1
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Pass B, Schoeneberg C. [Conservative fracture treatment in old people]. Z Gerontol Geriatr 2024; 57:321-329. [PMID: 38832983 DOI: 10.1007/s00391-024-02314-3] [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: 02/08/2024] [Accepted: 03/20/2024] [Indexed: 06/06/2024]
Abstract
The numbers of osteoporotic fractures will increase due to the demographic change, which particularly affects the proximal femur, pelvis, proximal humerus, wrist and vertebral column. Surgical treatment is superior to conservative treatment of proximal femoral fractures. Non-dislocated fractures of the wrist can also be treated with a plaster cast but studies suggest that the results in the first 12 months are better after surgical treatment. The situation is similar for fractures of the proximal humerus and non-dislocated fractures in particular can also be treated conservatively. A score and classification were recently developed for making decisions on the treatment of osteoporotic vertebral fractures. Fractures of the anterior and posterior pelvic ring can be treated conservatively with the patient under sufficient analgesia as long as there is no substantial dislocation. The highest priority in geriatric traumatology is fast remobilization.
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Affiliation(s)
- B Pass
- Klinik für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Deutschland
| | - C Schoeneberg
- Klinik für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Deutschland.
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2
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Grabmann C, Hussain I, Zeller A, Kirnaz S, Sullivan V, Sommer F. Early Postoperative Weight-Bearing Ability after Total Hip Arthroplasty versus Bipolar Hemiarthroplasty in Elderly Patients with Femoral Neck Fracture. J Clin Med 2024; 13:3128. [PMID: 38892839 PMCID: PMC11172539 DOI: 10.3390/jcm13113128] [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: 09/01/2023] [Revised: 10/29/2023] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Femoral neck fractures are among the most common types of fractures and particularly affect elderly patients. Two of the most common treatment strategies are total hip arthroplasty (THA) and bipolar hemiarthroplasty (BA). However, the role of the different treatment strategies in the postoperative weight-bearing ability in the early postoperative phase is still not entirely clear. Methods: Patients who underwent either THA or BA were consecutively included in our prospective cohort study. Gait analysis was performed during the early postoperative period. The gait analysis consisted of a walking distance of 40 m coupled with the turning movement in between. During the gait analysis, the duration of the measurement, the maximum peak force and the average peak force were recorded. Results: A total of 39 patients were included, 25 of whom underwent BA and 14 of whom underwent THA. The maximum peak force during the gait analysis was, on average, 80.6% ± 19.5 of the body weight in the BA group and 78.9% ± 21.6 in the THA group. The additionally determined average peak force during the entire gait analysis was 66.8% ± 15.8 of the body weight in the BA group and 60.5% ± 15.6 in the THA group. Conclusions: Patients with femoral neck fractures undergoing THA and BA can achieve sufficient weight bearing on the operated leg in the early postoperative period. In our study, BA did not allow for a significantly higher average and maximum loading capacity compared with THA.
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Affiliation(s)
- Chiara Grabmann
- University Hospital of Munich, Ludwig Maximilian University, 81377 Munich, Germany
| | - Ibrahim Hussain
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, USA
| | - Anne Zeller
- University Hospital of Munich, Ludwig Maximilian University, 81377 Munich, Germany
| | - Sertac Kirnaz
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, USA
| | - Vincent Sullivan
- Department of Biological Sciences, University of South Carolina, Columbia, SC 29208, USA
| | - Fabian Sommer
- New York Presbyterian Hospital, Weill Cornell Medicine, New York, NY 10065, USA
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Clotet-Vidal S, Saez Prieto ME, Duch Llorach P, Gutiérrez ÁS, Casademont Pou J, Torres Bonafonte OH. Malnutrition, Functional Decline, and Institutionalization in Older Adults after Hospital Discharge Following Community-Acquired Pneumonia. Nutrients 2023; 16:11. [PMID: 38201841 PMCID: PMC10780721 DOI: 10.3390/nu16010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND AND AIMS Community-acquired pneumonia (CAP) is a major threat to older adults, but mid-term implications are poorly described. The aim was to analyze functional decline, institutionalization, malnutrition, and risk factors after hospital admission for CAP. METHODS This prospective observational study included patients over 65 years discharged after CAP between May 2019 and July 2021. We performed a comprehensive geriatric assessment and a general nutritional assessment 30-60 days after CAP. This included the MNA and blood test with trace elements and vitamins. The main outcomes were functional decline, institutionalization, and malnutrition. Multivariate logistic regression was used for the analyses. RESULTS In total, 144 patients of 77.15 ± 7.91 years, 55.6% male, and 9% previously institutionalized were analyzed. At hospital admission, the Charlson Comorbidity Index (CCI) was 1.5 ± 1.6, the Pneumonia Severity Index was 98.1 ± 25.9, and the previous Barthel Index (BI) was 93.06 ± 17.13. Hospital stay was 9.72 ± 7.88 days. After 44.6 ± 14.4 days, 48.6% patients showed functional decline and 19.4% were institutionalized. Age (OR 1.17; CI 95% 1.09-1.26), previous institutionalization (29.1; 3.7-224.7), BI (1.09; 1.05-1.14), CCI (1.5; 1.1-2.1), and length of stay (1.1, 1.02-1.18) were independently associated with functional decline. The only predictors of new institutionalization were previous BI (0.96; 0.93-0.99) and length of stay (1.06; 1.00-1.13). The MNA indicated malnutrition in 28% of the community-dwelling patients and 67.9% of those institutionalized, with risk of malnutrition being 45.7% and 9.5%, respectively, after an average of 44.6 days of CAP diagnosis. The predictors of malnutrition were previous institutionalization (10.62; 2.20-51.21), BI (0.95; 0.92-0.98), and length of stay (1.12; 1.04-1.20). Micronutrient deficiencies were mainly zinc (61.8%), vitamin D (54.5%), and vitamin C (45.1%). An MNA score < 17 points or hypoalbuminemia showed good specificity to identify these deficiencies. CONCLUSIONS After CAP admission, functional decline, institutionalization, and malnutrition rates were high. Longer hospital stay was a common risk factor for all outcomes. The presence of hypoalbuminemia or an MNA < 17 in older patients should prompt suspicion of deficiencies in micronutrients, such as vitamin D, C, and zinc.
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Affiliation(s)
- Sandra Clotet-Vidal
- Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Medicine Department, Universitat Autònoma de Barcelona, 08913 Barcelona, Spain;
| | - M. Encarna Saez Prieto
- Geriatrics Unit, Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.E.S.P.); (Á.S.G.)
| | - Pol Duch Llorach
- Infectious Diseases Unit, Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
| | - Álvaro Santos Gutiérrez
- Geriatrics Unit, Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.E.S.P.); (Á.S.G.)
| | - Jordi Casademont Pou
- Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Medicine Department, Universitat Autònoma de Barcelona, 08913 Barcelona, Spain;
- Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
| | - Olga H. Torres Bonafonte
- Medicine Department, Universitat Autònoma de Barcelona, 08913 Barcelona, Spain;
- Geriatrics Unit, Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.E.S.P.); (Á.S.G.)
- Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
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Zhou M, Zha F, Liu F, Zhou J, Liu X, Li J, Yang Q, Zhang Z, Xiong F, Hou D, Weng H, Wang Y. Long-term care status for the elderly with different levels of physical ability: a cross-sectional survey in first-tier cities of China. BMC Health Serv Res 2023; 23:953. [PMID: 37674190 PMCID: PMC10481569 DOI: 10.1186/s12913-023-09987-3] [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: 01/05/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Long term care (LTC) services for functionally impaired senior citizens are crucial for addressing the challenges of aging. However, research on eligibility criteria and coverage of LTC in China is lacking. Our objective is to assess the current status of LTC and explore eligibility criteria and coverage for the elderly. METHODS This is a cross-sectional study conducted in two first-tier cities in China. Residents aged 65 or over were recruited from a nursing home and four primary hospitals. Participants were divided into three groups (bedridden, domestic, and community), then six grades (grade one to six) according to the Longshi Scale, and their functional ability was assessed using the Modified Barthel Index. Information such as diseases, complications, and daily care needs were collected. Nursing staff were invited to indicate patients' needs for care. A one-way ANOVA test, Kruskal Wallis H test and Mann-Whitney U test were used to explore the differences of variables in three Longshi groups or Longshi grades. RESULTS Among all 1157 participants, with an average age of 80.54, 69.3% were in the bedridden group. The most common diagnosis was stroke (71.4%), with the most prevalent complication being pulmonary infection (25.2%). In the nursing assessment, basic health care, disease care, activity care, complication prevention care and psychosocial care were summarized as the five main aspects of LTC for the elderly. Feeding, bathing, drinking, bowel management and bladder management were identified as the basic care which fulfills participants' basic physical needs in each Longshi group. Mouth care, artificial airway management, and body reposition, which can prevent immobility complications, were highly demanded by bedridden elderly. CONCLUSIONS The elderly in grade one to three are the ones in need of LTC most. The content of LTC for elderly should include basic care which fulfills their basic physical needs and complication care which can prevent immobility complications. The evidence of this research may contribute to the design of LTC in China. TRIAL REGISTRATION The study design was registered in the Chinese Clinical Trial Registry (ChiCTR-2000034067, Registered 22 Jun 2020, http://www.chictr.org.cn/showproj.aspx?proj=54770 ).
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Affiliation(s)
- Mingchao Zhou
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Fubing Zha
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Fang Liu
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Jing Zhou
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Xiangxiang Liu
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Jiehui Li
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Qingqing Yang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Zeyu Zhang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Feng Xiong
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Dianrui Hou
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Hongyun Weng
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China
| | - Yulong Wang
- Department of Rehabilitation, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, No.3002, Sungang West Road, Futian District, Shenzhen, Guangdong, 518000, China.
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Labaste F, Delort F, Ferré F, Bounes F, Reina N, Valet P, Dray C, Minville V. Postoperative delirium is a risk factor of institutionalization after hip fracture: an observational cohort study. Front Med (Lausanne) 2023; 10:1165734. [PMID: 37649978 PMCID: PMC10464946 DOI: 10.3389/fmed.2023.1165734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/10/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction Hip fracture is a common clinical problem in geriatric patients often associated with poor postoperative outcomes. Postoperative delirium (POD) and postoperative neurocognitive disorders (NCDs) are particularly frequent. The consequences of these disorders on postoperative recovery and autonomy are not fully described. The aim of this study was to determine the role of POD and NCDs on the need for institutionalization at 3 months after hip fracture surgery. Method A population-based prospective cohort study was conducted on hip fracture patients between March 2016 and March 2018. The baseline interview, which included a Mini-Mental State Examination (MMSE), was conducted in the hospital after admission for hip fracture. NCDs were appreciated by MMSE scoring evolution (difference between preoperative MMSE and MMSE at day 5 >2 points). POD was evaluated using the Confusion Assessment Method. The primary endpoint was the rate of new institutionalization at 3 months. We used a multivariate analysis to assess the risk of new institutionalization. Results A total of 63 patients were included. Thirteen patients (20.6%) were newly institutionalized at 3 months. Two factors were significantly associated with the risk of postoperative institutionalization at 3 months: POD (OR = 5.23; 95% CI 1.1-27.04; p = 0.04) and IADL evolution (OR = 1.8; 95% CI 1.23-2.74; p = 0.003). Conclusion Only POD but not NCDs was associated with the risk of dependency and institutionalization after hip fracture surgery. The prevention of POD appears to be essential for improving patient outcomes and optimizing the potential for returning home.
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Affiliation(s)
- François Labaste
- Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France
- Institut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, France
| | - François Delort
- Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France
| | - Fabrice Ferré
- Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France
| | - Fanny Bounes
- Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France
| | - Nicolas Reina
- Orthopedic Surgery Department, CHU Toulouse, Toulouse, France
| | - Philippe Valet
- Institut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, France
| | - Cédric Dray
- Institut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, France
| | - Vincent Minville
- Anesthesiology and Intensive Care Department CHU Toulouse, Toulouse, France
- Institut RESTORE UMR 1301-Inserm 5070-CNRS EFS Univ. P. Sabatier, Toulouse, France
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Deutschbein J, Lindner T, Möckel M, Pigorsch M, Gilles G, Stöckle U, Müller-Werdan U, Schenk L. Health-related quality of life and associated factors after hip fracture. Results from a six-month prospective cohort study. PeerJ 2023; 11:e14671. [PMID: 36942001 PMCID: PMC10024485 DOI: 10.7717/peerj.14671] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/11/2022] [Indexed: 03/17/2023] Open
Abstract
Background Hip fractures are a major public health problem with increasing relevance in aging societies. They are associated with high mortality rates, morbidity, and loss of independence. The aim of the EMAAge study was to determine the impact of hip fractures on patient-reported health-related quality of life (HRQOL), and to identify potential risk factors for worse outcomes. Methods EMAAge is a multicenter, prospective cohort study of patients who suffered a hip fracture. Patients or, if necessary, proxies were interviewed after initial treatment and after six months using standardized questionnaires including the EQ-5D-5L instrument, the Oxford Hip Score, the PHQ-4, the Short Nutritional Assessment Questionnaire, and items on patients living situation. Medical data on diagnoses, comorbidities, medications, and hospital care were derived from hospital information systems. Results A total of 326 patients were included. EQ-5D index values decreased from a mean of 0.70 at baseline to 0.63 at six months. The mean self-rated health on the EQ-VAS decreased from 69.9 to 59.4. Multivariable linear regression models revealed three relevant associated factors with the six-months EQ-5D index: symptoms of depression and anxiety, pre-fracture limitations in activities of daily living, and no referral to a rehabilitation facility had a negative impact. In addition, the six-months EQ-VAS was negatively associated with polypharmacy, living in a facility, and migration background. Conclusions Hip fractures have a substantial negative impact on patients HRQOL. Our results suggest that there are modifying factors that need further investigation including polypharmacy and migration background. Structured and timely rehabilitation seems to be a protective factor.
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Affiliation(s)
- Johannes Deutschbein
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Germany
| | - Tobias Lindner
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Germany
| | - Martin Möckel
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine Campus Mitte and Virchow, Germany
| | - Mareen Pigorsch
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Germany
| | - Gabriela Gilles
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Germany
| | - Ulrich Stöckle
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculosceletal Surgery (CMSC), Germany
| | - Ursula Müller-Werdan
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Geriatrics and Medical Gerontology, Germany
| | - Liane Schenk
- Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Germany
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Yoshioka R, Yamamoto S, Nakatani E. Effectiveness of suvorexant versus benzodiazepine receptor agonist sleep drugs in reducing the risk of hip fracture: Findings from a regional population-based cohort study. PLoS One 2023; 18:e0284726. [PMID: 37093840 PMCID: PMC10124872 DOI: 10.1371/journal.pone.0284726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/05/2023] [Indexed: 04/25/2023] Open
Abstract
Sleep drugs are often necessary to treat insomnia in older patients. Benzodiazepine receptor agonists (BZRAs) are primarily used for insomnia in these patients, but there are concerns regarding their association with delirium and bone fractures. Among sleep drugs, orexin receptor antagonists such as suvorexant have a lower risk of delirium than BZRAs, but their effectiveness in preventing hip fractures is unknown. Hip fracture is a life-threatening trauma in advanced-age patients and a social problem. Therefore, we investigated the relationship between suvorexant and hip fracture. The Shizuoka Kokuho Database was used to compare the time to hip fracture in patients who had been newly taking suvorexant and other sleep drugs such as benzodiazepines since November 2014. A proportional hazards model for hip fracture as an outcome was used to estimate the hazard ratio. Propensity scores were estimated using a logistic regression model, and the confounding factors were age, sex, several comorbidities, and each oral medication. The suvorexant group comprised 6860 patients (110 with hip fracture), and the BZRA group (benzodiazepines and Z-drugs) comprised 50,203 patients (1487 with hip fracture). In the matched cohort (6855:6855 patients), 259 and 249 patients in the suvorexant and BZRA group developed hip fractures during the observational period, respectively. The hazard ratio of the suvorexant group compared with the BZRA group was 1.48 (95% confidence interval, 1.20-1.82). In the subgroup analysis, patients in the suvorexant group had a higher risk of hip fracture if they were aged >75 years, had no diabetes, had no neurological disease, had no renal failure, had liver disease, had hypertension, were not taking alpha 1 blockers, and were not taking oral steroids. Among people in the Japanese regional population who use sleep drugs, patients taking suvorexant can be at higher risk of hip fracture than patients taking BZRAs.
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Affiliation(s)
- Ryozo Yoshioka
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Aoi-ku, Shizuoka, Japan
- Department of Emergency Medicine, Shizuoka General Hospital, Aoi-ku, Shizuoka, Japan
| | - Seiichiro Yamamoto
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Aoi-ku, Shizuoka, Japan
| | - Eiji Nakatani
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Aoi-ku, Shizuoka, Japan
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Han X, Zheng L, Mu YY, Li HZ, He XF. Association between OPG polymorphisms and osteoporosis risk: An updated meta-analysis. Front Genet 2022; 13:1032110. [PMID: 36437941 PMCID: PMC9682267 DOI: 10.3389/fgene.2022.1032110] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/24/2022] [Indexed: 10/15/2023] Open
Abstract
Background: Numerous studies have demonstrated an association between osteoprotegerin (OPG) polymorphisms (A163G (rs3102735), T245G (rs3134069), T950C (rs2073617), G1181C (rs2073618)) and osteoporosis risk. However, their conclusions are inconsistent. In addition, some new studies have been updated, and more importantly, previous meta-analyses have not tested for false-positive results. In order to further explore these associations, we recently conducted a meta-analysis. Objectives: To study the relationship between OPG polymorphisms A163G, T245G, T950C, G1181C and the risk of osteoporosis. Methods: PubMed, Medline, International Statistical Institute (ISI), China National Knowledge Infrastructure (CNKI) and China Wanfang Database were used for research searches. Associations were assessed with five genetic models using odds ratios (ORs) with 95% confidence intervals (CIs). In addition, confidence in statistically significant associations was assessed using false-positive report probability (FPRP), Bayesian probability of False discovery (BFDP), and Venice criteria. Results: On the whole, the OPG A163G polymorphism was not significantly associated with risk of osteoporosis. However, in a subgroup analysis, we found that the OPG A163G polymorphism increased the risk of osteoporosis in Caucasians (AG + GG vs AA: OR = 1.35, 95% CI = 1.06-1.73; AA + GG vs AG: OR = 0.64, 95% CI = 0.49-0.82) and the female (G vs A: OR = 1.30, 95% CI = 1.03-1.64; AG + GG vs AA: OR = 1.42, 95% CI = 1.18-1.71). At the same time, the OPG G1181C polymorphism reduces the risk of osteoporosis (C vs G: OR = 0.84, 95% CI = 0.74-0.95; CC vs GG: OR = 0.75, 95% CI = 0.60-0.93; GC + CC vs GG: OR = 0.80, 95% CI = 0.67-0.95; CC vs GG + GC: OR = 0.84, 95% CI = 0.70-1.00). Moreover, a significantly decreased risk of osteoporosis was also discovered in Asian (C vs G: OR = 0.80, 95% CI = 0.66-0.98; CC vs GG: OR = 0.67, 95% CI = 0.47-0.95; GC + CC vs GG: OR = 0.74, 95% CI = 0.58-0.95) and the female (C vs G: OR = 0.85, 95% CI = 0.75-0.97; CC vs GG: OR = 0.77, 95% CI = 0.61-0.96; GC + CC vs GG: OR = 0.79, 95% CI = 0.66-0.95). Finally, we did not find a close association between OPG T245G and T950C polymorphisms and osteoporosis risk. However, when we retained only studies in the control group that was consistent with Hardy-Weinberg equilibrium (HWE) and high-quality scores, we observed that the OPG A163G polymorphism increased the risk of osteoporosis in the overall analysis (G vs A: OR = 1.40, 95% CI = 1.16-1.68; GG vs AA: OR = 1.96, 95% CI = 1.20-3.21; AG + GG vs AA: OR = 1.45, 95% CI = 1.22-1.72). Finally, after the credibility assessment, we concluded that all statistically significant association results in the meta-analysis in this study and those in the previous study were 'positive results with low confidence'. Conclusion: In conclusion, our study concluded that all meaningful results between OPG A163G and G1181C polymorphisms and osteoporosis risk were false-positive results rather than true associations.
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Affiliation(s)
- Xu Han
- Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Lai Zheng
- Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Yi-Yang Mu
- Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Hong-Zhuo Li
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Xiao-Feng He
- Institute of Evidence-Based Medicine, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
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Ikram A, Norrish AR, Marson BA, Craxford S, Gladman JRF, Ollivere BJ. Can the Clinical Frailty Scale on admission predict 30-day survival, postoperative complications, and institutionalization in patients with fragility hip fracture? : a cohort study of 1,255 patients. Bone Joint J 2022; 104-B:980-986. [PMID: 35909371 PMCID: PMC9948448 DOI: 10.1302/0301-620x.104b8.bjj-2020-1835.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We assessed the value of the Clinical Frailty Scale (CFS) in the prediction of adverse outcome after hip fracture. METHODS Of 1,577 consecutive patients aged > 65 years with a fragility hip fracture admitted to one institution, for whom there were complete data, 1,255 (72%) were studied. Clinicians assigned CFS scores on admission. Audit personnel routinely prospectively completed the Standardised Audit of Hip Fracture in Europe form, including the following outcomes: 30-day survival; in-hospital complications; length of acute hospital stay; and new institutionalization. The relationship between the CFS scores and outcomes was examined graphically and the visual interpretations were tested statistically. The predictive values of the CFS and Nottingham Hip Fracture Score (NHFS) to predict 30-day mortality were compared using receiver operating characteristic area under the curve (AUC) analysis. RESULTS Significant non-linear associations between CFS and outcomes were observed. Risk of death within 30 days rose linearly for CFS 1 to 5, but plateaued for CFS > 5. The incidence of complications and length of stay rose linearly for CFS 1 to 4, but plateaued for CFS > 4. In contrast, the risk of new institutionalization rose linearly for CFS 1 to 8. The AUCs for 30-day mortality for the CFS and NHFS were very similar: CFS AUC 0.63 (95% CI 0.57 to 0.69) and NHFS AUC 0.63 (95% CI 0.57 to 0.69). CONCLUSION Use of the CFS may provide useful information on outcomes for fitter patients presenting with hip fracture, but completion of the CFS by the admitting orthopaedic team does not appear successful in distinguishing between higher CFS categories, which define patients with frailty. This makes a strong case for the role of the orthogeriatrician in the early assessment of these patients. Further work is needed to understand why patients assessed as being of mild, moderate, and severe frailty do not result in different outcomes. Cite this article: Bone Joint J 2022;104-B(8):980-986.
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Affiliation(s)
- Adeel Ikram
- Nottingham University Hospitals NHS Trust, Nottingham, UK,University of Nottingham, Nottingham, UK
| | - Alan R. Norrish
- Nottingham University Hospitals NHS Trust, Nottingham, UK,Queen Elizabeth Hospital, King’s Lynn, UK
| | - Ben A. Marson
- Nottingham University Hospitals NHS Trust, Nottingham, UK,University of Nottingham, Nottingham, UK
| | - Simon Craxford
- Nottingham University Hospitals NHS Trust, Nottingham, UK,University of Nottingham, Nottingham, UK
| | - John R. F. Gladman
- Nottingham University Hospitals NHS Trust, Nottingham, UK,University of Nottingham, Nottingham, UK,NIHR Nottingham Biomedical Research Unit, Nottingham, UK,NIHR Applied Research Collaboration East Midlands, Nottingham, UK
| | - Ben J. Ollivere
- Nottingham University Hospitals NHS Trust, Nottingham, UK,University of Nottingham, Nottingham, UK,NIHR Nottingham Biomedical Research Unit, Nottingham, UK,Correspondence should be sent to Ben J. Ollivere. E-mail:
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10
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Milman R, Zikrin E, Shacham D, Freud T, Press Y. Handgrip Strength as a Predictor of Successful Rehabilitation After Hip Fracture in Patients 65 Years of Age and Above. Clin Interv Aging 2022; 17:1307-1317. [PMID: 36072307 PMCID: PMC9441578 DOI: 10.2147/cia.s374366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose It is important to identify factors associated with the outcome of rehabilitation after hip fracture as an aid to planning the rehabilitation framework and the future discharge of patients. Previous studies have shown that handgrip strength (HGS) is one of the factors associated with the success of rehabilitation. Materials and Methods A retrospective study among patients 65 years of age and above who underwent surgical repair of a hip fracture followed by rehabilitation in the Geriatrics ward between September 2019 and December 2021. Successful rehabilitation was determined as Montebello Rehabilitation Factor Score Revised (MRFS-R) ≥50%. Associations were assessed between various sociodemographic and clinical variables, including HGS, and rehabilitation success. HGS was tested as a continuous and dichotomous variable, in accordance with various definitions of low muscle strength. Results Data were collected for 173 patients. The mean age was 81.2 ± 7.2 years and 68.2% were women. In a logistic regression model only HGS, as a continuous variable, was independently associated with rehabilitation success, with each increase of 1 kg increasing the chance for successful rehabilitation by 6.8%. Conclusion HGS is a simple tool for the planning of the rehabilitation process among patients with hip fracture.
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Affiliation(s)
- Rivka Milman
- Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer- Sheva, Israel
| | - Evgeniya Zikrin
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer- Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel
| | - David Shacham
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer- Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel
| | - Tamar Freud
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer- Sheva, Israel
| | - Yan Press
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer- Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer- Sheva, Israel
- Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Correspondence: Yan Press, Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel, Tel +972-8-6477433; +972-50-6263903, Fax +972-8-6407795, Email
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11
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Caffarelli C, Mondanelli N, Crainz E, Giannotti S, Frediani B, Gonnelli S. The Phenotype of Bone Turnover in Patients with Fragility Hip Fracture: Experience in a Fracture Liaison Service Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127362. [PMID: 35742610 PMCID: PMC9223564 DOI: 10.3390/ijerph19127362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 02/05/2023]
Abstract
Background: Hip fragility fractures are becoming one of the main health care problems in countries with an aging population. This study aimed to evaluate the clinical characteristics and the usefulness of bone turnover markers in patients with a hip fracture. Methods: In a cohort of 363 patients (84.1 ± 9.2 years) with hip fractures we measured 25-hydroxyvitamin D (25OHD), bone alkaline phosphatase, type I collagen β carboxy telopeptide (βCTX), and parathyroid hormone (PTH). We recorded patients’ Charlson Comorbidity Index (CCI) and previous history of fragility fractures. Results: Vitamin D and PTH levels were inversely correlated (r = −024; p < 0.001). The prevalence of 25OHD deficiency was 57.8%, the PTH levels greater than 65 pg/mL was in 47.0 %, and in those who had βCTX values the upper limit was 61.8%. Moreover, 62% of patients with a fragility hip fracture had a history of a previous fracture. The 25OHD serum levels were inversely associated with CCI and a previous fragility fracture. On the contrary, PTH and βCTX serum levels showed a positive significant correlation with CCI and previous fragility fractures. Conclusion: This study confirmed the usefulness of a bone turnover markers assessment, along with the comorbidities and history of previous fragility fractures in order to better identify the risk of hip fracture.
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Affiliation(s)
- Carla Caffarelli
- Department of Medicine, Surgery and Neuroscience, Section of Internal Medicine, University of Siena, 53100 Siena, Italy;
| | - Nicola Mondanelli
- Department of Medicine, Surgery and Neurosciences, Section of Orthopedics and Traumatology, University of Siena, 53100 Siena, Italy; (N.M.); (S.G.)
| | - Eduardo Crainz
- Department of Orthopaedics and Traumatology, Section of Orthopedics and Traumatology, University Hospital of Siena, 53100 Siena, Italy;
| | - Stefano Giannotti
- Department of Medicine, Surgery and Neurosciences, Section of Orthopedics and Traumatology, University of Siena, 53100 Siena, Italy; (N.M.); (S.G.)
| | - Bruno Frediani
- Department of Medicine, Surgery and Neurosciences, Rheumatology Unit, University of Siena, 53100 Siena, Italy;
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neuroscience, Section of Internal Medicine, University of Siena, 53100 Siena, Italy;
- Correspondence: ; Tel.: +39-0577-585468
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12
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Effect of Combining Operating Room Nursing Based on Clinical Quantitative Assessment with WeChat Health Education on Postoperative Complications and Quality of Life of Femoral Fracture Patients Undergoing Internal Fixation. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2452820. [PMID: 35186223 PMCID: PMC8849898 DOI: 10.1155/2022/2452820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the effect of combining operating room nursing based on clinical quantitative assessment with WeChat health education on postoperative complications and quality of life (QOL) of femoral fracture patients undergoing internal fixation. Methods Ninety femoral fracture patients treated in our hospital (July 2018 to July 2021) were chosen as the research objects and split into the control group (routine intervention) and the study group (combination of operating room nursing based on clinical quantitative assessment and WeChat health education) according to the nursing intervention modes, with 45 cases each. After nursing, the postoperative complications and QOL of patients were compared between the two groups. Results No statistical between-group differences in general data were observed (P > 0.05); the hospital stay, weight-bearing time, and fracture healing time were obviously shorter in the study group than in the control group (P < 0.05); 1 d after surgery, the VAS pain status was not significantly different between the two groups (P > 0.05), and 2 d and 3 d after surgery, the VAS scores were significantly lower in the study group than in the control group (P < 0.05); 1 d after surgery, the Harris scores of patients in the two groups were close and did not present statistical difference (P > 0.05), and 8 weeks after surgery, the Harris score was significantly higher in the study group than in the control group (P < 0.05); the scores on self-care agency such as self-concept, self-care skills, sense of self-care responsibility, and health knowledge level were significantly higher in the study group than in the control group (P < 0.05); compared with the control group, the probability of occurring incision infection, lung infection, pressure sore, swelling and pain, and other complications was significantly lower in the study group (P < 0.05). Conclusion Implementing operating room nursing based on clinical quantitative assessment combined with WeChat health education to femoral fracture patients undergoing internal fixation can effectively improve their postoperative clinical indicators, reduce their postoperative pain sensation and complication incidence, and effectively promote the joint motion range, which is conducive to enhancing their self-care agency and QOL.
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13
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Hsu B, Korda RJ, Lindley RI, Douglas KA, Naganathan V, Jorm LR. Use of health and aged care services in Australia following hospital admission for myocardial infarction, stroke or heart failure. BMC Geriatr 2021; 21:538. [PMID: 34635068 PMCID: PMC8504055 DOI: 10.1186/s12877-021-02519-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD), including myocardial infarction (MI), stroke and heart failure (HF) are the leading cause of death amongst the older population worldwide. The aim of this study is to investigate trajectories of use of health and aged care services after hospital admission for MI, stroke or HF among community-dwelling people not previously receiving aged care services. METHODS The study population comprised people aged 65+ years from the 45 and Up Study with linked records for hospital stays, aged care services and deaths for the period 2006-14. Among those with an index hospital admission for MI, stroke or HF, we developed Sankey plots to describe and visualize sequences and trajectories of service use (none, re-hospitalization, community care, residential care, death) in the 12 months following discharge. We used Cox proportional hazards models to estimate hazard ratios (HRs), for commencing community care and entering residential care (and the other outcomes) within 3, 6 and 12 months, compared to a matched group without MI, stroke or HF. RESULTS Two thousand six hundred thirty-nine, two thousand five hundred and two thousand eight hundred seventy-three people had an index hospitalization for MI, stroke and HF, respectively. Within 3 months of hospital discharge, 16, 32 and 29%, respectively, commenced community care (multivariable-adjusted HRs: 1.26 (95%CI:1.18-1.35), 1.53 (95%CI:1.44-1.64) and 1.39 (95%CI:1.32-1.48)); and 7, 18 and 14%, respectively, entered residential care (HRs: 1.25 (95%CI:1.12-1.41), 2.65 (95%CI:2.42-2.91) and 1.50 (95%CI:1.37-1.65)). Likewise, 26, 15 and 28%, respectively, were rehospitalized within 3 months following discharge (multivariable-adjusted HRs: 4.78 (95%CI:4.31-5.32), 3.26 (95%CI:2.91-3.65) and 4.94 (95%CI:4.47-5.46)). CONCLUSIONS Older people hospitalized for major CVD may be vulnerable to transition-related risks and have poor health trajectories, thus emphasizing the value of preventing such events and care strategies targeted towards this at-risk group.
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Affiliation(s)
- Benjumin Hsu
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia. .,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Richard I Lindley
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Kirsty A Douglas
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Repatriation Hospital and University of Sydney, Sydney, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
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14
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Marks L, Pass B, Knobe M, Volland R, Eschbach D, Lendemans S, Aigner R, Schoeneberg C. Quality of life, walking ability and change of living situation after trochanteric femur fracture in geriatric patients-Comparison between sliding hip screw and cephalomedullary nails from the registry for geriatric trauma. Injury 2021; 52:1793-1800. [PMID: 34039468 DOI: 10.1016/j.injury.2021.05.012] [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: 02/18/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is no well-established gold standard for treating trochanteric femur fractures in the elderly. The two common treatment options are cephalomedullary nails (CMN) and sliding hip screws (SHS). In this study, treatment using CMN and SHS were compared for a cohort of patients older than 70 years of age: The main outcomes were quality of life and main residence after surgery. METHODS In this retrospective study we analyzed 24,919 patients from 100 hospitals, treated between 2016 and 2019 and documented in the Registry for Geriatric Trauma. The impact of CMN vs. SHS on the walking ability, quality of life (QoL), living situation, mortality, and revision rate were analyzed. To analyze the change of the living situation, the main residence 120 days after surgery for patients, who lived in their own home before fracture, was described for both groups. FINDINGS A total of 10,995 patients could be included of which 10,436 patients were treated with CMN and 369 patients with SHS. 120 days postoperative the QoL differed significantly (p = 0.020) in favor of treatment using CMN. 26% of the SHS group who lived at home prior to surgery had to reside in a nursing home after surgery, whereas the rate was only 18% in the CMN group (p < 0.001). No significant difference in the mortality rate nor a difference in the walking ability 120 days postoperative were found. CMN were implanted more promptly (median: 13.9 vs. 18.4 hours; p < 0,001). No differences were found concerning the revision rate between the two groups, neither during inpatient treatment (p = 0.723) nor during the 120 day follow-up period (p = 0.524). INTERPRETATION There might be a benefit for geriatric patients with trochanteric femur fractures to be treated with a proximal femur nail in regard to a higher QoL and a reduced institutionalization rate. Mortality or revision rate was not affected by the chosen implant.
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Affiliation(s)
- L Marks
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany.
| | - B Pass
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany.
| | - M Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.
| | - R Volland
- AUC - Academy for Trauma Surgery, Munich, Germany.
| | - D Eschbach
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
| | - S Lendemans
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany.
| | - R Aigner
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
| | - C Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Essen, Germany.
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- Working Committee on Geriatric Trauma Registry of the German Trauma Society (DGU), Berlin, Germany
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15
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Soukkio PK, Suikkanen SA, Aartolahti EM, Kautiainen H, Kääriä SM, Hupli MT, Pitkälä KH, Sipilä S, Kukkonen-Harjula KT. Effects of Home-Based Physical Exercise on Days at Home, Health Care Utilization, and Functional Independence Among Patients With Hip Fractures: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:1692-1699. [PMID: 33939973 DOI: 10.1016/j.apmr.2021.04.004] [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: 01/29/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the effects of a physical exercise program on days lived at home, the use and costs of health care and social services, mortality, and functional independence among patients with hip fractures. DESIGN Randomized controlled trial with a parallel 2-group design consisting of a 12-month intervention and 12-month registry follow-up. SETTING Home-based intervention. PARTICIPANTS Patients aged ≥60 years (N=121) with operated hip fracture and who were living at home were randomized into physical exercise (n=61) and usual care (n=60) groups. INTERVENTIONS Supervised physical exercise twice a week. MAIN OUTCOME MEASURES The primary outcome was the number of days lived at home over 24 months. Secondary outcomes were the use and costs of health care and social services, mortality over 24 months, and Functional Independence Measure (FIM) over 12 months. RESULTS Over 24 months, there was no significant difference between the groups in terms of days lived at home (incidence rate ratio, 1.01; 95% confidence interval [CI], 0.90-1.14) or mortality (hazard ratio, 1.01; 95% CI, 0.42-2.43). The mean total costs of health care and social services did not differ between the groups. The costs per person-year were 1.26-fold (95% CI, 0.87-1.86) greater in the physical exercise group than in the usual care group over 12 months and 1.08-fold (95% CI, 0.77-1.70) over 24 months. The mean difference between the change in FIM of the groups over 12 months was 4.5 points (95% CI, 0.5-8.5; P=.029) in favor of the physical exercise group. CONCLUSIONS Long-term home-based physical exercise had no effect on the number of days lived at home over 24 months among patients with hip fractures. The intervention was cost neutral over these 24 months. The FIM scores improved in both groups over 12 months, but the improvement was significantly greater in the physical exercise group than in the usual care group.
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Affiliation(s)
- Paula K Soukkio
- Department of Rehabilitation, South Karelia Social and Health Care District (Eksote), Lappeenranta; Faculty of Sport and Health Sciences, University of Jyväskylä, University of Jyväskylä, Jyväskylä.
| | - Sara A Suikkanen
- Department of Rehabilitation, South Karelia Social and Health Care District (Eksote), Lappeenranta; Faculty of Sport and Health Sciences, University of Jyväskylä, University of Jyväskylä, Jyväskylä
| | - Eeva M Aartolahti
- Faculty of Sport and Health Sciences, University of Jyväskylä, University of Jyväskylä, Jyväskylä
| | - Hannu Kautiainen
- Department of General Practice, University of Helsinki, Helsinki
| | | | - Markku T Hupli
- Department of Rehabilitation, South Karelia Social and Health Care District (Eksote), Lappeenranta
| | - Kaisu H Pitkälä
- Department of General Practice, University of Helsinki, Helsinki; Helsinki University Hospital, Unit of Primary Health Care, Helsinki
| | - Sarianna Sipilä
- Faculty of Sport and Health Sciences, University of Jyväskylä, University of Jyväskylä, Jyväskylä; Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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16
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Schoeneberg C, Pass B, Volland R, Knobe M, Eschbach D, Ketter V, Lendemans S, Aigner R. Four-month outcome after proximal femur fractures and influence of early geriatric rehabilitation: data from the German Centres of Geriatric Trauma DGU. Arch Osteoporos 2021; 16:68. [PMID: 33846869 DOI: 10.1007/s11657-021-00930-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/16/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study analyzed the outcome of orthogeriatric patients with hip fracture 4 months after surgery. The overall mortality rate was 12.2%. Sixty-five percent presented a degradation in walking ability, and 16% had to move to a nursing home. Early geriatric rehabilitation reduces the mortality rate and increases the rate of anti-osteoporotic treatment. PURPOSE Hip fractures are increasingly common with severe consequences. Therefore, the German Trauma Society (DGU) implemented an orthogeriatric co-management and developed the concept for certified Centre for Geriatric Trauma DGU. The patients' treatment data and the optional 120 days of follow-up were collected in the Registry for Geriatric Trauma DGU (ATR-DGU). This study analyzed these 4-month treatment results. METHODS A retrospective analysis of the ATR-DGU was conducted. Outcome parameters were the rate of readmission, rate of re-surgery, anti-osteoporotic therapy, housing, mortality, walking ability, and quality of life (QoL) 120 days post-surgery. The influence of the early geriatric rehabilitation (EGR) was evaluated using a regression analysis. RESULTS The follow-up data from 9780 patients were included. After 120 days, the mortality rate was 12.2%, the readmission rate 4%, and the re-surgery rate 3%. The anti-osteoporotic treatment increased from 20% at admission to 32%; 65% of the patients had a degradation in walking ability, and 16% of the patients who lived in their domestic environment pre-surgery had to move to a nursing home. QoL was distinctly reduced. The EGR showed a positive influence of anti-osteoporotic treatment (p<0.001) and mortality (p=0.011) but led to a slight reduction in QoL (p=0.026). CONCLUSION The 4-month treatment results of the ATR-DGU are comparable to international studies. The EGR led to a significant rise in anti-osteoporotic treatment and a reduction in mortality with a slight reduction in QoL.
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Affiliation(s)
- Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany.
| | - Bastian Pass
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany
| | - Ruth Volland
- AUC, Academy for Trauma Surgery GmbH, Munich, Germany
| | - Matthias Knobe
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Daphne Eschbach
- Center for Orthopedics and Trauma Surgery, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Vanessa Ketter
- Center for Orthopedics and Trauma Surgery, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Sven Lendemans
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany
| | - Rene Aigner
- Center for Orthopedics and Trauma Surgery, University Hospital of Giessen and Marburg, Marburg, Germany
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Doyle K, Lavan A, Kenny RA, Briggs R. Delayed Blood Pressure Recovery After Standing Independently Predicts Fracture in Community-Dwelling Older People. J Am Med Dir Assoc 2021; 22:1235-1241.e1. [PMID: 33516675 DOI: 10.1016/j.jamda.2020.12.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Orthostatic hypotension, characterized by delayed blood pressure (BP) recovery after standing, is a risk factor for falls but the longitudinal relationship with fracture is not yet known. The aim of this study was to examine the prospective risk of fracture associated with delayed BP recovery. DESIGN Longitudinal study with 8-year follow-up. SETTING AND PARTICIPANTS More than 3000 (54% female) community-dwelling people aged ≥50 years from a large longitudinal study on ageing. METHODS Orthostatic BP was measured using a finometer when standing from lying. Delayed BP recovery was defined as systolic BP ≥20 mm Hg lower and/or diastolic BP ≥10 mm Hg from the baseline value at 30, 60, and 90 seconds after standing. Participants with a fracture reported at any of waves 2 to 5 were defined as having incident fracture. Logistic regression models were used to estimate odds ratios (ORs) for the association between delayed BP recovery and incident fracture. RESULTS Seven percent (212/3117) of participants sustained a fracture during follow-up. Delayed BP recovery at 30 seconds was a significant predictor of any fracture [OR 1.80, 95% confidence interval (CI) 1.28-2.53] and hip fracture (OR 4.44, 95% CI 2.03-9.71) in fully adjusted models. Delayed BP recovery at 30 seconds did not predict wrist or vertebral fracture. Delayed BP recovery at 60 seconds also predicted any fracture (OR 1.74, 95% CI 1.19-2.54) and hip fracture (OR 4.66, 95% CI 2.12-10.26) whereas delayed BP recovery at 90 seconds predicted any (OR 1.99, 95% CI 1.38-2.87), wrist (OR 1.87, 95% CI 1.19-2.95), and hip fracture (OR 3.39, 95% CI 1.45-7.93) in fully adjusted models. CONCLUSION and Implications: Delayed BP recovery independently predicts fracture in community-dwelling older people, is potentially modifiable, and can be measured in an ambulatory setting. Because of the morbidity and mortality associated with fractures, identification of such risk factors is crucial in order to inform preventative strategies.
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Affiliation(s)
- Kate Doyle
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - Amanda Lavan
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland; The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland; Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Rose-Anne Kenny
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland; The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland; Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Robert Briggs
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland; The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland; Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.
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Reber KC, Lindlbauer I, Schulz C, Rapp K, König HH. Impact of morbidity on care need increase and mortality in nursing homes: a retrospective longitudinal study using administrative claims data. BMC Geriatr 2020; 20:439. [PMID: 33129263 PMCID: PMC7603768 DOI: 10.1186/s12877-020-01847-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background A growing number of older people are care dependent and live in nursing homes, which accounts for the majority of long-term-care spending. Specific medical conditions and resident characteristics may serve as risk factors predicting negative health outcomes. We investigated the association between the risk of increasing care need and chronic medical conditions among nursing home residents, allowing for the competing risk of mortality. Methods In this retrospective longitudinal study based on health insurance claims data, we investigated 20,485 older adults (≥65 years) admitted to German nursing homes between April 2007 and March 2014 with care need level 1 or 2 (according to the three level classification of the German long-term care insurance). This classification is based on required daily time needed for assistance. The outcome was care level change. Medical conditions were determined according to 31 Charlson and Elixhauser conditions. Competing risks analyses were applied to identify chronic medical conditions associated with risk of care level change and mortality. Results The probability for care level change and mortality acted in opposite directions. Dementia was associated with increased probability of care level change compared to other conditions. Patients who had cancer, myocardial infarction, congestive heart failure, cardiac arrhythmias, renal failure, chronic pulmonary disease, weight loss, or recent hospitalization were more likely to die, as well as residents with paralysis and obesity when admitted with care level 2. Conclusion This paper identified risk groups of nursing home residents which are particularly prone to increasing care need or mortality. This enables focusing on these risk group to offer prevention or special treatment. Moreover, residents seemed to follow specific trajectories depending on their medical conditions. Some were more prone to increased care need while others had a high risk of mortality instead. Several conditions were neither related to increased care need nor mortality, e.g., valvular, cerebrovascular or liver disease, peripheral vascular disorder, blood loss anemia, depression, drug abuse and psychosis. Knowledge of functional status trajectories of residents over time after nursing home admission can help decision-makers when planning and preparing future care provision strategies (e.g., planning of staffing, physical equipment and financial resources).
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Affiliation(s)
- Katrin C Reber
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ivonne Lindlbauer
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Claudia Schulz
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Wahlsten LR, Smedegaard L, Brorson S, Gislason G, Palm H. Living settings and cognitive impairment are stronger predictors of nursing home admission after hip fracture surgery than physical comorbidities A nationwide Danish cohort study. Injury 2020; 51:2289-2294. [PMID: 32622625 DOI: 10.1016/j.injury.2020.06.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/13/2020] [Accepted: 06/24/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Sustaining a hip fracture is a life changing event for many elderlies. While doctors and researchers tend to be preoccupied with mortality and complication rates, patients are more concerned by other aspects e.g. loss of independence and ability to remain in their own home. This study aimed to i) determine age-stratified one-year event rates of admission to nursing home after discharge, and ii) identify risk factors associated with nursing home admission. METHODS Community dwelling patients aged 60-100 years undergoing their first hip fracture surgery in 2005 - 2015 were identified in nationwide administrative registries. Outcome was admission to nursing home within one year of discharge. To assess risk factors, we performed age-stratified cumulative incidence curves and multivariate cause specific cox regression models adjusted for age, sex, social factors, and comorbidities. RESULTS A total of 53,157 patients were included. One-year risk increased with advancing age from 3.2% of patients aged 60 to 69, up to 22.4% in the eldest group aged 90-100 years. Living alone and dementia were strong risk factors HR 9.22 [95% CI 5.60-15.18, p = <0.0001] and HR 6.73 [95% CI 4.80- 9.44, p = 0.0001] respectively for patients aged 60 to 69 years, the effect decreased with higher age down to HR 2.75 [95% CI 2.12- 3.57, p = <0.0001] and HR 2.15 [95% CI 1.88- 2.46, p = <0.0001] for patients ≥ 90 years. Other important risk factors were pre-injury home care, Parkinson's disease and depression. Surprisingly, physical comorbidities i.e. kidney disease, chronic obstructive pulmonary disease, diabetes and cancer did not increase the risk of nursing home admission. CONCLUSION Future initiatives aimed to reduce loss of independence and nursing home admission, among patients with first time hip fracture, should devote attention to living settings and cognitive impairment rather than physical comorbidity.
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Affiliation(s)
- Liv Riisager Wahlsten
- Department of Orthopaedics, Copenhagen University Hospital Herlev-Gentofte, Hospitalsvej 1, 2900 Hellerup, Denmark.
| | - Lærke Smedegaard
- Department of Cardiology, Research 1, Copenhagen University Hospital Herlev-Gentofte, Hospitalsvej 6 3.sal, 2900 Hellerup, Denmark
| | - Stig Brorson
- Department of Orthopaedic Surgery, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Research 1, Copenhagen University Hospital Herlev-Gentofte, Hospitalsvej 6 3.sal, 2900 Hellerup, Denmark
| | - Henrik Palm
- Department of Orthopaedics, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
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Schoeneberg C, Knobe M, Babst R, Friess T, Volland R, Hartwig E, Schmidt W, Lendemans S, Buecking B. [120-day follow-up after proximal femoral fractures-first results from the Geriatric Trauma Registry DGU®]. Unfallchirurg 2020; 123:375-385. [PMID: 31598740 DOI: 10.1007/s00113-019-00730-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Geriatric trauma centers which are certified to the status of a Geriatic Trauma Center DGU® based on the criteria catalogue as outlined by the German Trauma Society (DGU), are required to participate in the Geriatric Trauma Register (ATR-DGU) for quality management and outcome analyses. The evaluation is pseudoanonymous and includes data on all treated hip fracture patients over 70 years old. This has been in regular use since 2016. This study analyzed the postoperative evaluation of gait, mortality, quality of life, hospital readmission and treatment of osteoporosis after 120 days. METHODS A voluntary retrospective data evaluation of the ATR-DGU 120-day follow-up from 2017 was carried out. Written consent for the analysis and publication of the data was obtained from six clinics that already participated in the follow-up. The primary target parameters were mortality rate, readmission and revision rates, gait quality, osteoporosis treatment and quality of life according to EQ-5D-3L. The patient data were completely pseudonymized and a descriptive analysis was carried out. RESULTS In this study 957 patients from the 6 hospitals were included. The average age was 84.5 years (±6.8 years). The mortality rate during the acute treatment phase was 5%. The 120-day follow-up could be evaluated in 412 patients, 10% of these required hospital readmission due to complications oft he same fracture and of these 6% required revision surgery. The mortality rate at 120 days was 12%. In 54% of the patients the fracture led to deterioration of mobility and 49% of patients received osteoporosis treatment after 120 days. The results of the EQ-5D-3L at 120 days revealed improvement as compared to the values on postoperative day 7; however, the preoperative status with respect to mobility and quality of life could not be regained. CONCLUSION Despite the clear advantages of interdisciplinary treatment, the results are still limited concerning mobilization and quality of life. Further analysis of causative and influencing factors is necessary.
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Affiliation(s)
- Carsten Schoeneberg
- Klinik für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Deutschland.
| | - Matthias Knobe
- Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum RWTH, Aachen, Deutschland.,Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Luzern, Schweiz
| | - Reto Babst
- Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, Luzern, Schweiz
| | - Thomas Friess
- Projektkoordination AltersTraumaZentrum DGU®, Herne, Deutschland
| | - Ruth Volland
- AUC, Akademie der Unfallchirurgie GmbH, München, Deutschland
| | - Erich Hartwig
- Klinik für Orthopädie und Unfallchirurgie, ViDia Kliniken Karlsruhe Standort Diakonissenkrankenhaus, Karlsruhe, Deutschland
| | - Wolfgang Schmidt
- Klinik für Unfallchirurgie, Sportorthopädie und Kindertraumatologie, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland
| | - Sven Lendemans
- Klinik für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Deutschland
| | - Benjamin Buecking
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Deutschland.,DRK-Kliniken Nordhessen, Klinik für Orthopädie, Unfallchirurgie und Alterstraumatologie, Kassel, Deutschland
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Werner M, Krause O, Macke C, Herold L, Ranker A, Krettek C, Liodakis E. Orthogeriatric co-management for proximal femoral fractures. Can two additions make a big difference? BMC Musculoskelet Disord 2020; 21:371. [PMID: 32527237 PMCID: PMC7291750 DOI: 10.1186/s12891-020-03392-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Proximal femoral fractures are a major socioeconomic burden and they occur mainly in geriatric patients. High mortality and complication rates are reported. To reduce the mortality and morbidity of these patients, co-management with geriatricians has been recommended. Most previous studies have focused on relatively comprehensive care models. Models with only a few additions to the usual care have not been extensively evaluated. METHODS This retrospective observational study included all patients aged ≥70 years (mean age: 84.5 ± 7.1 years, 70% women) with an isolated proximal femoral fracture treated surgically in our institution from May 2018 to October 2019. In the first 9 months, patients were treated with the usual care (control group, n = 103). In the second 9 months, patients were treated with our multidisciplinary care model (intervention group, n = 104), which included the usual care, plus: (1) one multidisciplinary ward round per week and (2) one "elective" operation slot per day reserved for proximal femoral fractures. Baseline characteristics and outcome measures of the hospital stay were extracted from electronic health records. A 3-month follow-up was conducted by phone. RESULTS Baseline characteristics were comparable between groups (p > 0.05). The hospital stay was shorter in the intervention group than in the control group (7.8 ± 4.3 vs. 9.1 ± 4.5; p = 0.022). The intervention reduced the waiting time for surgery by more than 10 h (intervention: 25.4 ± 24.5 vs. control: 35.8 ± 34.1 h; p = 0.013). A structured phone interview was not performed in 30.9% of the cases. The model reduced the overall dissatisfaction rate by more than half (12.9% vs. 32.4%; p = 0.008). On the other hand, the groups had similar perioperative complication rates (25% vs. 24.3%; p > 0.9999) and mortality (4.8% vs. 3.9%; p > 0.9999) and they remained similar at the 3-month follow-up (complications: 20.3% vs. 17.6% p = 0.831, mortality: 18.2% vs. 15.0% p = 0.573). CONCLUSION We found that two additions to the usual proximal femoral fracture regimen could significantly improve the overall satisfaction rate, reduce the length of hospital stay and shorten the waiting time for surgery. In contrast to previous studies, we observed no significant improvements in complication or mortality rates. Further changes in the standard care might be needed for this purpose.
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Affiliation(s)
- Maic Werner
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Olaf Krause
- Institute for General Medicine, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christian Macke
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Lambert Herold
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Alexander Ranker
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Emmanouil Liodakis
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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22
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van der Burg DA, Diepstraten M, Wouterse B. Long-term care use after a stroke or femoral fracture and the role of family caregivers. BMC Geriatr 2020; 20:150. [PMID: 32321439 PMCID: PMC7178980 DOI: 10.1186/s12877-020-01526-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background There has been a shift from institutional care towards home care, and from formal to informal care to contain long-term care (LTC) costs in many countries. However, substitution to home care or informal care might be harder to achieve for some conditions than for others. Therefore, insight is needed in differences in LTC use, and the role of potential informal care givers, across specific conditions. We analyze differences in LTC use of previously independent older patients after a fracture of femur and stroke, and in particular examine to what extent having a partner and children affects LTC use for these conditions. Methods Using administrative data on Dutch previously independent older people (55+) with a fracture of femur or stroke in 2013, we investigate their LTC use in the year after the condition takes place. We use administrative treatment data to select individuals who were treated by a medical specialist for a stroke or femoral fracture in 2013. Subsequent LTC use is measured as using no formal care, home care, institutional care or being deceased at 13 consecutive four-weekly periods after initial treatment. We relate long-term care use to having a partner, having children, other personal characteristics and the living environment. Results The probability to use no formal care 1 year after the initial treatment is equally high for both conditions, but patients with a fracture are more likely to use home care, while patients with a stroke are more likely to use institutional care or have died. Having a spouse has a negative effect on home care and institutional care use, but the timing of the effect, especially for institutional care, differs strongly between the two conditions. Having children also has a negative effect on formal care use, and this effect is consistently larger for patients with a fracture than patients with a stroke. Conclusion As the condition and the effect of potential informal care givers matter for subsequent long-term care use, policy makers should take the expected prevalence of specific conditions within the older people population into account when designing long-term care policies.
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Affiliation(s)
| | - Maaike Diepstraten
- The Netherlands Bureau for Economic Policy Analysis (CPB), The Hague, The Netherlands
| | - Bram Wouterse
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
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Mitchell R, Draper B, Close J, Harvey L, Brodaty H, Do V, Driscoll TR, Braithwaite J. Future hospital service utilisation in older adults living in long-term residential aged care or the community hospitalised with a fall-related injury. Osteoporos Int 2019; 30:1995-2008. [PMID: 31342137 DOI: 10.1007/s00198-019-05096-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
UNLABELLED This study identified group-based trajectories of hospitalisation for older adults who were living in residential aged care facilities (RACF) or the community for up to 4 years after an index fall injury hospitalisation. Greater than 3 subsequent fall injury hospitalisations and time until move to a RACF were key predictors of RACF and community-living trajectory group memberships, respectively. INTRODUCTION To examine hospital service use trajectories of people aged ≥ 65 years who had a fall injury hospitalisation and were either living in a residential aged care facility (RACF) or the community at the time of the index fall and to identify factors predictive of their trajectory group membership. METHOD A group-based trajectory analysis of hospitalisations of people aged ≥ 65 years who had a fall injury hospitalisation during 2008-2009 in New South Wales, Australia, was conducted. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived based on number of subsequent hospital admissions following the index fall injury hospitalisation. Multinominal logistic regression examined predictors of trajectory group membership. RESULTS There were 24,729 fall injury hospitalisations; 78.8% of fallers were living in the community and 21.2% in a RACF. Five distinct trajectory groups were identified for community-living and four trajectory groups for RACF residents. Key predictors of trajectory group membership for both community-living and RACF residents were age group, number of comorbidities and dementia status. For RACF residents, depression, assistance with activities of daily living and number of subsequent fall injury admissions were also predictors of group membership, with time to move to a RACF a predictor of group membership for community living. CONCLUSIONS Identifying trajectories of ongoing hospital use informs targeting of strategies to reduce hospital admissions and design of services to allow community-living individuals to remain as long as possible within their own residence.
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Affiliation(s)
- R Mitchell
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia.
| | - B Draper
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - J Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - L Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - H Brodaty
- Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - V Do
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - T R Driscoll
- School of Public Health, University of Sydney, Camperdown, Australia
| | - J Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia
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Schoeneberg C, Friess T, Buecking B, Krinner S, Lendemans S, Schumacher J. [Online survey for assessment of geriatric early rehabilitation complex treatment in geriatric trauma centers of the DGU by the medical services of the health funds]. Unfallchirurg 2019; 123:368-374. [PMID: 31451842 DOI: 10.1007/s00113-019-00715-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Orthogeriatric co-management of proximal femoral fractures has been proven to effectively reduce mortality rates. This involves extending resources in hospitals treating these patients as well as dealing with the possibility of prolonged periods of hospitalization. The increase in costs of orthogeriatric co-management are best illustrated by the implementation of geriatric early rehabilitation complex treatment. In view of the problems concerning billing this complex treatment, an online survey was carried among certified geriatric trauma centers of the German Trauma Society (DGU®). METHODS Based on a trauma-geriatric consensus 20 questions were formulated by the Academy of Trauma Surgery (AUC) as an online questionnaire and sent to all 75 certified geriatric trauma centers. Apart from a description of the results, a subanalysis based on the figures presented by the case closing departments (geriatrics or trauma surgery) was included. The questions covered a 2-year period of experiences from 2016 to 2018. RESULTS A total of 26 of the 75 certified geriatric trauma centers participated (35%). A continuous increase in cost analysis evaluations by the medical services of the health funds was observed. A rise from 38% in 2016 to 45% in 2018 was seen. An analogous rejection trend from 16% to 24% during this period was evident as well. Subanalysis revealed significantly higher cost evaluation by the medical services of the health funds and cost rejection rates if trauma departments were the case closing disciplines. CONCLUSION The online survey revealed significantly higher assessment and rejection rates when compared to other hospital services. This could prove potentially detrimental to the future of orthogeriatric co-management.
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Affiliation(s)
- Carsten Schoeneberg
- Klinik für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Deutschland.
| | - Thomas Friess
- Projektkoordination AltersTraumaZentrum DGU®, Herne, Deutschland
| | - Benjamin Buecking
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Deutschland
| | | | - Sven Lendemans
- Klinik für Orthopädie und Unfallchirurgie, Alfried Krupp Krankenhaus, Hellweg 100, 45276, Essen, Deutschland
| | - Jens Schumacher
- Klinik für Orthopädie und Unfallchirurgie, Innere Medizin, Städtisches Klinikum Dessau, Dessau, Deutschland
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Benzinger P, Riem S, Bauer J, Jaensch A, Becker C, Büchele G, Rapp K. Risk of institutionalization following fragility fractures in older people. Osteoporos Int 2019; 30:1363-1370. [PMID: 30877349 DOI: 10.1007/s00198-019-04922-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/27/2019] [Indexed: 12/15/2022]
Abstract
UNLABELLED Previously independent living older people suffering fractures of the hip have a high risk of new admission to a nursing home during the subsequent months. This study shows that older people admitted to hospital for fractures of the pelvis and spine have a similar risk of admission to a nursing home. INTRODUCTION Fall-related fractures are a serious threat to the health and well-being of older persons. Long-term consequences of hip fractures such as institutionalization and mortality are well-known. The impact of other fragility fractures is less well-understood. The aim of this study was to estimate risks of institutionalization and death for different fragility fractures and compare them with the corresponding risks after hip fracture. METHODS Data was retrieved from a German health insurance company. Between 2005 and 2008 more than 56,000 community-dwelling people with a hospital admission or discharge diagnosis of a fracture of the femur, spine, pelvis, proximal humerus, distal radius, tibia, or fibula were included. Crude and age-adjusted 6-month incidence rates for institutionalization and death were calculated. To compare the risks of institutionalization or mortality of non-hip fractures with the risk after hip fracture, multivariate regression models were applied. RESULTS Crude institutionalization rates and mortality were highest in patients with hip fracture. However, after adjustment for age, functional status, and comorbidity, risks of institutionalization after fractures of pelvis (relative risk (RR), 0.94; 95% confidence interval (CI) 0.86; 1.02 in women and 0.89; 95% CI 0.70; 1.12 in men), and spine (RR, 0.95; 95% CI 0.87; 1.03 in women and 0.91; 95% CI 0.76; 1.08 in men) were not statistically different compared to the risk after hip fracture. CONCLUSIONS The risk of institutionalization after fractures of the spine and pelvis was similar to the risk after hip fracture. These fracture sites seem to be associated with a significant decline in physical function.
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Affiliation(s)
- P Benzinger
- Center for Geriatric Medicine, Bethanien Krankenhaus Heidelberg, University of Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Germany.
- Faculty of Social and Health Studies, University of Applied Sciences Kempten, Bahnhofstraße 61, 87435, Kempten, Germany.
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany.
| | - S Riem
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany
- Klinik für Unfallchirurgie, Kreiskrankenhaus Lörrach, Spitalstraße 25, 79539, Lörrach, Germany
| | - J Bauer
- Center for Geriatric Medicine, Bethanien Krankenhaus Heidelberg, University of Heidelberg, Rohrbacher Straße 149, 69126, Heidelberg, Germany
| | - A Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany
| | - C Becker
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany
| | - G Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany
| | - K Rapp
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstraße 22, 89081, Ulm, Germany
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Li T, Jiang S, Lu C, Yang W, Yang Z, Hu W, Xin Z, Yang Y. Melatonin: Another avenue for treating osteoporosis? J Pineal Res 2019; 66:e12548. [PMID: 30597617 DOI: 10.1111/jpi.12548] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/24/2018] [Accepted: 12/24/2018] [Indexed: 12/28/2022]
Abstract
Melatonin is a signal molecule that modulates the biological circadian rhythms of vertebrates. Melatonin deficiency is thought to be associated with several disorders, including insomnia, cancer, and cardiovascular and neurodegenerative diseases. Accumulating evidence has also indicated that melatonin may be involved in the homeostasis of bone metabolism. Age-related reductions in melatonin are considered to be critical factors in bone loss and osteoporosis with aging. Thus, serum melatonin levels might serve as a biomarker for the early detection and prevention of osteoporosis. Compared to conventional antiosteoporosis medicines, which primarily inhibit bone loss, melatonin both suppresses bone loss and promotes new bone formation. Mechanistically, by activating melatonin receptor 2 (MT2), melatonin upregulates the gene expression of alkaline phosphatase (ALP), bone morphogenetic protein 2 (BMP2), BMP6, osteocalcin, and osteoprotegerin to promote osteogenesis while inhibiting the receptor activator of NF-kB ligand (RANKL) pathway to suppress osteolysis. In view of the distinct actions of melatonin on bone metabolism, we hypothesize that melatonin may be a novel remedy for the prevention and clinical treatment of osteoporosis.
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Affiliation(s)
- Tian Li
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences, Northwest University, Xi'an, China
- School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
| | - Shuai Jiang
- Department of Aerospace Medicine, The Fourth Military Medical University, Xi'an, China
| | - Chenxi Lu
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences, Northwest University, Xi'an, China
| | - Wenwen Yang
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences, Northwest University, Xi'an, China
| | - Zhi Yang
- School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
| | - Wei Hu
- School of Basic Medicine, The Fourth Military Medical University, Xi'an, China
| | - Zhenlong Xin
- Graduate School, The Fourth Military Medical University, Xi'an, China
| | - Yang Yang
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, Faculty of Life Sciences, Northwest University, Xi'an, China
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Baer M, Neuhaus V, Pape HC, Ciritsis B. Influence of mobilization and weight bearing on in-hospital outcome in geriatric patients with hip fractures. SICOT J 2019; 5:4. [PMID: 30816088 PMCID: PMC6394234 DOI: 10.1051/sicotj/2019005] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/28/2019] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Early recovery of mobilization after a fracture of the hip is associated with improved long-term ability to walk, lower complication rates, and mortality. In this context, early mobilization and full weight bearing are favorable. The aim of this study was (1) to analyze the influence of time between operation and first mobilization on in-hospital outcome and (2) the influence of early mobilization, full weight bearing, and ASA on pain, mobility of the hip, and ability to walk during the in-hospital phase of recovery. METHODS This is a retrospective in-hospital study of 219 patients aged 70 years or older who were treated with surgery after a hip fracture. Data were collected by a review of medical records. The outcomes were mortality, complications, length of stay, and the Merle d'Aubigné score which evaluates pain, mobility of the hip, and ability to walk. Factors were sought in bivariate and multivariate analyses. RESULTS A shorter time between operation and first mobilization was significantly associated with lower in-hospital mortality and complications. Early mobilization (within 24 h after the operation) and full weight bearing had no influence on pain, mobility of the hip, and ability to walk as well as length of stay in our cohort. Fracture type and treatment influenced mobility of the hip, while age as well as physical health status affected the ability to walk. DISCUSSION Patients with femoral neck fractures, respectively after total hip arthroplasty, had less pain and showed better mobility of the hip and ability to walk during hospitalization than patients with trochanteric fractures; these results were irrespective of early vs. late mobilization and full vs. partial weight bearing. Foremost, a shorter time between operation and first mobilization is associated with lower complication and mortality rates.
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Affiliation(s)
- Manuel Baer
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Valentin Neuhaus
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hans Christoph Pape
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bernhard Ciritsis
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Rapp K, Büchele G, Dreinhöfer K, Bücking B, Becker C, Benzinger P. Epidemiology of hip fractures : Systematic literature review of German data and an overview of the international literature. Z Gerontol Geriatr 2019; 52:10-16. [PMID: 29594444 PMCID: PMC6353815 DOI: 10.1007/s00391-018-1382-z] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/23/2018] [Accepted: 03/02/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hip fractures are regarded as a worldwide epidemic and a major public health concern. Changing risk factors, local differences and temporal trends contribute to the particular epidemiology of hip fractures. This overview gives a comprehensive insight into the epidemiology of hip fractures and reviews where German data have contributed to the literature. METHODS The review of the epidemiology of hip fractures in Germany is based on a systematic literature search in PubMed. Information about the global epidemiology of hip fractures was provided by a selective literature review focusing on specific aspects of the epidemiology of hip fractures. RESULTS Hip fracture rates vary more than 100-fold between different countries. In most high-income countries, a rise in age-standardized hip fracture rates was observed until the 1980s and 1990s and a decrease thereafter. Such a decrease has not been observed for Germany so far. Many factors, diseases and drugs have been found to be associated with hip fractures and there is some evidence that fracture risk in later life is already programmed during fetal life and early childhood. Of the hip fracture burden 50% occur in people with disability and in need of care. In nursing homes approximately 4 fractures can be expected in 100 women per year. In people with intellectual or developmental disabilities comparable risks of hip fracture occur 10-40 years earlier than in the general population. Incidence of disability, institutionalization and death are frequent consequences of hip fractures. CONCLUSION The epidemiology of hip fractures is characterized by a high burden of disease, local differences, temporal trends, well-defined high-risk populations and many established risk factors.
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Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany.
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Karsten Dreinhöfer
- Department of Musculoskeletal Rehabilitation, Prevention and Health Service Research, Center for Sport Science and Sport Medicine (CSSB), Center for Musculoskeletal Surgery (CMSC), Charité Universitätsmedizin, Berlin, Germany
- Department of Orthopedics and Traumatology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Benjamin Bücking
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg GmbH, Baldingerstraße, 35043, Marburg, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Petra Benzinger
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
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Schulz C, Büchele G, Rehm M, Rothenbacher D, Roigk P, Rapp K, Günster C, König HH, Reber K. Patient Characteristics as Indicator for Care Dependence after Hip Fracture: A Retrospective Cohort Study Using Health Insurance Claims Data From Germany. J Am Med Dir Assoc 2018; 20:451-455.e3. [PMID: 30448158 DOI: 10.1016/j.jamda.2018.09.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Hip fractures are common consequences of falls in older adults and, among other negative health outcomes, often lead to care dependence in the long term. Until 2016, the German long-term care insurance classified care recipients according to a standardized classification system consisting of 3 care levels. It was based on required assistance in performing activities of daily living and assessed by a qualified physician or nurse. Thus, care level reflects the degree of care dependence. The aim of this study was to determine relevant patient characteristics, which are related to the likelihood of increasing care dependence in terms of worsening care level after hip fracture. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Statutory health insurance claims data including 122,922 insured individuals living in Germany and aged 65 years or older, who sustained a hip fracture from 2009 through 2011. MEASURES The association of patient characteristics with worsening care level in the quarterly period after hip fracture was investigated by means of multinomial logit regression analysis. Death constitutes a competing risk and was modeled as additional nominal outcome. RESULTS Among all patients, crude rates were 30.9% for worsening care level, 54.8% for unchanged care level, and 14.4% for death after hip fracture. The multivariate analysis revealed that patient factors male sex, increasing age, increasing comorbidity, increasing inpatient length of stay, and a lack of inpatient rehabilitation were significantly associated with a worsening care level. CONCLUSIONS/IMPLICATIONS This study uses the German standardized measurement of care dependence in terms of worsening care level after hip fracture and finds various related patient characteristics. Knowledge of these characteristics helps to identify possible risk groups for care dependence after hip fracture, for which special attention can be provided regarding treatment and prevention of hip fractures.
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Affiliation(s)
- Claudia Schulz
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Martin Rehm
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Patrick Roigk
- Robert-Bosch-Hospital, Department of Clinical Gerontology, Stuttgart, Germany
| | - Kilian Rapp
- Robert-Bosch-Hospital, Department of Clinical Gerontology, Stuttgart, Germany
| | | | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Reber
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Cost-effectiveness of a home safety intervention to prevent falls in impaired elderly people living in the community. Arch Osteoporos 2018; 13:122. [PMID: 30413893 DOI: 10.1007/s11657-018-0535-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/22/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Among others, the German National Prevention Conference recently recommended the provision of preventive options for elderly to maintain their independent living. Because a home safety assessment and modification program (HSM) has shown to be effective in avoiding falls and risk of falling in elderly, the aim of this analysis was to evaluate the cost-effectiveness of HSM in patients aged ≥ 80 years who receive non-institutionalized long-term care. METHODS In order to reflect quality-adjusted life years (QALYs) and costs resulting from HSM, a Markov-model with a time horizon of 20 years was performed from the perspective of the German statutory health insurance (SHI) and statutory long-term care insurance (LCI). The model assumed that HSM reduces fall-related hip fractures in accordance with the reduction of the rate of falls. Data was obtained from public databases and from various literature searches. The robustness of the results was assessed in deterministic and probabilistic sensitivity analyses. RESULTS In women, the incremental cost-effectiveness ratio of HSM compared to no prevention was €9580 per QALY, while in men, it was €57,589. For the German SHI/LCI, in total, the provision of HSM to patients ≥ 80 years who receive non-institutionalized long-term care would result in annual costs of €7.7 million. The results were robust in several sensitivity analyses. CONCLUSIONS Provided that the rate of falls is a valid surrogate endpoint for the rate of fall-related hip fractures, HSM could be a promising approach for investments in preventive options targeting the reduction of fall-related fractures in elderly women.
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Smedegaard L, Kragholm K, Numé AK, Charlot MG, Gislason GH, Hansen PR. Nursing home admission after myocardial infarction in the elderly: A nationwide cohort study. PLoS One 2018; 13:e0202177. [PMID: 30110366 PMCID: PMC6093673 DOI: 10.1371/journal.pone.0202177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/30/2018] [Indexed: 12/19/2022] Open
Abstract
Background Data on nursing home admission after myocardial infarction (MI) in the elderly are scarce. We investigated nursing home admission within 6 months and 2 years after MI including predictors for nursing home admission in a nationwide cohort of elderly patients. Methods Using Danish nationwide registries, we identified all subjects 65 years or older residing at home who were discharged following first-time MI in the period 2008–2015. We determined sex- and age-stratified incidence rates per 1000 person years (IRs) and incidence rate ratios (IRRs) of nursing home admissions using Poisson regression models compared to the Danish population 65 years or older with no prior MI. Poisson regression models were also applied to identify predictors of nursing home admission. Results The 26,539 patients who were discharged after MI had a median age of 76 (quartile 1-quartile 3: 70–83) years. The IRs of nursing home admission after MI increased with increasing age and for 80-84-year-old women IRs after 6 months and 2 years were 113.9 and 62.9, respectively, compared to 29.4 for women of the same age with no prior MI. The IRs for 80-84-year-old men after MI were 56.0 and 36.2, respectively, compared to 24.3 for men of the same age with no prior MI. In adjusted analyses the 6 months and 2 years IRRs for 80-84-year-old subjects were 2.56 (95% CI 2.11–3.10) and 1.41 (95% CI 1.22–1.65) for women and 1.74 (95% CI 1.34–2.25) and 1.05 (95% CI 0.88–1.26) for men, respectively. Predictors were advanced age, dementia, home care, Parkinson’s disease, cerebrovascular disease, living alone, depression, and arrhythmia. Conclusion In elderly patients discharged following first-time MI, the risk of subsequent nursing home admission within 6 months was 2-fold higher compared to an age-stratified population with no prior MI. After 2 years this risk remained higher in women.
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Affiliation(s)
- Laerke Smedegaard
- Herlev & Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
- * E-mail:
| | - Kristian Kragholm
- Aalborg University Hospital, Department of Clinical Epidemiology and Biostatistics, Aalborg, Denmark
| | - Anna-Karin Numé
- Herlev & Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
| | - Mette Gitz Charlot
- Herlev & Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
| | - Gunnar Hilmar Gislason
- Herlev & Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
- The Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - Peter Riis Hansen
- Herlev & Gentofte University Hospital, Department of Cardiology, Hellerup, Denmark
- Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Alejandro P, Constantinescu F. A Review of Osteoporosis in the Older Adult: An Update. Rheum Dis Clin North Am 2018; 44:437-451. [PMID: 30001785 DOI: 10.1016/j.rdc.2018.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Osteoporosis in the elderly population is common. It results in more than 1.5 million fractures per year in the United States. The goal of managing osteoporosis is to prevent fractures. In men, osteoporosis is underrecognized and undertreated. More men than women die every year as a consequence of hip fractures. Bisphosphonates are the first-line treatment of men and women. In the past several years, advances in bone biology have resulted in major therapeutic advances. A review of diagnosis and treatment of osteoporosis is described.
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Affiliation(s)
- Paloma Alejandro
- Division of Rheumatology, MedStar Washington Hospital Center, Georgetown University Medical Center, 110 Irving Street Northwest 2A-66, Washington, DC 20010, USA.
| | - Florina Constantinescu
- Division of Rheumatology, MedStar Washington Hospital Center, Georgetown University Medical Center, 110 Irving Street Northwest 2A-66, Washington, DC 20010, USA
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Abstract
Osteoporosis in the elderly population is common. It results in more than 1.5 million fractures per year in the United States. The goal of managing osteoporosis is to prevent fractures. In men, osteoporosis is underrecognized and undertreated. More men than women die every year as a consequence of hip fractures. A review of diagnosis and treatment of osteoporosis is described in this article. Bisphosphonates are the first-line treatment for men and women. In the past several years, advances in bone biology have resulted in major therapeutic advances.
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Affiliation(s)
- Paloma Alejandro
- Division of Rheumatology, MedStar Washington Hospital Center, Georgetown University Medical Center, 110 Irving Street Northwest 2A-66, Washington, DC 20010, USA.
| | - Florina Constantinescu
- Division of Rheumatology, MedStar Washington Hospital Center, Georgetown University Medical Center, 110 Irving Street Northwest 2A-66, Washington, DC 20010, USA
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Frisoli A, Martin FG, Carvalho ACDC, Borges J, Paes AT, Ingham SJM. Sex effects on the association between sarcopenia EWGSOP and osteoporosis in outpatient older adults: data from the SARCOS study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:615-622. [PMID: 30624502 PMCID: PMC10118671 DOI: 10.20945/2359-3997000000087] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 10/03/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective was to evaluate the association between sarcopenia (EWGSOP) and osteoporosis in older adults. SUBJECTS AND METHODS This is a cross sectional analysis of a baseline evaluation of the SARCopenia and OSteoporosis in Older Adults with Cardiovascular Diseases Study (SARCOS). Three hundred and thirty-two subjects over 65 years of age were evaluated. Sarcopenia was determined by EWGSOP flowchart and Osteoporosis was established by WHO's criteria. Physical function, comorbidities and medications were evaluated. RESULTS Women were older (79.8 ± 7.2 years) than men (78.21 ± 6.7 years) (p = 0.042). Osteoporosis occurred in 24.8% of men, and in 42.7% of women (p < 0.001); sarcopenia occurred in 25.5% of men and in 17.7%, of women (p = 0.103). Osteoporosis was diagnosed in 68% of sarcopenic women, however only 20.7% (p = 0.009) of women with osteoporosis had sarcopenia; in older men, 44.7% of individuals with sarcopenia presented osteoporosis and 42.9% (p = 0.013) of men with osteoporosis showed sarcopenia. In an adjusted logistic regression analyses for sarcopenia, osteoporosis presented a statistically significant association with sarcopenia in men [OR: 2.930 (95% CI: 1.044-8.237; p = 0.041)] but not in women [OR: 2.081 (0.787-5.5; p = 0.142)]; in the adjusted logistic regression analyses for osteoporosis, a statistically significant association occurred in men [OR: 2.984 (95% CI: 1.144-7.809; p = 0.025)], but not in women [OR: 2.093 (0.962-3.714; p = 0.137)]. CONCLUSION According to sex, there are significant differences in the association between sarcopenia EWGSOP and osteoporosis in outpatient older adults. It is strong and significant in males; in females, despite showing a positive trend, it was not statistically significant.
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Khatib J, Stote K, Gosmanov AR. Utility of DXA screening for diagnosis of osteoporosis in US veterans aged 70 years and older. J Investig Med 2017; 66:298-303. [DOI: 10.1136/jim-2017-000557] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 11/04/2022]
Abstract
Dual energy X-ray absorptiometry (DXA) is recommended for osteoporosis screening in men aged 70 years and older but supportive data is limited. The aim of this study was to determine the efficacy of DXA for the diagnosis of increased fragility in this group of subjects. We retrospectively identified men aged 70 years and older without prior history of fracture and/or conditions predisposing to low bone mineral density (BMD) who attended the VA endocrinology clinic and performed DXA for osteoporosis screening. We analyzed the relationship between BMD and demographic, anthropometric data and biochemical parameters using linear regression models. Out of 55 subjects identified, 13 (24%) men had normal BMD, 30 (54%) had osteopenia and 12 (22%) had a diagnosis of osteoporosis based on the femoral neck (FN) T-score. Lumbar spine T-scores were normal in all three groups. Weight and body mass index (BMI) were significantly higher in the normal BMD group compared with the osteopenia and osteoporosis groups (p<0.001). After adjustments for age, weight, BMI, vitamin D concentrations, and diabetes status, differences in the FN BMD among the groups remained significant (p<0.001). Based on the Fracture Risk Assessment Tool (FRAX) score calculations in 43 non-osteoporotic patients, 15 patients with osteopenia had a 10-year hip fracture probability ≥3%. Screening with DXA in male US veterans aged 70 years and older without known osteoporosis risk factors revealed that up to 50% of men may qualify for diagnostic workup to determine the etiology of low BMD and/or to meet criteria to initiate pharmacological therapy to reduce future fracture risk.
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Mas MÀ, Closa C, Santaeugènia SJ, Inzitari M, Ribera A, Gallofré M. Hospital-at-home integrated care programme for older patients with orthopaedic conditions: Early community reintegration maximising physical function. Maturitas 2016; 88:65-9. [DOI: 10.1016/j.maturitas.2016.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/22/2016] [Accepted: 03/03/2016] [Indexed: 12/29/2022]
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Marazzi MC, Inzerilli MC, Madaro O, Palombi L, Scarcella P, Orlando S, Maurici M, Liotta G. Impact of the Community-Based Active Monitoring Program on the Long Term Care Services Use and In-Patient Admissions of the Over-74 Population. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/aar.2015.46020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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