpose This bibliometric review aims to provide an overview, to investigate the status and trends in research in the field of orthogeriatric care of the most influential literature. Methods From the Core Collection databases in the Thomson Reuters Web of Knowledge, the most influential original articles with reference to orthogeriatric care were identified in December 2020 using a multistep approach. A total of 50 articles were included and analysed in this bibliometric review. Results The 50 most cited articles were published between 1983 and 2017. The number of total citations per article ranged from 34 to 704 citations (mean citations per article: n = 93). Articles were published in 34 different journals between 1983 and 2017. In the majority of publications, geriatricians (62%) accounted for the first authorship, followed by others (20%) and (orthopaedic) surgeons (18%). Articles mostly originated from Europe (76%), followed by Asia–pacific (16%) and Northern America (8%). Key countries (UK, Sweden, and Spain) and key topic (hip fracture) are key drivers in the orthogeriatric research. The majority of articles reported about therapeutic studies (62%). Conclusion This bibliometric review acknowledges recent research. Orthogeriatric care is an emerging research topic in which surgeons have a potential to contribute and other topics such as intraoperative procedures, fractures other than hip fractures or elective surgery are related topics with the potential for widening the field to research.
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20
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Dahl C, Holvik K, Meyer HE, Stigum H, Solbakken SM, Schei B, Søgaard AJ, Omsland TK. Increased Mortality in Hip Fracture Patients Living Alone: A NOREPOS Study. J Bone Miner Res 2021; 36:480-488. [PMID: 33403722 DOI: 10.1002/jbmr.4212] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/16/2020] [Accepted: 11/04/2020] [Indexed: 12/29/2022]
Abstract
Hip fracture is associated with excess mortality, persisting for many years after the fracture. Several factors may affect survival; however, the role of social support has been less studied. Living situation could be an indicator of a person's social support, which predicts mortality in the general population. In this longitudinal cohort study, we considered whether living alone was a risk factor for post-hip fracture mortality compared with living with a partner. Information on hip fractures from all hospitals in Norway from 2002 to 2013 was combined with the 2001 National Population and Housing Census. The association between living situation and mortality during 12.8 years of follow-up in 12,770 men and 22,067 women aged 50 to 79 years at fracture was investigated using flexible parametric survival analysis. We also estimated relative survival of hip fracture patients compared with that of the non-fractured background population in the same living situation (alone or with a partner). Higher mortality after hip fracture was found in both men and women living alone versus with a partner (hazard ratio [HR] men = 1.37, 95% confidence interval [CI] 1.29-1.44; HR women = 1.23, 95% CI 1.18-1.28, adjusting for age, education level, urbanization degree, and number of children). We demonstrated the strongest association in male hip fracture patients aged <60 years (long-term mortality HR = 3.29, 95% CI 2.25-6.49). Compared with the general population, relative survival 8 years after a hip fracture was 43% in men and 61% in women living alone, whereas relative survival in those living with a partner was 51% in men and 67% in women. In conclusion, hip fracture patients who lived alone had higher mortality than those living with a partner and lower survival relative to the general population. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Cecilie Dahl
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kristin Holvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Haakon E Meyer
- Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Hein Stigum
- Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri M Solbakken
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Berit Schei
- Institute of Community Medicine and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim, Norway
| | - Anne-Johanne Søgaard
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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21
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Takahashi K, Momosaki R, Yasufuku Y, Nakamura N, Maeda K. Nutritional Therapy in Older Patients With Hip Fractures Undergoing Rehabilitation: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2020; 21:1364-1364.e6. [DOI: 10.1016/j.jamda.2020.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 11/25/2022]
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22
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De Vincentis A, Behr AU, Bellelli G, Bravi M, Castaldo A, Cricelli C, Galluzzo L, Iolascon G, Maggi S, Martini E, Momoli A, Onder G, Paoletta M, Roselli M, Ruggeri M, Santacaterina F, Tritapepe L, Zurlo A, Antonelli Incalzi R. Management of hip fracture in the older people: rationale and design of the Italian consensus on the orthogeriatric co-management. Aging Clin Exp Res 2020; 32:1393-1399. [PMID: 32358728 DOI: 10.1007/s40520-020-01574-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hip fracture (HF) is a burdening health problem in older people. The orthogeriatric approach has been shown to favour functional recovery and reduce mortality, but its implementation in clinical practice cannot rely upon shared management protocols and greatly varies among different healthcare systems. Here, we present the rationale and design of the Italian consensus document on the management of HF in older people. METHODS A panel of multidisciplinary experts from ten Italian scientific societies involved in the care of HF and including geriatricians, orthopaedics, anaesthesiologists, physiatrists and general practitioners, will join to establish the content validity of a list of statements. A Delphi consensus methodology will be applied to obtain the opinions of the panel and to provide the final recommendations. OBJECTIVES The document will include indications on the following relevant topics: (1) optimal care path of older subjects with HF; (2) management of comorbidities and pre-operative alteration of physiological parameters; (3) management of selected categories of patients at expected increased risk of adverse outcomes; (4) continuity of care out of hospital; (5) screening and correction of risk factors for HF in older subjects; (6) information and divulgation of shared management strategies. The objective of the consensus will be to inform clinicians, patients, researchers, and health policy makers about the best management strategies for HF in older people and their inherent limitations, thus facilitating communication between stakeholders and promoting the most cost/effective models of care.
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Affiliation(s)
- Antonio De Vincentis
- Geriatric and Gerontology Department, Campus Bio-Medico University of Rome, via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Astrid Ursula Behr
- Operative Unit of Anesthesia and Resuscitation, Hospital of Camposampiero, Padua, Italy
| | - Giuseppe Bellelli
- Acute Geriatric and Orthogeriatric Unit, S. Gerardo Hospital, Monza, Italy
- Milano-Bicocca University, Milan, Italy
| | - Marco Bravi
- Physical and Rehabilitation Medicine Department, Campus Bio-Medico University of Rome, Rome, Italy
| | | | | | - Lucia Galluzzo
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Emilio Martini
- Orthogeriatric Unit, Azienda Ospedaliero Universitaria di Modena, Ospedale Civile Di Baggiovara, Modena, Italy
| | - Alberto Momoli
- Orthopedic and Traumatology Unit, San Bortolo Hospital, Vicenza, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Roselli
- Orthopedic and Traumatology Unit, "Maria Vittoria" Hospital, Torino, Italy
| | - Mauro Ruggeri
- Società Italiana Di Medicina Generale (SIMG), Firenze, Italy
| | - Fabio Santacaterina
- Physical and Rehabilitation Medicine Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luigi Tritapepe
- Operative Unit of Anesthesia and Intensive Care Medicine, San Camillo-Forlanini Hospital, Rome, Italy
| | - Amedeo Zurlo
- Geriatric and Orthogeriatric Unit, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - Raffaele Antonelli Incalzi
- Geriatric and Gerontology Department, Campus Bio-Medico University of Rome, via Alvaro del Portillo, 200, 00128, Rome, Italy
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23
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Tavares JT, Biasotto-Gonzalez DA, Boa Sorte Silva NC, Suzuki FS, Lucareli PRG, Politti F. Age-Related Changes in Postural Control in Physically Inactive Older Women. J Geriatr Phys Ther 2020; 42:E81-E86. [PMID: 29286981 DOI: 10.1519/jpt.0000000000000169] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The maintenance of postural control is influenced by the complexity of a given task. Tasks that require greater attention and cognitive involvement increase the risk of falls among older adults. The aim of the present study was to evaluate the adaptation of the postural control system to different levels of task complexity in physically inactive young and older women. METHODS A cross-sectional study was conducted with adult women classified as physically inactive based on the results of the International Physical Activity Questionnaire. The participants were 27 young (20-30 years of age) and 27 older (60-80 years of age) women. Sway velocity of the center of pressure in the anterior-posterior and medial-lateral directions was calculated using a force plate under 6 conditions: standing directly on the force plate or on a foam placed over the force plate, eyes open or closed, and dual-task complexity with and without the foam. RESULTS AND DISCUSSION A 2-way analysis of variance revealed that sway velocity increased in both groups when the task conditions were altered. The older women exhibited significantly greater sway velocity compared with the young women on all tasks. However, the patterns of postural control adaptation to the different levels of complexity were similar among all participants. CONCLUSIONS In this study, the adaption of the postural control system to different levels of task complexity did not differ between physically inactive young and physically inactive older women. However, the physically inactive older women exhibited greater sway velocity compared with the young women.
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Affiliation(s)
- Juliana Teles Tavares
- Postgraduate Program in Rehabilitation Sciences, Physical Therapy Department, Universidade Nove de Julho, São Paulo, Brazil
| | | | | | - Frank Shiguemitsu Suzuki
- Postgraduate Program in Rehabilitation Sciences, Physical Therapy Department, Universidade Nove de Julho, São Paulo, Brazil
| | - Paulo Roberto Garcia Lucareli
- Postgraduate Program in Rehabilitation Sciences, Physical Therapy Department, Universidade Nove de Julho, São Paulo, Brazil
| | - Fabiano Politti
- Postgraduate Program in Rehabilitation Sciences, Physical Therapy Department, Universidade Nove de Julho, São Paulo, Brazil
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Prognostic factors for discharge to home and residing at home 12 months after hip fracture: an Anoia hip study. Aging Clin Exp Res 2020; 32:925-933. [PMID: 31377999 DOI: 10.1007/s40520-019-01273-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/09/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Hip fracture is often associated with loss of physical function and institutionalization. The aim of this study is to describe the prognostic factors for discharge to home and residing there 12 months after a hip fracture. METHODS A prospective study that includes patients aged ≥ 69 years that live at home before the fracture, admitted from June 1st, 2010, to May 31st, 2013. We registered the demographic data, presurgical function and cognitive assessment, surgical waiting time, type of fracture and complications during hospitalization. RESULTS We included 273 patients (mean age 84.8 ± 6.1 years; 80% women), 130 (47.6%) were discharged directly to their own home. The predictors of discharge to home were a lower Geriatrics Dementia Scale score (OR 1.42; 95% CI 1.17-1.71; p < 0.001), a higher Barthel Index score at discharge (OR 1.07; 95% CI 1.05-1.10; p < 0.001) and a longer hospital stay (OR 1.14; 95% CI 1.02-1.27; p = 0.019). At 12 months, 169 (63.5%) were still residing at home. Predictors of residing at home 12 months after the hip fracture were age (OR 1.07; 95% CI 1.02-1.12; p = 0.010), the discharge Barthel Index score (OR 0.96; 95% CI 0.94-0.98; p < 0.001), the Geriatrics Dementia Scale score (OR 1.27; 95% CI 1.05-1.52; p = 0.013), the surgical waiting time (OR 3.42; 95% CI 1.077-10.89; p = 0.037) and Charlson comorbidity index (OR 1.27; 95% CI 1.05-1.55; p = 0.016). CONCLUSION Prognostic factors for discharging to home and remaining there 12 months after a hip fracture are those that reflect a better health condition prior to the fracture and better functionality at the hospital discharge for hip fracture.
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25
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Delgado A, Cordero G-G E, Marcos S, Cordero-Ampuero J. Influence of cognitive impairment on mortality, complications and functional outcome after hip fracture: Dementia as a risk factor for sepsis and urinary infection. Injury 2020; 51 Suppl 1:S19-S24. [PMID: 32067771 DOI: 10.1016/j.injury.2020.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/08/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the relation between cognitive impairment on arrival at hospital in patients older than 65 years with a hip fracture, and their mortality, medical and surgical complications, and functional outcomes. PATIENTS AND METHODS Observational study of a single-center prospective consecutive cohort of 955 patients older than 64 years diagnosed of hip fracture from December/2012 to December/2015. Average age was 86±7.2 (65-104) years and 725 (75.9%) were female. Fractures were extracapsular in 538 cases (56.3%) and intracapsular in 417 (43.7%). Patients were controlled clinically and radiographically in outpatient clinic after 1, 3, 6, and 12 months. Data about basal cognitive status, walking ability before the fracture, medical and surgical complications, functional outcomes and mortality were collected for the year following the fracture. STATISTICAL ANALYSIS Bivariate analysis (Pearson, Fisher, Mann-Whitney, Wilcoxon) was applied to study statistically significant relations, and contingence coefficients (CC) were calculated. RESULTS Patients with cognitive impairment showed a higher overall mortality, (p = 0,000; CC=0,197) even after hospital discharge (p = 0.000; CC=0.198). Similarly, patients with dementia presented a higher rate of respiratory infections (p = 0,029; CC=0,093), urinary tract infections (p = 0,008; CC=0,108) and sepsis (p = 0,011; CC=0,105). On the contrary, we found no correlations between mental status and surgical complications, even for prosthesis dislocation (p = 0.136). Patients with dementia started from poorer functional situations (p = 0,000; CC=0,367) and ended follow-up with lower walking ability (p = 0,000; CC=0,43), but cognitive impairment did not relate statistically with a worse functional recovery (p = 0,304): that is, the proportion of patients who maintained their previous ability to walk was similar in both groups, those with altered mental status and those without it. CONCLUSIONS Cognitive impairment is a risk factor for mortality in patients with a hip fracture. It is also a risk factor for suffering respiratory and urinary tract infection and sepsis. These two late risks factors have not been published previously. Functional recovery is not conditioned by cognitive impairment, although further studies need to be developed to evaluate the actual role of cognitive impairment on postoperative progression of patients.
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Affiliation(s)
- A Delgado
- Department of Orthopaedic Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, 28006 Madrid, Spain
| | - E Cordero G-G
- Department of Orthopaedic Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, 28006 Madrid, Spain
| | - S Marcos
- Department of Orthopaedic Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, 28006 Madrid, Spain
| | - J Cordero-Ampuero
- Department of Orthopaedic Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, 28006 Madrid, Spain.
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Hershkovitz A, Nissan R. The Association Between Antipsychotic Drug Use and Rehabilitation Outcome in Post-Acute Hip Fractured Patients: A Retrospective Cohort Study. J Appl Gerontol 2020; 40:661-669. [DOI: 10.1177/0733464820904564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Antipsychotic (AP) use may lead to numerous side effects which may affect rehabilitation outcomes. A retrospective cohort study was carried out on 448 hip fractured patients admitted to a post-acute geriatric rehabilitation center. Functional improvement was measured by the Functional Independence Measure (FIM), motor FIM (mFIM), and mFIM effectiveness. A multiple linear regression model and regression analysis was used to evaluate the level of association between AP use and achievement of favorable functional gain. AP users exhibited lower functional ability on admission and at discharge, achieved a significantly lower functional gain and required longer rehabilitation time compared with nonusers. AP use by post-acute hip fractured patients negatively affects their chances of achieving favorable rehabilitation outcome after adjustment for confounders.
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Affiliation(s)
- Avital Hershkovitz
- “Beit Rivka” Geriatric Rehabilitation Center, Petah Tikva, Israel
- Tel Aviv University, Israel
| | - Ran Nissan
- “Beit Rivka” Geriatric Rehabilitation Center, Petah Tikva, Israel
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Ju JB, Zhang PX, Jiang BG. Risk Factors for Functional Outcomes of the Elderly with Intertrochanteric Fracture: A Retrospective Cohort Study. Orthop Surg 2020; 11:643-652. [PMID: 31456321 PMCID: PMC6712441 DOI: 10.1111/os.12512] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/07/2019] [Accepted: 07/10/2019] [Indexed: 11/28/2022] Open
Abstract
Objective To identify baseline factors relevant to functional outcomes and health‐related quality of life in the elderly with intertrochanteric fractures. Methods For the present study, 168 patients with intertrochanteric fracture who were assigned to different treatments between January 2016 and December 2017 were retrospectively selected. Hip function was assessed by Harris hip score (HHS), and health‐related quality of life was evaluated by Barthel index (BI) of activities of daily living (ADL) and EuroQol 5‐dimensions (EQ‐5D) score, respectively. Data were analyzed by t‐test, ANOVA, Pearson's correlation, χ2‐test, and multivariate linear regression. Results A total of 164 (97.6%) patients completed the follow‐up, with an average follow‐up time of 15.7 ± 6.9 months; 39 (23.8%) patients died during the follow‐up period and 125 (76.2%) patients were eligible for the functional analysis. HHS at final follow‐up of 125 patients was 71.8 ± 13.1, and the following were associated with hip functional recovery: age (−0.45, 95% confidence interval (CI) −0.73 to −0.18, P < 0.01), serum albumin (0.65, 95% CI 0.04 to 1.27, P < 0.05), and ADL at discharge (0.18, 95% CI 0.01 to 0.33, P < 0.05). The Barthel index at final follow up in this cohort was 80.2 ± 18.1, and multivariable linear regression analysis showed that age (−0.49, 95% CI −0.85 to −0.12; P < 0.05), ADL score at discharge (0.29, 95% CI 0.07 to 0.51; P < 0.05) and internal fixation (16.3, 95% CI 3.3 to 29.3; P < 0.05) were associated with ADL at final follow‐up. EQ‐5D at final follow‐up was 0.74 ± 0.2, with which HHS (0.012, 95% CI 0.011 to 0.013; P < 0.01) was positively associated. Conclusion We identify several baseline factors associated with hip functional outcome, health utility, and ADL in the elderly after an intertrochanteric fracture, of which we could modify mutable factors to achieve better outcomes. These findings could help to inform treatment and functional prognosis.
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Affiliation(s)
- Jia-Bao Ju
- Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Pei-Xun Zhang
- Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Bao-Guo Jiang
- Department of Orthopaedics and Traumatology, Peking University People's Hospital, Beijing, China
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Frailty defined by 19 items as a predictor of short-term functional recovery in patients with hip fracture. Injury 2019; 50:2272-2276. [PMID: 31635908 DOI: 10.1016/j.injury.2019.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/04/2019] [Accepted: 10/04/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Many hip fracture patients have decreased functional status inhibiting recovery to pre-fracture functional status. The prevalence of frailty in patients with hip fracture is high, but little is known how frailty is associated with functional recovery. The aim of this study was to determine whether frailty can predict functional recovery and clinical outcomes during the acute phase in hip fracture. PATIENTS AND METHODS This study was retrospective observational study from two acute hospitals. Participants were recruited from hip fracture patients who underwent surgery. The main exposure was frailty defined using 19-item modified Frailty Index (mFI). The main outcome was functional recovery, evaluated by postoperative efficiency on the motor-Functional Independence Measure (FIM) score. Secondary outcomes included postoperative complication and discharge disposition. Multiple logistic regression analyses were performed using each outcome as a dependent variable and mFI as an independent variable. RESULTS Sample included 274 patients (mean age 83.7 ± 7.4 years, female 80.7%). Patients with higher mFI exhibited lower functional recovery, defined by efficiency on the motor-FIM score, and tended to run into complications and not return home (P < .001). In multiple logistic regression analyses, higher mFI was significantly associated with increased likelihood of lower functional recovery (odds ratio [OR], 1.60; 95% CI, 1.32-1.93; P < .001), occurrence of postoperative complication (OR, 1.32; 95% CI, 1.13-1.54; P < .001) and not returning home (OR, 1.77; 95% CI, 1.38-2.26; P < .001). CONCLUSIONS Frailty defined by 19-item mFI can predict short-term functional recovery during acute phase following hip fracture. Frailty is also associated with postoperative complication and discharge disposition.
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Neuerburg C, Förch S, Gleich J, Böcker W, Gosch M, Kammerlander C, Mayr E. Improved outcome in hip fracture patients in the aging population following co-managed care compared to conventional surgical treatment: a retrospective, dual-center cohort study. BMC Geriatr 2019; 19:330. [PMID: 31775659 PMCID: PMC6880371 DOI: 10.1186/s12877-019-1289-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 09/23/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hip fracture patients in the aging population frequently present with various comorbidities, whilst preservation of independency and activities of daily living can be challenging. Thus, an interdisciplinary orthogeriatric treatment of these patients has recognized a growing acceptance in the last years. As there is still limited data on the impact of this approach, the present study aimed to evaluate the long-term outcome in elderly hip fracture patients, by comparing the treatment of a hospital with integrated orthogeriatric care (OGC) with a conventional trauma care (CTC). METHODS We conducted a retrospective, two-center, cohort study. In two maximum care hospitals all patients presenting with a hip fracture at the age of ≥ 70 years were consecutively assigned within a 1 year period and underwent follow-up examination 12 months after surgery. Patients treated in hospital site A were treated with an interdisciplinary orthogeriatric approach (co-managed care), patients treated in hospital B underwent conventional trauma care. Main outcome parameters were 1 year mortality, readmission rate, requirement of care (RC) and personal activities of daily living (ADL). RESULTS A total of 436 patients were included (219 with OGC / 217 with CTC). The mean age was 83.55 (66-99) years for OGC and 83.50 (70-103) years for CTC (76.7 and 75.6% of the patients respectively were female). One year mortality rates were 22.8% (OGC) and 28.1% (CTC; p = 0.029), readmission rates were 25.7% for OGC compared to 39.7% for CTC (p = 0.014). Inconsistent data were found for activities of daily living. After 1 year, 7.8% (OGC) and 13.8% (CTC) of the patients were lost to follow-up. CONCLUSIONS Interdisciplinary orthogeriatric management revealed encouraging impact on the long-term outcome of hip fracture patients in the aging population. The observed reduction of mortality, requirements of care and readmission rates to hospital clearly support the health-economic impact of an interdisciplinary orthogeriatric care on specialized wards. TRIAL REGISTRATION The study was approved and registered by the bavarian medical council (BLAEK: 7/11192) and the local ethics committee of munich university (Reg. No. 234-16) and was conducted as a two-center, cohort study at a hospital with integrated orthogeriatric care and a hospital with conventional trauma care.
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Affiliation(s)
- Carl Neuerburg
- Department of General, Trauma and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, D-81377, Munich, Germany.
| | - Stefan Förch
- Department of Trauma, Orthopedic, Hand and Reconstructive surgery, University Hospital Augsburg, Augsburg, Germany
| | - Johannes Gleich
- Department of General, Trauma and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, D-81377, Munich, Germany
| | - Wolfgang Böcker
- Department of General, Trauma and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, D-81377, Munich, Germany
| | - Markus Gosch
- Department of Medicine 2/Geriatrics, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Christian Kammerlander
- Department of General, Trauma and Reconstructive Surgery, University Hospital Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, D-81377, Munich, Germany
| | - Edgar Mayr
- Department of Trauma, Orthopedic, Hand and Reconstructive surgery, University Hospital Augsburg, Augsburg, Germany
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Xu BY, Yan S, Low LL, Vasanwala FF, Low SG. Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review. BMC Musculoskelet Disord 2019; 20:568. [PMID: 31775693 PMCID: PMC6882152 DOI: 10.1186/s12891-019-2950-0] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/14/2019] [Indexed: 12/17/2022] Open
Abstract
Background Hip fracture is an important and prevalent medical condition associated with adverse outcomes. The aim of this article is to systematically review and summarise the predictors of poor functional outcomes and mortality for patients with hip fractures. Methods We conducted a systemic literature search using PubMed, EMBASE and Cochrane Library. We included English peer-reviewed cohort studies that examined predictors of poor functional outcomes (such as independence in Activities of Daily Living) and mortality for patients with hip fracture published in the past 15 years (from 1 Jan 2004 up to 30 May 2019). Two independent researchers evaluated the articles for eligibility. Consensus on the eligibility was sought and a third researcher was involved if there was disagreement. A standardised form was used to extract relevant data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Results We retrieved 4339 and included 81 articles. We identified two emerging predictors of poor functional outcomes and mortality for patients with hip fractures: low hand grip strength and frailty in line with an emerging concept of “physical performance”. The predictors identified in this systematic review can be grouped into 1) medical factors, such as presence of co-morbidities, high American Society of Anesthesiologists (ASA) grade, sarcopenia, 2) surgical factors including delay in operation (e.g. > 48 h), type of fracture s, 3) socio-economic factors which include age, gender, ethnicity, and 4) system factors including lower case-volume centers. Conclusions This systematic review identified multiple significant predictors of poor functional outcomes and mortality, with the hand grip strength and frailty being important emerging predictors in the most recent literature. These predictors would further inform healthcare providers of their patients’ health status and allow for early intervention for modifiable predictors.
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Affiliation(s)
- Bang Yu Xu
- Department of Post Acute and Continuity Care, SingHealth Community Hospital - Sengkang, 1 Anchorvale St, Singapore, 544835, Singapore.
| | - Shi Yan
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Lian Leng Low
- Department of Family Med & Continuing Care, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Farhad Fakhrudin Vasanwala
- Department of Post Acute and Continuity Care, SingHealth Community Hospital - Sengkang, 1 Anchorvale St, Singapore, 544835, Singapore
| | - Sher Guan Low
- Department of Post Acute and Continuity Care, SingHealth Community Hospital - Sengkang, 1 Anchorvale St, Singapore, 544835, Singapore
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Sawa Y, Kayashita J, Nikawa H. Occlusal support is associated with nutritional improvement and recovery of physical function in patients recovering from hip fracture. Gerodontology 2019; 37:59-65. [PMID: 31749289 DOI: 10.1111/ger.12446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/26/2019] [Accepted: 10/30/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study aimed to elucidate the association between occlusal support and nutritional improvement and recovery of activities of daily living (ADLs) among elderly patients recovering from hip fracture. BACKGROUND Many patients with hip fracture are malnourished, and malnutrition is associated with poor functional outcomes. Poor oral status is one reason for malnutrition because loss of occlusal support leads to masticatory disorders and can cause nutrient deficiencies. METHODS We evaluated 202 elderly patients aged 65 years and older (mean age, 84.9 ± 7.9 years). We assessed nutritional status using the Mini Nutritional Assessment-Short Form and ADLs using functional independence measure (FIM) scores. Occlusal support was recorded in accordance with the Eichner Index. We categorised participants into two groups according to the presence or absence of occlusal support, and statistical analyses were performed to investigate the differences between the groups. RESULTS One group contained 152 participants (mean age, 85.5 ± 7.4 years) with occlusal support, and the other group contained 50 participants (mean age, 83.0 ± 8.9 years) without occlusal support. The group with occlusal support had greater gain of FIM and higher FIM efficiency than did the other group. Multivariate analyses showed that occlusal support was independently associated with nutritional improvement [odds ratio (OR) = 4.00, 95% confidence intervals (CI) = 1.90-8.43] and motor FIM efficiency (R2 = .338, P < .001). CONCLUSIONS Our findings suggest that occlusal support is associated with nutritional improvement and the recovery of ADLs in patients recovering from hip fracture.
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Affiliation(s)
- Yukiko Sawa
- Department of Nutrition and Dietetics, Kashima Hospital, Matsue, Japan.,Department of Oral Biology and Engineering, Integrated Health Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Hiroki Nikawa
- Department of Oral Biology and Engineering, Integrated Health Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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[Impact of a centralised hospital admission system on the efficacy and efficiency of a geriatric functional recovery unit]. Rev Esp Geriatr Gerontol 2019; 55:18-24. [PMID: 31594677 DOI: 10.1016/j.regg.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/29/2019] [Accepted: 08/02/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the influence of a change in the management of admissions on the activity and care outcomes of a Geriatric Functional Recovery Unit (GFRU). MATERIAL AND METHODS A retrospective observational study was conducted. Since 2000, the Hospital Central Cruz Roja GFRU has been collecting data grouped into periods of 4 years, except for the centralised admissions (September 2016-December 2018). The data collected on admission included the Red Cross Functional and Mental scales, the Barthel index, the main diagnosis of the functional decline (grouped into stroke, orthopaedic problem, and multifactorial immobility episodes), and comorbidity evaluated by the Charlson index. The following outcome variables were analysed: the overall and relative functional gain at discharge; length of hospital stay; the functional efficiency, discharges to nursing homes, and transfers to acute care units. An analysis was made of the relationship between the admissions from the centralised unit and the previous period (directly admission managed by GFRU), using multivariate analysis (linear regression for continuous outcome variables and logistic regression for the dichotomous ones), adjusted for admission variables. RESULTS Patients admitted from the centralised unit showed a greater overall and relative functional gain (difference between both means: 3.49 points, 95% CI; 1.65-5.33, and 12.41%, 95% CI; 0.74-24.08, respectively), longer stay (12.92 days, 95% CI; 11.54-14.30) and lower efficiency (-0.36, 95% CI; -0.16 to -0.57), higher risk of institutionalisation (OR 1.61, 95% CI; 1.19-2.16), and transfers to acute care units (OR 3.16, 95% CI; 2.24-4.47). CONCLUSIONS A centralised admissions system had an influence on the improvement of functional parameters in the patients, but with a longer length of hospital stay, and lower efficiency. Increases in institutionalisation at discharge and transfers to acute care units were also observed.
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Factors Associated with Sarcopenia and 7-Year Mortality in Very Old Patients with Hip Fracture Admitted to Rehabilitation Units: A Pragmatic Study. Nutrients 2019; 11:nu11092243. [PMID: 31540409 PMCID: PMC6770746 DOI: 10.3390/nu11092243] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Admitted bedridden older patients are at risk of the development of sarcopenia during hospital stay (incident sarcopenia). The objective of this study was to assess the factors associated with sarcopenia (incident and chronic) and its impact on mortality in older people with hip fracture. Methods: A multicenter, pragmatic, prospective observational study was designed. Older subjects with hip fracture admitted to two rehabilitation units were included. Sarcopenia was assessed at admission and at discharge according to the revised EWGSOP (European Working Group on Sarcopenia in Older People) consensus definition. The mortality was evaluated after 7 years of follow-up. Results: A total of 187 subjects (73.8% women) age 85.2 ± 6.3 years were included. Risk factors associated to incident and chronic sarcopenia were undernutrition (body mass index—BMI and Mini Nutritional Assessment−Short Form—MNA-SF), hand-grip strength and skeletal muscle index. During follow-up 114 patients died (60.5% sarcopenic vs. 39.5% non-sarcopenic, p = 0.001). Cox regression analyses showed that factors associated to increased risk of mortality were sarcopenia (HR: 1.67, 95% CI 1.11–2.51) and low hand-grip strength (HR: 1.76, 95% CI 1.08–2.88). Conclusions: Older patients with undernutrition have a higher risk of developing sarcopenia during hospital stay, and sarcopenic patients have almost two times more risk of mortality than non-sarcopenic patients during follow-up after hip fracture.
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Cognitive impairment and postoperative outcomes in patients undergoing primary total hip arthroplasty: A systematic review. J Clin Anesth 2019; 56:65-76. [DOI: 10.1016/j.jclinane.2019.01.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/12/2019] [Accepted: 01/18/2019] [Indexed: 12/11/2022]
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Cao SJ, Chen D, Yang L, Zhu T. Effects of an abnormal mini-mental state examination score on postoperative outcomes in geriatric surgical patients: a meta-analysis. BMC Anesthesiol 2019; 19:74. [PMID: 31092206 PMCID: PMC6521510 DOI: 10.1186/s12871-019-0735-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 04/18/2019] [Indexed: 02/05/2023] Open
Abstract
Background Perioperative cognitive impairment (CI) following surgeries is prevalent in geriatric surgical population aged 60 and older. This meta-analysis was designed to investigate whether the Mini-Mental State Examination (MMSE) has prognostic value on adverse outcomes in aged surgical patients. Methods PubMed, Cochrane, Embase and Medline through the Ovid were searched. Meta-analyses were carried out for CI versus non-cognitive impairment (NCI). Quality of evidence was assessed by the GRADE approach. Results One randomized controlled trial, two retrospective cohort trials, and 18 prospective cohort trials were included in the meta-analysis. Perioperative diagnosis of CI by the MMSE had higher rates of patients suffering from postoperative delirium (POD) [odd ratio (OR) 5.02, 95% confidence interval (CI) 3.27, 7.71, P < 0.00001], in-hospital mortality (OR 7.51, 95% CI 2.17, 26.02, P = 0.001), mortality within 1 year (OR 2.53, 95% CI 1.95,3.29, P < 0.00001). Postoperative CI patients had no extended length of stay in orthopedic [standardized mean difference (SMD) -0.10, 95% CI -0.20, 0.17, P = 0.91)] nor rehabilitation wards ((SMD, 0.04; 95% CI, − 0.23 to 0.31; P = 0.78). Conclusion Older patients with perioperative CI were more likely to suffer from POD and mortality. The MMSE showed certain value on risk stratification and prognosis evaluation in geriatric surgical population. Trial registration PROSPERO CRD42018108739. Electronic supplementary material The online version of this article (10.1186/s12871-019-0735-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shuang-Jiao Cao
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Dongxu- Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Lei Yang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
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Ouellet JA, Ouellet GM, Romegialli AM, Hirsch M, Berardi L, Ramsey CM, Cooney LM, Walke LM. Functional Outcomes After Hip Fracture in Independent Community-Dwelling Patients. J Am Geriatr Soc 2019; 67:1386-1392. [PMID: 30964203 DOI: 10.1111/jgs.15870] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To determine predictors of new activities of daily living (ADLs) disability and worsened mobility disability and secondarily increased daily care hours received, in previously independent hip fracture patients. DESIGN Retrospective cohort study. SETTING Academic hospital with ambulatory follow-up. PARTICIPANTS Community-dwelling adults 65 years or older independent in ADLs undergoing hip fracture surgery in 2015 (n = 184). MEASUREMENTS Baseline, 3- and 6-month ADLs, mobility, and daily care hours received were ascertained by telephone survey and chart review. Comorbidities, medications, and characteristics of hospitalization were extracted from patient charts. Models for each outcome used logistic regression with a backward elimination strategy, adjusting a priori for age, sex, and race. RESULTS Predictors of new ADL disability at 3 months were dementia (odds ratio [OR] = 11.81; P = .001) and in-hospital delirium (OR = 4.20; P = .002), and at 6 months were age (OR = 1.04; P = .014), dementia (OR = 9.91; P = .001), in-hospital delirium (OR = 3.00; P = .031) and preadmission opiates (OR = 7.72; P = .003). Predictors of worsened mobility at 3 months were in-hospital delirium (OR = 4.48; P = .001) and number of medications (OR = 1.13; P = .003), and at 6 months were age (OR = 1.06; P = .001), preadmission opiates (OR = 7.23; P = .005), in-hospital delirium (OR = 3.10; P = .019), and number of medications (OR = 1.13; P = .013). Predictors of increased daily care hours received at 3 and 6 months were age (3 months: OR = 1.07; P = .014; 6 months: OR = 1.06; P = .017) and number of medications (3 months: OR = 1.13; P = .004; 6 months: OR = 1.22; P = .013). The proportion of patients with ADL disability and care hours received did not change from 3 to 6 months, yet there were significant improvements in mobility. CONCLUSION Age, dementia, in-hospital delirium, number of medications, and preadmission opiate use were predictors of poor outcomes in independent older adults following hip fracture. Further investigation is needed to identify factors associated with improved mobility measures from 3 to 6 months to ultimately optimize recovery.
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Affiliation(s)
| | - Gregory M Ouellet
- Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut
| | | | | | - Lisa Berardi
- Yale New Haven Health System, New Haven, Connecticut
| | - Christine M Ramsey
- Yale School of Medicine, Yale Center for Medical Informatics, New Haven, Connecticut.,Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Leo M Cooney
- Section of Geriatrics, Yale School of Medicine, New Haven, Connecticut
| | - Lisa M Walke
- Division of Geriatrics, University of Pennsylvania, Philadelphia, Pennsylvania
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Morandi A, Mazzone A, Bernardini B, Suardi T, Prina R, Pozzi C, Gentile S, Trabucchi M, Bellelli G. Association between delirium, adverse clinical events and functional outcomes in older patients admitted to rehabilitation settings after a hip fracture: A multicenter retrospective cohort study. Geriatr Gerontol Int 2019; 19:404-408. [DOI: 10.1111/ggi.13628] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 12/24/2018] [Accepted: 01/10/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Alessandro Morandi
- Department of Rehabilitation and Aged Care; “Fondazione Camplani” Hospital; Cremona Italy
- Geriatric Research Group; Brescia Italy
| | - Andrea Mazzone
- Department of Rehabilitation, Redaelli Geriatric Institute; Milan Italy
| | - Bruno Bernardini
- Department of Neurorehabilitation; IRCCS Humanitas Research Hospital; Milan Italy
| | - Teresa Suardi
- Department of Rehabilitation, Redaelli Geriatric Institute; Milan Italy
| | - Roberto Prina
- Department of Rehabilitation, Redaelli Geriatric Institute; Vimodrone Italy
| | - Christian Pozzi
- University of Applied Sciences and Arts of Southern Switzerland (SUPSI); Manno Switzerland
| | - Simona Gentile
- Department of Rehabilitation and Aged Care; “Fondazione Camplani” Hospital; Cremona Italy
- Geriatric Research Group; Brescia Italy
| | - Marco Trabucchi
- Department of Rehabilitation, University of Tor Vergata; Rome Italy
| | - Giuseppe Bellelli
- Department of Rehabilitation, School of Medicine and Surgery; University of Milano-Bicocca, Acute Geriatric Unit, S. Gerardo Hospital; Monza Italy
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Sheehan KJ, Williamson L, Alexander J, Filliter C, Sobolev B, Guy P, Bearne LM, Sackley C. Prognostic factors of functional outcome after hip fracture surgery: a systematic review. Age Ageing 2018; 47:661-670. [PMID: 29668839 DOI: 10.1093/ageing/afy057] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Indexed: 11/13/2022] Open
Abstract
Objective this systematic review aimed to identify immutable and modifiable prognostic factors of functional outcomes and their proposed mechanism after hip fracture surgery. Design systematic search of MEDLINE, Embase, CINAHL, PEDRO, OpenGrey and ClinicalTrials.gov for observational studies of prognostic factors of functional outcome after hip fracture among surgically treated adults with mean age of 65 years and older. Study selection, quality assessment, and data extraction were completed independently by two reviewers. The Quality in Prognosis Studies Tool was used for quality assessment and assigning a level of evidence to factors. Proposed mechanisms for reported associations were extracted from discussion sections. Results from 33 studies of 9,552 patients, we identified 25 prognostic factors of functional outcome after hip fracture surgery. We organised factors into groups: demographics, injury and comorbidities, body composition, complications, and acute care. We assigned two factors a weak evidence level-anaemia and cognition. We assigned Parkinson's disease an inconclusive evidence level. We could not assign an evidence level to the remaining 22 factors due to the high risk of bias across studies. Frailty was the proposed mechanism for the association between anaemia and functional outcome. Medication management, perceived potential, complications and time to mobility were proposed as mechanisms for the association between cognition and functional outcome. Conclusion we identified one modifiable and one immutable prognostic factor for functional outcomes after hip fracture surgery. Future research may target patients with anaemia or cognitive impairment by intervening on the prognostic factor or the underlying mechanisms.
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Affiliation(s)
- K J Sheehan
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - L Williamson
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - J Alexander
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - C Filliter
- Department of Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada
| | - B Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - P Guy
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada
| | - L M Bearne
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population Health & Environmental Sciences, Kings College London, London, UK
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Auais M, French SD, Beaupre L, Giangregorio L, Magaziner J. Identifying research priorities around psycho-cognitive and social factors for recovery from hip fractures: An international decision-making process. Injury 2018; 49:1466-1472. [PMID: 29739655 DOI: 10.1016/j.injury.2018.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/16/2018] [Indexed: 02/02/2023]
Abstract
UNLABELLED Hip fractures rank in the top ten disabling conditions worldwide. With an ageing population, this public health problem is expected to increase. Despite the success of surgery for hip fractures and the extensive health services utilisation, health outcomes are often poor. Considering the recovery process as multifactorial and intervening to address all relevant factors may improve recovery rates. However, we need first to fully understand the factors contributing to recovery after hip fractures, including psycho-cognitive and social factors. The purpose of this study was to identify future research priorities for understanding the role of psycho-cognitive and social factors in the recovery process for community-dwelling older adults after hip fracture and to survey world experts to confirm the identified priorities. METHODS This was a two-stage process. First, a workshop of international experts in hip fracture care (researchers and clinician-scientists) was held in 2016 in Montreal, Quebec, Canada. Using Nominal Group Technique accompanied by Multi-voting Technique, workshop attendees identified the most important future research areas for psycho-cognitive and social factors contributing to recovery after hip fractures. Second, an online survey of the International Fragility Fracture Network (FFN), which includes researchers and clinicians interested in fragility fractures, followed the meeting. The survey respondents reviewed and added to priorities from the first stage and then ranked the top priorities. RESULTS Twenty-three experts participated in the meeting (from five countries) and 152 participants (from 29 countries) responded to the survey. Top priorities for the psycho-cognitive domain were preventing and treating in-hospital delirium; comparing the effectiveness of targeted versus multifactorial interventions; studying interactions between psycho-cognitive, social, and environmental factors in the recovery process; and modifying the environment to enhance patients' cognitive reserves. Top priorities for the social domain were understanding the role of social factors in the recovery process; understanding patients' perspectives on important social factors; identifying components of social support relevant to recovery; understanding attitudes towards patients with hip fractures among all stakeholders; and understanding the social support needs for caregivers. CONCLUSION A set of future research priorities to understand the role of psycho-cognitive and social factors has been developed and confirmed through a rigorous international decision-making process. These priorities offer valuable guidance for researchers, scientific bodies, and funding agencies.
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Affiliation(s)
- Mohammad Auais
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.
| | - Simon D French
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada; Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | - Lauren Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Jay Magaziner
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, USA
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Rehabilitation strategy for hip fracture, focused on behavioral psychological symptoms of dementia for older people with cognitive impairment: A nationwide Japan rehabilitation database. PLoS One 2018; 13:e0200143. [PMID: 29975757 PMCID: PMC6033436 DOI: 10.1371/journal.pone.0200143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/20/2018] [Indexed: 11/25/2022] Open
Abstract
The aim is to investigate the relationship between a positive outcome on rehabilitation after hip fracture and behavioral psychological symptoms of dementia (BPSD) transition during rehabilitation. This study is a retrospective cohort study based on the Japan Rehabilitation Database. We recruited 756 subjects 65 years of age or older from 31 hospitals in the database. All subjects were in the hospital as patients undergoing rehabilitation for hip fracture. Functional independence measure (FIM), walking ability, Mini-Mental State Examination (MMSE), and BPSD were measured both at the beginning and at the end of rehabilitation. MMSE for 23 or under was defined as the cognitive-impaired group. MMSE for 24 or over was used as the cognitively intact group. Cognitive impaired participants were divided into four groups: participants presented no BPSD both at the beginning of rehabilitation and at the end of rehabilitation (Group (-/-)), participants presented BPSD at the beginning of rehabilitation but resolved at the end of rehabilitation (Group (+/-)), participants had no BPSD at the beginning of rehabilitation but appeared at the end of rehabilitation (Group (-/+)) and participants had sign of BPSD both at the beginning of rehabilitation and at the end of rehabilitation (Group (+/+)). The endpoints were waking ability, FIM gain. As results, one hundred thirty-seven cognitive-impaired older people patients out of 471 (29.1%) suffered from BPSD at the beginning of rehabilitation. FIM gains in cognitively intact group, Group (-/-), Group (+/-), Group (-/+) and Group (+/+) were 24.8 ± 18.7, 17.5 ± 16.9, 27.3 ± 19.7, 17.8 ± 12.2 and 12.2 ± 17.2, respectively. The Group (+/-) was significantly connected to a positive outcome for rehabilitation. The present study suggested that the management of BPSD can lead to better functional recovery during rehabilitation.
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Nutritional Status and Nutritional Treatment Are Related to Outcomes and Mortality in Older Adults with Hip Fracture. Nutrients 2018; 10:nu10050555. [PMID: 29710860 PMCID: PMC5986435 DOI: 10.3390/nu10050555] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/09/2018] [Accepted: 04/25/2018] [Indexed: 01/16/2023] Open
Abstract
Malnutrition is very prevalent in geriatric patients with hip fracture. Nevertheless, its importance is not fully recognized. The objective of this paper is to review the impact of malnutrition and of nutritional treatment upon outcomes and mortality in older people with hip fracture. We searched the PubMed database for studies evaluating nutritional aspects in people aged 70 years and over with hip fracture. The total number of studies included in the review was 44, which analyzed 26,281 subjects (73.5% women, 83.6 ± 7.2 years old). Older people with hip fracture presented an inadequate nutrient intake for their requirements, which caused deterioration in their already compromised nutritional status. The prevalence of malnutrition was approximately 18.7% using the Mini-Nutritional Assessment (MNA) (large or short form) as a diagnostic tool, but the prevalence was greater (45.7%) if different criteria were used (such as Body Mass Index (BMI), weight loss, or albumin concentration). Low scores in anthropometric indices were associated with a higher prevalence of complications during hospitalization and with a worse functional recovery. Despite improvements in the treatment of geriatric patients with hip fracture, mortality was still unacceptably high (30% within 1 year and up to 40% within 3 years). Malnutrition was associated with an increase in mortality. Nutritional intervention was cost effective and was associated with an improvement in nutritional status and a greater functional recovery. To conclude, in older people, the prevention of malnutrition and an early nutritional intervention can improve recovery following a hip fracture.
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Beunza-Sola M, Hidalgo-Ovejero ÁM, Martí-Ayerdi J, Sánchez-Hernández JG, Menéndez-García M, García-Mata S. Study of fall risk-increasing drugs in elderly patients before and after a bone fracture. Postgrad Med J 2017; 94:76-80. [PMID: 28916557 DOI: 10.1136/postgradmedj-2017-135129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/26/2017] [Accepted: 08/03/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Accidental falls have a significant economic and human impact. The use of certain drugs is one of the modifiable risk factors associated with these events. OBJECTIVE The aim of this study was to determine the prevalence of use and to explore changes in treatment with fall-related drugs in patients over 65 years of age admitted as a result of a fall-related fracture. METHODS Observational and prospective study performed in a tertiary level hospital. A list of fall risk-increasing drugs (FRIDs) was drawn up. The main study variables were number and type of FRIDs prescribed at admission and 1 month after the fracture and number, type, treating physician and place where changes in FRIDs were implemented. RESULTS In total, 252 patients were included. At admission, 91.3% were receiving at least one FRID, mean daily use was 3.1 FRIDs and the most frequently prescribed FRIDs were diuretics (18%), renin-angiotensin system-acting agents (15.8%) and antidepressants (15%). One month later, mean daily use was 3.4 FRIDs (p=0.099) and a significant increase was detected in the use of hypnotics (p=0.003) and antidepressants (p=0.042). A total of 327 changes in treatment were recorded (1.3 changes/patient). Of the changes, 52.6% were new prescriptions, 72.2% occurred at discharge and 56.6% were ordered by a geriatrician. CONCLUSIONS The use of FRIDs among patients with a fall-related fracture is very high. This use rises 1 month after the fracture, significantly in the case of hypnotics and antidepressants.
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Affiliation(s)
| | - Ángel M Hidalgo-Ovejero
- Department of Orthopaedic Surgery and Traumatology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Jon Martí-Ayerdi
- Department of Orthopaedic Surgery and Traumatology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | - Miguel Menéndez-García
- Department of Orthopaedic Surgery and Traumatology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Serafín García-Mata
- Department of Orthopaedic Surgery and Traumatology, Complejo Hospitalario de Navarra, Pamplona, Spain
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Magny E, Vallet H, Cohen-Bittan J, Raux M, Meziere A, Verny M, Riou B, Khiami F, Boddaert J. Pressure ulcers are associated with 6-month mortality in elderly patients with hip fracture managed in orthogeriatric care pathway. Arch Osteoporos 2017; 12:77. [PMID: 28852954 DOI: 10.1007/s11657-017-0365-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/27/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Despite orthogeriatric management, 12% of the elderly experienced PUs after hip fracture surgery. PUs were significantly associated with a low albumin level, history of atrial fibrillation coronary artery disease, and diabetes. The risk ratio of death at 6 months associated with pressure ulcer was 2.38 (95% CI 1.31-4.32%, p = 0.044). INTRODUCTION Pressure ulcers in hip fracture patients are frequent and associated with a poor outcome. An orthogeriatric management, recommended by international guidelines in hip fracture patients and including pressure ulcer prevention and treatment, could influence causes and consequences of pressure ulcer. However, remaining factors associated with pressure ulcer occurrence and prognostic value of pressure ulcer in hip fracture patients managed in an orthogeriatric care pathway remain unknown. METHODS From June 2009 to April 2015, all consecutive patients with hip fracture admitted to a unit for Post-operative geriatric care were evaluated for eligibility. Patients were included if their primary presentation was due to hip fracture and if they were ≥ 70 years of age. Patients were excluded in the presence of pathological fracture or if they were already hospitalized at the time of the fracture. In our unit, orthogeriatric principles are implemented, including a multi-component intervention to improve pressure ulcer prevention and management. Patients were followed-up until 6 months after discharge. RESULTS Five hundred sixty-seven patients were included, with an overall 14.4% 6-month mortality (95% CI 11.6-17.8%). Of these, 67 patients (12%) experienced at least one pressure ulcer. Despite orthogeriatric management, pressure ulcers were significantly associated with a low albumin level (RR 0.90, 95% CI 0.84-0.96; p = 0.003) and history of atrial fibrillation (RR 1.91, 95% CI 1.05-3.46; p = 0.033), coronary artery disease (RR 2.16, 95% CI 1.17-3.99; p = 0.014), and diabetes (RR 2.33, 95% CI 1.14-4.75; p = 0.02). A pressure ulcer was associated with 6-month mortality (RR 2.38, 95% CI 1.31-4.32, p = 0.044). CONCLUSION In elderly patients with hip fracture managed in an orthogeriatric care pathway, pressure ulcer remained associated with poorly modifiable risk factors and long-term mortality.
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Affiliation(s)
- Emmanuelle Magny
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
| | - Helene Vallet
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
| | - Judith Cohen-Bittan
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
| | - Mathieu Raux
- Department of Anesthesiology and Critical Care, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France
| | - Antony Meziere
- Department of Rehabilitation, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
| | - Marc Verny
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France
| | - Bruno Riou
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France
- Department of Emergency Medicine and Surgery, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
| | - Frédéric Khiami
- Department of Orthopedic Surgery and Trauma, Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, Ivry sur Seine, France
| | - Jacques Boddaert
- Department of Geriatrics, Unit of Perioperative Geriatric care (UPOG), Groupe Hospitalier (GH) Pitié-Salpêtrière - Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), 47-83 Boulevard de l'Hôpital, 75013, Paris, Ivry sur Seine, France.
- Sorbonne Universités UPMC Univ Paris 06, DHU FAST, UMRS INSERM 1166, IHU ICAN, UMRS INSERM 1158, CNRS UMR 8256, Paris, France.
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Malafarina V, Uriz-Otano F, Malafarina C, Martinez JA, Zulet MA. Effectiveness of nutritional supplementation on sarcopenia and recovery in hip fracture patients. A multi-centre randomized trial. Maturitas 2017; 101:42-50. [PMID: 28539168 DOI: 10.1016/j.maturitas.2017.04.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 04/18/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Functional deterioration and reduced mobility in elderly patients with a hip fracture are associated with a loss of both muscle mass and function (sarcopenia). The aim of this study was to assess whether oral nutritional supplementation (ONS) improves muscle mass and nutritional markers (BMI, proteins) in elderly patients with hip fracture. METHODS Patients aged 65 years and over with hip fractures admitted to either of two rehabilitation facilities were included. Patients with diabetes, with Barthel index scores <40 prior to the fracture or with pathological fractures were excluded. A random-numbers generator was used to randomly allocate patients to the intervention group (IG) or the control group (CG). Those in the IG received a standard diet plus ONS in the form of two bottles a day of β-hydroxy-β-methylbutyrate (HMB), while those in the CG received a standard diet only. The intervention was not blinded. In order to assess changes in body mass index (BMI), anthropometric parameters were recorded at both admission and discharge. Patients' functional situation was evaluated using the Barthel index (BI) and the Functional Ambulation Categories (FAC) score. Muscle mass was assessed using bioelectrical impedance analysis, which allowed us to calculate appendicular lean mass (aLM). The outcome variable was the difference between aLM upon discharge, minus aLM upon admission (Δ-aLM). RESULTS Of the 107 randomised patients (IG n55, CG n52), 49 finished the study in the IG and 43 in the CG. BMI and aLM were stable in IG patients, whilst these parametres decreased in the CG. A significant difference was observed between the two groups (p<0.001, and p=0.020 respectively). The predictive factors for Δ-aLM were ONS (p=0.006), FAC prior to fracture (p<0.001) and BI prior to fracture (p=0.007). The concentration of proteins (p=0.007) and vitamin D (p.001) had increased more in the IG than in the CG. CONCLUSION A diet enriched in HMB improves muscle mass, prevents the onset of sarcopenia and is associated with functional improvement in elderly patients with hip fractures. Orally administered nutritional supplements can help to prevent the onset of sarcopenic obesity. TRIAL REGISTRATION www.clinicaltrials.gov identifier: NCT01404195, registered 22 July 2011, HYPERPROT-GER Study.
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Affiliation(s)
- Vincenzo Malafarina
- Department of Nutrition, Food Science and Physiology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain; Department of Geriatrics, Complejo Hospitalario de Navarra, Pamplona, Spain.
| | | | | | - J Alfredo Martinez
- Department of Nutrition, Food Science and Physiology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain; CIBERobn, Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain; Centre for Nutrition Research, Faculty of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - M Angeles Zulet
- Department of Nutrition, Food Science and Physiology, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain; CIBERobn, Physiopathology of Obesity and Nutrition, Instituto de Salud Carlos III, Madrid, Spain; Centre for Nutrition Research, Faculty of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
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Influence of Cognitive Impairment on Mobility Recovery of Patients With Hip Fracture. Am J Phys Med Rehabil 2017; 96:109-115. [DOI: 10.1097/phm.0000000000000550] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Hall AJ, Lang IA, Endacott R, Hall A, Goodwin VA. Physiotherapy interventions for people with dementia and a hip fracture-a scoping review of the literature. Physiotherapy 2017; 103:361-368. [PMID: 28843451 DOI: 10.1016/j.physio.2017.01.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 01/17/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND People with dementia are 2.7 times more likely to suffer a hip fracture than those without and their management is estimated to cost £0.92 billion per year. Yet there has been little focus on the effectiveness of interventions for this population. OBJECTIVE The aim of this scoping review was to summarise the current available evidence for physiotherapy interventions for people with dementia who fracture their hip as well as to identify gaps in the literature that may require further research. DATA SOURCES A systematic search of the following databases was undertaken-TRIP, CINAHL, Amed, Embase, PEDro, PsycINFO, Cochrane Library, Open Grey, Ethos, ISRCTN, Proquest, PROSPERO and UK Clinical Trials Gateway. STUDY SELECTION Articles were included if they described an intervention which is considered within the scope of a physiotherapist and targeted those with both a hip fracture and dementia. SYNTHESIS METHODS A narrative summary was then undertaken to describe the current state of the literature. RESULTS Twenty six studies were included, of which thirteen were observational, six RCTs, two qualitative, two surveys and three systematic reviews. Only nine studies focused explicitly on physiotherapy interventions. CONCLUSION The findings of this scoping review suggest there is limited evidence to guide physiotherapists in the management of people with dementia who fracture their hip. No evidence was found about perceptions or experiences of patients in this group or of the physiotherapists involved in their care. Further research is needed to develop and evaluate physiotherapy interventions for people with dementia who fracture their hip.
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Affiliation(s)
- A J Hall
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, United Kingdom.
| | - I A Lang
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, United Kingdom
| | - R Endacott
- Centre for Health and Social Care Innovation, Faculty of Health and Human Sciences, Plymouth University, United Kingdom
| | - A Hall
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, United Kingdom
| | - V A Goodwin
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter, United Kingdom
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Outcome parameters in orthogeriatric co‑management - a mini-review. Wien Klin Wochenschr 2016; 128:492-496. [PMID: 27858179 DOI: 10.1007/s00508-016-1118-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/19/2016] [Indexed: 01/14/2023]
Abstract
Recognizing hip and other fragility fractures as an adverse event of chronic geriatric conditions led to the concept of orthogeriatric co-management (OGC). OGC today represents various forms of structural cooperation between orthopedic trauma surgeons and multiprofessional geriatric teams taking care of frail elderly patients. The models are country specific. Despite several published models there are still no clear recommendations on how this service should be best organized. The 12 outcome parameters published by the Experts' Roundtable in 2013 were recommended to be used for the further assessment of different OCG models. This literature review was prepared accordingly and showed the need for further studies to determine the best OGC model and to define a uniform set of outcome parameters for use in future clinical studies.
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Pérez-Ros P, Martinez-Arnau FM, Malafarina V, Tarazona-Santabalbina FJ. A one-year proprioceptive exercise programme reduces the incidence of falls in community-dwelling elderly people: A before-after non-randomised intervention study. Maturitas 2016; 94:155-160. [PMID: 27823737 DOI: 10.1016/j.maturitas.2016.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/12/2016] [Accepted: 09/09/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND The risk of falls increases with age. Balance alteration and polypharmacy are independent contributors to an increased risk of falls. OBJECTIVE The primary aim was to assess whether a proprioceptive exercise programme reduces the incidence of falls. A secondary aim was to assess the association between drugs and falls. DESIGN This was a before-after non-randomised intervention study. PARTICIPANTS The study recruited independent and cognitively intact community-dwelling people aged over 69 years, from December 2012 to May 2014. METHODS The intervention was done by a nurse and consisted of a monthly supervised group session of proprioceptive training for 1 year, supplemented by a home diary exercise. Daily medication was reviewed. RESULTS We included 572 subjects (63.3% women), mean age 76.1±3.9 years. The mean number of drugs prescribed at the start of the study was 4.7±3.0and 353 of the participants (61.7%) were taking four or more drugs a day. The elderly who fell were more dependent in their activities of daily living (Barthel index), and their balance was worse (determined using the Tinetti scale), as were their results on a cognitive scale (the MEC). After the intervention, an increase in self-perceived quality of life (EQ5D) was reported. The incidence of falls was reduced from 37.5% in the 12 months prior to the intervention to 25.7% in the 12 months after the intervention. During the follow-up, beta-blocker use was associated with an increased incidence of falls (OR=2.05; 95%IC: 1.24-3.39; p=0.005). In contrast, antiplatelet/anticoagulation drugs were associated with a lower risk of falls (OR=0.7; 95%IC: 0.55-0.88; p=0.003). CONCLUSIONS The proprioceptive exercise programme reduced the incidence of falls in community-dwelling older people. Multiple drug use was an independent predictor of an increased risk of falls, and specific drug groups were associated with falls.
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Affiliation(s)
- Pilar Pérez-Ros
- Nursing Faculty, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.
| | - Francisco M Martinez-Arnau
- Nursing Faculty, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain; Department of Physiotherapy, Universitat de Valencia, Spain
| | - Vincenzo Malafarina
- Department of Geriatrics, Complejo Hospitalario de Navarra, Pamplona, Spain; Department of Nutrition, Food Science and Physiology, School of Pharmacy, Universidad de Navarra, Pamplona, Spain
| | - Francisco J Tarazona-Santabalbina
- Nursing Faculty, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain; Department of Geriatrics, Hospital Universitario de la Ribera, Valencia, Spain
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Uriz-Otano F, Pla-Vidal J, Tiberio-López G, Malafarina V. Factors associated to institutionalization and mortality over three years, in elderly people with a hip fracture—An observational study. Maturitas 2016; 89:9-15. [DOI: 10.1016/j.maturitas.2016.04.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 12/20/2022]
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Tarazona-Santabalbina FJ, Belenguer-Varea Á, Rovira E, Cuesta-Peredó D. Orthogeriatric care: improving patient outcomes. Clin Interv Aging 2016; 11:843-56. [PMID: 27445466 PMCID: PMC4928624 DOI: 10.2147/cia.s72436] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard.
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Affiliation(s)
- Francisco José Tarazona-Santabalbina
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
| | - Ángel Belenguer-Varea
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
| | - Eduardo Rovira
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
| | - David Cuesta-Peredó
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
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