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Su SF, Lin SN. Effects of comprehensive geriatric care on depressive symptoms, emergency department visits, re-hospitalization and discharge to the same residence in older persons receiving hip-fracture surgery: A meta-analysis. Int J Nurs Pract 2022; 28:e13099. [PMID: 35978458 DOI: 10.1111/ijn.13099] [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: 01/03/2021] [Revised: 06/04/2022] [Accepted: 07/23/2022] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to evaluate depressive symptoms, emergency department visits, re-hospitalization and discharge to the same residence of comprehensive geriatric care in patients receiving hip-fracture surgery. BACKGROUND Hip fractures among older persons result in restricted activities of daily living, longer hospital stays, frequent emergency department visits and re-presentation to hospital, which may increase depressive symptoms and death risk. The benefits of comprehensive geriatric care have not been determined. DESIGN A five-step Cochrane collaboration meta-analysis was used. DATA SOURCES Randomized controlled trials published from 1980 to 2020 in which comprehensive geriatric care was provided following hip-fracture surgery were retrieved from the Cochrane Library, Clinical Key, Embase, MEDLINE, OVID and PubMed databases. Indicators were depressive symptoms, emergency department visits, re-hospitalization and discharge to the same residence. REVIEW METHODS The Group Reading Assessment, Risk of Bias 2.0 tool, modified Jadad scale and Comprehensive Meta-Analysis Version 3 software were used. RESULTS Overall, 1291 patients from six randomised controlled trials were included. Comprehensive geriatric care improved depressive symptoms and lowered emergency department visits but did not improve re-hospitalization rates or discharge to the same residence. CONCLUSION Comprehensive geriatric care should include depression management and individualized care plans. Further depression-related studies are required to verify their benefits.
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Affiliation(s)
- Shu-Fen Su
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Shu-Ni Lin
- Department of Nursing, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
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Moral-Cuesta D, Gutiérrez-Misis A, Veloz BAC, Matovelle-Ochoa P, Epelde IM, Alarcón TA, Díez-Sebastián J, Galbete A, Maestre IM, Velilla NM, González-Montalvo JI. Profile and 3-month evolution of geriatric patients after a hip fracture followed-up at a Fracture Liaison Service (FLS). Rev Esp Geriatr Gerontol 2022; 57:205-211. [PMID: 35872030 DOI: 10.1016/j.regg.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 05/29/2022] [Accepted: 06/23/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION There are few studies on Fracture Liaison Service (FLS) that evaluate older patients after a hip fracture (HF) through comprehensive geriatric assessment. We aim to determine these patients' characteristics, outcomes, and prescribed treatments. METHODS A retrospective observational study of a cohort of patients older than 65 years admitted with HFs to an orthogeriatric unit between February 25th (2013) and December 16th (2016). After hospitalization, those patients with a good baseline social, functional, and cognitive situation were referred to the FLS. A comprehensive geriatric assessment and treatment adjustment were conducted. A comparison between FLS patients and HF patients non-referred was made. RESULTS From 1887 patients admitted to the orthogeriatric unit, 469 (23%) were referred to the FLS. Of those, 335 were women (77.2%) and 337 (77.6%) lived in the community. The FLS patients had a better functional status (97.1% of the patients with independent gait versus 79.2%) than non-FLS patients (p<0.001). After 3 months in the FLS, 356 (82%) patients had independent gait and had improved their analytical values. Antiosteoporotic treatment was prescribed to 322 patients (74%), vitamin D supplements to 397 (91.5%), calcium to 321 (74%), and physical exercise to 421 (97%). CONCLUSIONS Patients referred to an FLS were younger, with a better functional and cognitive situation. At hospital discharge, they frequently presented gait impairment and laboratory abnormalities (anemia, hypoproteinemia, vitamin D deficiency) that presented good recovery due to the patient's previous baseline. These patients benefit from comprehensive treatment (pharmacological and non-pharmacological).
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Affiliation(s)
- Debora Moral-Cuesta
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, Spain.
| | - Alicia Gutiérrez-Misis
- Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación Biomédica del Hospital Universitario La Paz (IdiPaz), Madrid, Spain
| | - Bernardo Abel Cedeño Veloz
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, Spain; Centro de Investigación Biomédica de Navarra (Navarrabiomed), Pamplona, Spain
| | | | - Itxaso Marin Epelde
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, Spain
| | - Teresa Alarcón Alarcón
- Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación Biomédica del Hospital Universitario La Paz (IdiPaz), Madrid, Spain; Servicio de Geriatría, Hospital Universitario La Paz, Madrid, Spain
| | - Jesús Díez-Sebastián
- Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Sección de Epidemiología Clínica del Servicio de Medicina Preventiva, Madrid, Spain
| | - Arkaitz Galbete
- Centro de Investigación Biomédica de Navarra (Navarrabiomed), Pamplona, Spain
| | | | - Nicolás Martínez Velilla
- Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (Idisna), Pamplona, Spain; Centro de Investigación Biomédica de Navarra (Navarrabiomed), Pamplona, Spain
| | - Juan Ignacio González-Montalvo
- Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Instituto de Investigación Biomédica del Hospital Universitario La Paz (IdiPaz), Madrid, Spain; Servicio de Geriatría, Hospital Universitario La Paz, Madrid, Spain
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Prognostic value of orthogeriatric assessment parameters on mortality: a 2-year follow-up. Eur J Trauma Emerg Surg 2021; 48:2905-2914. [PMID: 34173021 PMCID: PMC9360057 DOI: 10.1007/s00068-021-01727-8] [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: 03/09/2021] [Accepted: 06/08/2021] [Indexed: 12/04/2022]
Abstract
Introduction Since the arise of orthogeriatric co-management patients’ outcome and survival has improved. There are several assessment parameters that screen the precondition of orthogeriatric patients including mobility, activities of daily living, comorbidities, place of residence and need for care just to name a few. In a 2-year follow-up on an orthogeriatric co-managed ward the fracture-independent predictive value of typical assessment parameters and comorbidities on the associated mortality was examined. Methods All patients treated on an orthogeriatric co-managed ward from February 2014 to January 2015 were included. No fracture entity was preferred. Emphasis was set on following parameters: age, gender, Parker-Mobility Score (PMS), Barthel Index (BI), Charlson-Comorbidity Index (CCI), dementia, depression, sarcopenia, frequent falling, length of stay (LOS), care level (CL) and place of residence (POR). In a 2-year follow-up the patients’ death rates were acquired. SPSS (IBM Corp., Armonk, New York, USA) and Cox regression was used to univariately analyze the expression of the mentioned parameters and mortality course over 2 years from discharge. In a multivariate analysis intercorrelations and independent relationships were examined. Results A follow-up rate of 79.6% by assessing 661 patients was achieved. In the univariate analysis linear inverse correlation between PMS and BI and mortality and a linear positive correlation between CCI and higher mortality were observed. There was also a significant relationship between lower survival and age, dementia, sarcopenia, frequent falling, higher institutionalized place of residence and higher CL. No univariate correlation between 2-year mortality and gender, depression and LOS was found. In the multivariate Cox regression, the only independent risk factors remaining were lower PMS (HR: 1.81; 95%CI: 1.373–2.397), lower BI (HR: 1.64; 95%CI: 1.180–2.290) and higher age per year (HR: 1.04; 95%CI: 1.004–1.067). Conclusion Age, PMS, BI, CCI, preexisting dementia, sarcopenia, frequent falling, POR and CL are univariate predictors of survival in the orthogeriatric context. An independency could only be found for PMS, BI and age in our multivariate model. This underlines the importance of preexisting mobility and capability of self-support for the patient’s outcome in terms of survival.
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Ríos-Germán PP, Gutierrez-Misis A, Queipo R, Ojeda-Thies C, Sáez-López P, Alarcón T, Puime AO, Gómez-Campelo P, Navarro-Castellanos L, González-Montalvo JI. Differences in the baseline characteristics, management and outcomes of patients with hip fractures depending on their pre-fracture place of residence: the Spanish National Hip Fracture Registry (RNFC) cohort. Eur Geriatr Med 2021; 12:1021-1029. [PMID: 33970467 DOI: 10.1007/s41999-021-00503-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE One in four hip fracture patients comes from an aged care facility. This study aimed to compare the characteristics of these subjects with their community-dwelling counterparts at baseline, during hospitalization and 1-month post-fracture. METHODS We analyzed data from a cohort of older adults admitted with hip fractures to 75 Spanish hospitals, collected prospectively in the Spanish National Hip Fracture Registry between 2016 and 2018. We classified participants according to pre-fracture residence: community dwellers vs. aged care facilities residents. We collected demographic records at baseline, along with variables relating to in-hospital evolution and discharge to geriatric rehabilitation units. Patients or relatives were interviewed at 1-month follow-up. RESULTS Out of 18,262 patients, 4,422 (24.2%) lived in aged care facilities. Aged care facilities residents were older (median age: 89 vs. 86 years), less mobile (inability to walk independently: 20.8% vs. 9.4%) and had more cognitive impairment (Pfeiffer's SPMSQ > 3, 75.3% vs. 34.8%). They were more likely to receive conservative treatment (5.4% vs. 2.0%) and less likely to be mobilized early (58.2% vs. 63.0%). At discharge, they received less vitamin D supplements (68.5% vs. 72.4%), less anti-osteoporotic medication (29.3% vs. 44.3%), and were referred to geriatric rehabilitation units less frequently (5.4% vs. 27.5%). One-month post-fracture, 45% of aged care facilities residents compared to 28% of community dwellers experienced a severe gait decline. Aged care facilities residents had a higher one-month mortality (10.6% vs. 6.8%). CONCLUSION Hip fracture patients from aged care facilities are more vulnerable than their community-dwelling peers and are managed differently both during hospitalization and at discharge. Gait decline is disproportionately higher among those admitted from aged care.
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Affiliation(s)
- Peggy P Ríos-Germán
- Department of Geriatric Medicine, Geriatric Service, Hospital Universitario La Paz, Paseo La Castellana 261, 28046, Madrid, Spain. .,La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.
| | - Alicia Gutierrez-Misis
- La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.,Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rocío Queipo
- La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.,European University of Madrid, Madrid, Spain
| | - Cristina Ojeda-Thies
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Pilar Sáez-López
- La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.,Department of Geriatric Medicine, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | - Teresa Alarcón
- Department of Geriatric Medicine, Geriatric Service, Hospital Universitario La Paz, Paseo La Castellana 261, 28046, Madrid, Spain.,La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Angel Otero Puime
- La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.,Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Paloma Gómez-Campelo
- La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | | | - Juan Ignacio González-Montalvo
- Department of Geriatric Medicine, Geriatric Service, Hospital Universitario La Paz, Paseo La Castellana 261, 28046, Madrid, Spain.,La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.,Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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Pérez-Rodríguez P, Rabes-Rodríguez L, Sáez-Nieto C, Alarcón TA, Queipo R, Otero-Puime Á, Gonzalez Montalvo JI. Handgrip strength predicts 1-year functional recovery and mortality in hip fracture patients. Maturitas 2020; 141:20-25. [PMID: 33036698 DOI: 10.1016/j.maturitas.2020.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 04/29/2020] [Accepted: 06/16/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Muscle strength is a possible predictor of adverse events. It could have prognostic value in patients with hip fracture (HF). The aim of this study was to determine if handgrip strength is associated with functional impairment, readmissions, and mortality at one year in elderly patients with HF. DESIGN A prospective observational study was carried out. It included a cohort of patients aged 65 years or older with a diagnosis of fragility HF, consecutively from January 2013 to February 2014 and seen in follow-up at one year. Statistical analysis was performed using SPSS v21 software. MAIN OUTCOME MEASURES Five hundred and nine patients with a mean age of 85.4 ± 0.3 years were included, of whom 403 (79.2 %) were women. Clinical and functional outcomes, laboratory parameters and anthropometric measurements were collected. RESULTS Of the total sample, 339 (66.6 %) had reduced handgrip strength, and these patients were older, more frequently institutionalized, had poorer functional and cognitive status, higher comorbidity, higher surgical risk, lower body mass index and a greater intra-hospital mortality (all p < 0.01). At one year, patients with lower handgrip strength had a major change in their ability to walk (32.7 % vs. 10.9 %, p < 0.001) and a higher mortality rate (30.4 % vs. 8.8 %, p < 0.001). However, in patients over 91 years of age, there was no association between lower handgrip strength and change in ability to walk. There were no differences in the number of readmissions. CONCLUSION Low handgrip strength in elderly patients with HF predicts greater functional disability and higher long-term mortality.
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Affiliation(s)
| | | | | | | | - Rocío Queipo
- Department of Pharmacy and Biotechnology. European University of Madrid, Madrid, Spain
| | - Ángel Otero-Puime
- Department of Preventive Medicine, Autonomous University Madrid, Spain
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García-Gollarte F, Ríos Germán PP, Alarcón T, Paz FJ, Cuenllas-Díaz Á, González-Montalvo JI. [Functional and clinical outcomes in patients admitted to nursing homes after hip fractures. Implementation of a multi-level intervention program]. Rev Esp Geriatr Gerontol 2020; 55:11-17. [PMID: 31288950 DOI: 10.1016/j.regg.2019.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 04/06/2019] [Accepted: 04/24/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to determine the clinical and functional outcomes of patients discharged to nursing homes after a hip fracture. METHODS The study included all patients admitted to a group of nursing homes after a hip fracture in 2016. A geriatric assessment protocol was applied, and patients were treated with a specific protocol for 90 days. They were assessed for nutritional status (Mini-Nutritional Assessment and Body Mass Index), pain (Visual Analogue Scale, and the PAINAD Scale), the presence of pressure ulcers, blood test (D vitamin, haemoglobin, proteins), and functional status (Barthel index and Functional Assessment Categories). RESULTS Out of a total of 175 patients, 116 (75%) met the inclusion criteria. The mean age was 84.9 years old (±6.7 SD), and 91 (78.4%) were women. At admission, 73.8% of 65 residents had anaemia, 76.7% hypovitaminosis D, 88% malnutrition or «at risk of malnutrition», and 15.3% had pressure ulcers. After 90 days, the moderate-severe functional status (Barthel index < 60) was reduced from 90.4 to 39.6%, dependence due to gait from 97.3 to 36.1%, and moderate-severe pain from 88.9 to 14.4%. Most of the pressure ulcers healed (94.4%). CONCLUSIONS Patients admitted to nursing homes after a hip fracture had poor clinical and functional status. This study shows that after 90 days from admission these patients had positive outcomes in terms of functionality, gait, pain control, and pressure ulcers healing.
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Affiliation(s)
| | - Peggy P Ríos Germán
- Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación, Hospital La Paz (IdiPAZ), Madrid, España.
| | - Teresa Alarcón
- Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación, Hospital La Paz (IdiPAZ), Madrid, España
| | | | | | - Juan Ignacio González-Montalvo
- Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España; Instituto de Investigación, Hospital La Paz (IdiPAZ), Madrid, España
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