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Nieboer MF, van der Jagt OP, de Munter L, de Jongh MAC, van de Ree CLP. Health status after periprosthetic proximal femoral fractures. Bone Joint J 2024; 106-B:442-449. [PMID: 38688518 DOI: 10.1302/0301-620x.106b5.bjj-2023-1062.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims Periprosthetic proximal femoral fractures (PFFs) are a major complication after total hip arthroplasty (THA). Health status after PFF is not specifically investigated. The aim of this study is to evaluate the health status pattern over two years after sustaining a PFF. Methods A cohort of patients with PFF after THA was derived from the Brabant Injury Outcomes Surveillance (BIOS) study. The BIOS study, a prospective, observational, multicentre follow-up cohort study, was conducted to obtain data by questionnaires pre-injury and at one week, and one, three, six, 12, and 24 months after trauma. Primary outcome measures were the EuroQol five-dimension three-level questionnaire (EQ-5D-3L), the Health Utility Index 2 (HUI2), and the Health Utility Index 3 (HUI3). Secondary outcome measures were general measurements such as duration of hospital stay and mortality. Results A total of 70 patients with a PFF were included. EQ-5D utility scores were significantly lower on all timepoints except at six months' follow-up compared to pre-injury. EuroQol visual analogue scale (EQ-VAS) scores at one month's follow-up were significantly lower compared to pre-injury. The percentage of reported problems at two years was higher for all dimensions except anxiety/depression when compared to pre-injury. The mean EQ-5D utility score was 0.26 higher in males compared to females (95% confidence interval (CI) 0.01 to 0.42; p = 0.003). The mean EQ-VAS score for males was 8.9 points higher when compared to females over all timepoints (95% CI 1.2 to 16.7; p = 0.027). Mortality was 10% after two years' follow-up. Conclusion PFF patients are a frail population with substantial functional impairment at baseline. Post-injury, they have a significant and clinically relevant lower health status two years after trauma when compared to pre-injury. Health status improves the most between one and three months after injury. Two years after PFF, more patients experience problems in mobility, self-care, usual activities, and pain/discomfort than pre-injury.
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Affiliation(s)
- Michael F Nieboer
- Department of Orthopaedic Surgery, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, the Netherlands
- Department of Orthopaedic Surgery, Bergman Clinics, Breda, the Netherlands
| | - Olav P van der Jagt
- Department of Orthopaedic Surgery, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, the Netherlands
| | - Leonie de Munter
- Department of Traumatology, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, the Netherlands
| | - Mariska A C de Jongh
- Department of Traumatology, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, the Netherlands
- Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, the Netherlands
| | - Cornelis L P van de Ree
- Department of Orthopaedic Surgery, Elisabeth-TweeSteden Hospital (ETZ), Tilburg, the Netherlands
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Schloemann DT, Ricciardi BF, Thirukumaran CP. Disparities in the Epidemiology and Management of Fragility Hip Fractures. Curr Osteoporos Rep 2023; 21:567-577. [PMID: 37358663 DOI: 10.1007/s11914-023-00806-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to synthesize the recently published scientific evidence on disparities in epidemiology and management of fragility hip fractures. RECENT FINDINGS There have been a number of investigations focusing on the presence of disparities in the epidemiology and management of fragility hip fractures. Race-, sex-, geographic-, socioeconomic-, and comorbidity-based disparities have been the primary focus of these investigations. Comparatively fewer studies have focused on why these disparities may exist and interventions to reduce disparities. There are widespread and profound disparities in the epidemiology and management of fragility hip fractures. More studies are needed to understand why these disparities exist and how they can be addressed.
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Affiliation(s)
- Derek T Schloemann
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Benjamin F Ricciardi
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Caroline P Thirukumaran
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Iking J, Fischhuber K, Stolberg-Stolberg J, Raschke MJ, Katthagen JC, Köppe J. Quality of Life and Pain after Proximal Humeral Fractures in the Elderly: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1728. [PMID: 37893445 PMCID: PMC10608543 DOI: 10.3390/medicina59101728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: The proximal humeral fracture (PHF) is one of the most common fractures in elderly patients. A PHF might influence the quality of life (QoL) on several different levels, especially in elderly patients, but it is unclear which treatment option results in a better QoL outcome. Therefore, we aimed to systematically review the current literature for studies that have analyzed the QoL and pain of elderly patients treated either surgically or non-operatively for PHF. Materials and Methods: A comprehensive search of the literature was performed in the PubMed database from January to April 2023. Studies describing the QoL or the level of pain of patients older than 60 years with the EuroQoL-5 Dimension (EQ-5D) score or the visual analogue scale (VAS) after the treatment of PHF, either non-operatively (non-OP), with open-reduction and internal fixation using a locking plate (LPF), or with reverse total shoulder arthroplasty (RTSA) were included. Twelve studies were analyzed descriptively and the individual risk of bias was assessed using the ROB2 and ROBINS-I tools. Results: A total of 12 studies with 712 patients at baseline were included (78% female sex, mean age 75.2 years). The reported VAS scores at 12-month follow-up (FU) ranged from 0.7 to 2.5. The calculated overall mean VAS score across all studies showed a decreasing tendency for all treatments, with an increasing FU time up to 12 months after PHF. None of the studies reported any significant differences of the EQ-5D across the groups. The overall calculated EQ-5D indices showed an increasing trend after 6-8 weeks FU, but did not differ significantly between the three treatments. Conclusions: In conclusion, the current literature suggests that there are no clinically important differences between the QoL or pain in elderly patients with PHF after non-operative treatment or surgical treatment with LPF or RTSA. However, the number of studies and level of evidence is rather low and further trials are urgently needed.
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Affiliation(s)
- Janette Iking
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, Germany; (J.I.)
- Research Group “Mathematical Surgery”, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany
| | - Karen Fischhuber
- Research Group “Mathematical Surgery”, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstrasse 56, 48149 Muenster, Germany
| | - Josef Stolberg-Stolberg
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, Germany; (J.I.)
- Research Group “Mathematical Surgery”, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany
| | - Michael J. Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, Germany; (J.I.)
| | - Jan Christoph Katthagen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building W1, 48149 Muenster, Germany; (J.I.)
- Research Group “Mathematical Surgery”, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany
| | - Jeanette Köppe
- Research Group “Mathematical Surgery”, University Hospital Muenster, University of Muenster, 48149 Muenster, Germany
- Institute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstrasse 56, 48149 Muenster, Germany
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Merchán-Galvis AM, Muñoz-García DA, Solano F, Velásquez JC, Sotelo NF, Molina DA, Caicedo JP, Concha JM, Calvache JA, Martínez-Zapata MJ. Delayed surgery and health related quality of life in patients with proximal femoral fracture. Sci Rep 2023; 13:11131. [PMID: 37429947 DOI: 10.1038/s41598-023-33592-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/15/2023] [Indexed: 07/12/2023] Open
Abstract
This study aimed to establish factors associated with delayed surgery in patients with proximal femoral fracture and to assess patients' health-related quality of life (HRQoL) after surgery including all-cause 6-months mortality. This was a single-center, observational, prospective cohort study that included patients with a proximal femur fracture. We described patients' HRQoL measured by EuroQoL (EQ-5D-5L and EQ-VAS) questionnaire and perioperative complications (including mortality) 6 months after surgery. We included 163 patients with a mean age of 80.5 years, the majority were women and 76.1% reported falling from their own height. The mean time between hospital admission and surgery was 8.3 days (SD 4.9 days) and the mean hospital stay was 13.5 days (SD 10.4 days). After adjustment, the principal factor associated with delayed surgery was adjournment in surgery authorization (3.7 days). EQ-5D-5L index values and the VAS score at 1 month after surgery were 0.489 and 61.1, at 3 months were 0.613 and 65.8, and at 6 months 0.662 and 66.7 respectively. Mortality at 6 months of follow-up was 11% (18 patients). In conclusion, administrative authorization was the strongest associated factor with delayed time from hospital admission to surgery. HRQoL of patients with a proximal femoral fracture improved 6 months after surgery.Trial registration: NCT04217642.
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Affiliation(s)
- Angela María Merchán-Galvis
- Iberoamerican Cochrane Centre-Public Health and Clinical Epidemiology, IIBSant Pau, Barcelona, Spain.
- Department of Social Medicine and Family Health, Universidad del Cauca, Popayán, Colombia.
| | | | - Felipe Solano
- Department of Anaesthesiology, Universidad del Cauca, Popayán, Colombia
| | | | | | | | | | - Juan Manuel Concha
- Department of Surgical Sciences, Universidad del Cauca, Popayán, Colombia
| | - José Andrés Calvache
- Department of Anaesthesiology, Universidad del Cauca, Popayán, Colombia
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - María José Martínez-Zapata
- Iberoamerican Cochrane Centre-Public Health and Clinical Epidemiology, IIBSant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER of Epidemiology and Public Health), Madrid, Spain
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Shehu E, Trevisan C, Sambo S, Ceolin C, Pavan S, Piazzani F, Sergi G, March A. Sex Differences in the Burden of Hip Fractures on Functional Status in Older Age. J Womens Health (Larchmt) 2023; 32:57-62. [PMID: 36459629 DOI: 10.1089/jwh.2021.0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: Hip fractures can dramatically impact the health and self-sufficiency of older people. We investigated the influence of pre-fracture functional status on functional decline and mortality after hip fracture, and possible sex differences in this regard. Materials and Methods: The sample comprised 288 older patients hospitalized with hip fracture in an Orthogeriatric Unit. Data on perioperative management and multidimensional evaluation were collected. After 15 months, we obtained information on housing arrangements, new falls, walking level, and self-sufficiency (Barthel Index [BI]) through outpatient visits or phone interviews. Data on re-hospitalizations and deaths were obtained from hospital records. Results: The sample median age was 87 years, and 75% were women. The median pre-fracture BI was 75 (interquartile range [IQR]: 50, 100), and at follow-up it decreased by a median of 20 (IQR: 40, -5) points. Sex differences emerged among those with the highest pre-fracture functional status (BI ≥85), with women showing lower BI loss than men (-15 [IQR: -40, 0] vs. -30 [IQR: -80, -15], respectively; p = 0.04). A pre-fracture BI ≥85 (vs. <85) was associated with a 41% lower mortality rate (95% confidence interval [95% CI]: 0.21-0.79), especially in women (hazard ratios = 0.28, 95% CI: 0.11-0.69). Moreover, male sex was an independent risk factor for functional loss after a hip fracture (odds ratio = 2.52, 95% CI: 1.09-5.80). Conclusions: Older men may have a worse functional prognosis than women after a hip fracture. This difference seemed to be exacerbated in cases of high pre-fracture functional performance, suggesting that females have a greater functional reserve, namely better adaptation and recovery strategies to deal with the fracture. Clinical Trial Registration: Registration code: NCT02687698.
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Affiliation(s)
- Enron Shehu
- Geriatric Unit, Department of Medicine (DIMED), University of Padua, Padova, Italy.,Department of Geriatrics, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Caterina Trevisan
- Geriatric Unit, Department of Medicine (DIMED), University of Padua, Padova, Italy
| | - Sara Sambo
- Geriatric Unit, Department of Medicine (DIMED), University of Padua, Padova, Italy
| | - Chiara Ceolin
- Geriatric Unit, Department of Medicine (DIMED), University of Padua, Padova, Italy
| | - Silvia Pavan
- Department of Geriatrics, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Fabrizio Piazzani
- Department of Geriatrics, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Giuseppe Sergi
- Geriatric Unit, Department of Medicine (DIMED), University of Padua, Padova, Italy
| | - Albert March
- Department of Geriatrics, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
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Martinez-Carranza N, Lindqvist K, Modig K, Hedström M. Factors associated with non-walking 4 months after hip fracture. A prospective study of 23,759 fractures. Injury 2022; 53:2180-2183. [PMID: 35307165 DOI: 10.1016/j.injury.2021.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/07/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Despite advances in new surgical techniques and improvements in medical care of the last decades a considerable number of patients will not regain their ability to walk after a hip fracture. AIMS To further identify risk factors associated with non-walking 4-months after a hip fracture. MATERIAL AND METHODS Register-based, longitudinal study with a 4-month follow-up. The collected data from the Swedish hip fracture registry, RIKSHÖFT, contained all hip fracture between 201301-01-2015-12-31 in Sweden. All patients older than 50 years with a non-pathological fracture and who were able to walk before the fracture were included. The association of sex, age, general health, dementia and type of discharge with complete loss of walking after a hip fracture were investigated using a multivariate analysis. RESULTS Included were 23,759 patients. At the 4-month follow-up, 10% were unable to walk. Twenty-five per cent of patients with dementia lost their ability to walk compared to 7% of those with no cognitive dysfunction. Adjusted odds ratio (OR) for factors associated with loss of walking ability were; discharge to institutionalized care rather than their own home or a rehabilitation unit (OR=1.91; 95% CI=1.67-2.18), dementia (OR=1.80; 95% CI=1.57-2.06), male gender (OR=1.59; 95% CI=1.40-1.81) and ASA score grade III-V (OR=1.37; 95% CI=1.20-1.55) but not age (OR=1.01; 95% CI=1.00-1.02). CONCLUSIONS An important factor associated with a complete loss of walking ability after a hip fracture is the discharge to institutionalized care. This factor might be influenced either by favouring rehabilitation units or by improving the rehabilitation protocols.
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Affiliation(s)
- N Martinez-Carranza
- Department of, Institution of Clinical Sciences, Intervention and Technology (CLINTEC). Karolinska Institutet, Stockholm, Sweden; Division of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
| | - K Lindqvist
- Department of, Institution of Clinical Sciences, Intervention and Technology (CLINTEC). Karolinska Institutet, Stockholm, Sweden
| | - K Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet
| | - M Hedström
- Division of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
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González-Marcos E, González-García E, Rodríguez-Fernández P, González-Bernal JJ, Sánchez-González E, González-Santos J. Predictors of Moderate or Severe Cognitive Impairment at Six Months of the Hip Fracture in the Surgical Patient over 65 Years of Age. J Clin Med 2022; 11:jcm11092608. [PMID: 35566734 PMCID: PMC9101953 DOI: 10.3390/jcm11092608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/21/2022] [Accepted: 05/03/2022] [Indexed: 12/04/2022] Open
Abstract
Background: cognitive impairment is known to be very common in patients with hip fractures, but studies are needed to help understand the relationship between both events. Our goal was to determine the relationship between moderate or severe cognitive impairment and hip fractures during the six months following that episode. Methods: a retrospective longitudinal study was conducted on a sample of 665 people over 65 years of age. The main variable of the study was cognitive impairment at six months of fracture, assessed using the Pfeiffer scale (PS). Other data related to clinical features were also collected for further analysis. Results: binary logistic regression analyses showed that the main factors related to moderate or severe cognitive impairment at the sixth month of the fracture were age (OR = 1.078), initial cognitive impairment (OR = 535.762), and discharge (OR = 547.91), cognitive worsening at the sixth month with respect to the time of admission (OR = 7.024), moderate dependence on admission (OR = 15.474) and at six months (OR = 8.088), poor ambulation at discharge (OR = 5.071) and institutionalization prior to admission (OR = 5.349) or during the first semester after fracture (OR = 6.317). Conclusions: this research provides evidence about the clinical factors that predict moderate or severe cognitive decline at the sixth month in patients undergoing surgery for a hip fracture.
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Affiliation(s)
| | - Enrique González-García
- Traumatology and Orthopedic Surgery Service, Burgos University Hospital, 09006 Burgos, Spain;
| | - Paula Rodríguez-Fernández
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain;
- Correspondence: (P.R.-F.); (J.J.G.-B.)
| | - Jerónimo J. González-Bernal
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain;
- Correspondence: (P.R.-F.); (J.J.G.-B.)
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Orwig DL, Abraham DS, Hochberg MC, Gruber-Baldini A, Guralnik JM, Cappola AR, Golden J, Hicks GE, Miller RR, Resnick B, Shardell M, Sterling RS, Bajracharya R, Magaziner J. Sex Differences in Recovery Across Multiple Domains Among Older Adults With Hip Fracture. J Gerontol A Biol Sci Med Sci 2021; 77:1463-1471. [PMID: 34555162 PMCID: PMC9255694 DOI: 10.1093/gerona/glab271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Hip fractures are a public health problem among older adults, but most research on recovery after hip fracture has been limited to females. With growing numbers of hip fractures among males, it is important to determine how recovery outcomes may differ between the sexes. METHODS 168 males and 171 females were enrolled within 15 days of hospitalization with follow-up visits at 2, 6, and 12 months postadmission to assess changes in disability, physical performance, cognition, depressive symptoms, body composition, and strength, and all-cause mortality. Generalized estimating equations examined whether males and females followed identical outcome recovery assessed by the change in each outcome. RESULTS The mean age at fracture was similar for males (80.4) and females (81.4), and males had more comorbidities (2.5 vs 1.6) than females. Males were significantly more likely to die over 12 months (hazard ratio 2.89, 95% confidence interval: 1.56-5.34). Changes in outcomes were significantly different between males and females for disability, gait speed, and depressive symptoms (p < .05). Both sexes improved from baseline to 6 months for these measures, but only males continued to improve between 6 and 12 months. There were baseline differences for most body composition measures and strength; however, there were no significant differences in change by sex. CONCLUSIONS Findings confirm that males have higher mortality but suggest that male survivors have continued functional recovery over the 12 months compared to females. Research is needed to determine the underlying causes of these sex differences for developing future prognostic information and rehabilitative interventions.
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Affiliation(s)
- Denise L Orwig
- Address correspondence to: Denise L. Orwig, PhD, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 West Redwood Street, Suite 200, Baltimore, MD 21201, USA. E-mail:
| | - Danielle S Abraham
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Marc C Hochberg
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Ann Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Anne R Cappola
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Justine Golden
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Gregory E Hicks
- Department of Physical Therapy, University of Delaware, Newark, USA
| | - Ram R Miller
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | - Barbara Resnick
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, USA
| | - Michelle Shardell
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Robert S Sterling
- Department of Orthopedics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rashmita Bajracharya
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
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9
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Osipov B, Christiansen B. Mechanisms for increased systemic fracture risk after index fracture. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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10
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Chammout G, Kelly-Pettersson P, Hedbeck CJ, Bodén H, Stark A, Mukka S, Sköldenberg O. Primary hemiarthroplasty for the elderly patient with cognitive dysfunction and a displaced femoral neck fracture: a prospective, observational cohort study. Aging Clin Exp Res 2021; 33:1275-1283. [PMID: 32705584 PMCID: PMC8081713 DOI: 10.1007/s40520-020-01651-8] [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: 05/06/2019] [Accepted: 07/07/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND At least one-third of hip fracture patients have some degree of impaired cognitive status, which may complicate their postoperative rehabilitation. AIM We aimed to describe the outcome for elderly patients with cognitive dysfunction operated with hemiarthroplasty (HA) for a femoral neck fracture and to study the impact postoperative geriatric rehabilitation has on functional outcome up to 1 year after surgery. METHODS 98 patients with a displaced femoral neck fracture with a mean age of 86 years were included and followed up to 1 year. The outcomes were hip-related complications and reoperations, the capacity to return to previous walking ability, health-related quality of life, hip function and mortality. RESULTS The prevalence of hip complications leading to a major reoperation was 6% and the 1-year mortality rate was 31%. The lack of geriatric rehabilitation was correlated with poorer outcomes overall and those who receive geriatric rehabilitation were less likely to be confined to a wheelchair or bedridden at the 1-year follow-up. CONCLUSIONS Hemiarthroplasty is an acceptable option for elderly patients with a displaced femoral neck fracture and cognitive dysfunction. A lack of structured rehabilitation is associated with a significant deterioration in walking ability despite a well-functioning hip. However, the causality of this could be due to selection bias of healthier patients being sent to geriatric rehabilitation.
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Abstract
Hip fracture is a leading cause of profound morbidity in individuals aged 65 years and older, ranking in the top 10 causes of loss of disability-adjusted life-years for older adults. Worldwide, the number of people with hip fracture is expected to rise significantly due to the aging population and other factors. Physical therapist management is recommended within medical, surgical, and multidisciplinary clinical practice guideline (CPGs) and is considered to be the standard of care in rehabilitation for people with hip fracture. The goal of this CPG was to review the evidence relevant to physical therapist management and to provide evidence-based recommendations for physical therapy diagnosis, prognosis, intervention, and assessment of outcome in adults with hip fracture. J Orthop Sports Phys Ther 2021;51(2):CPG1-CPG81. doi:10.2519/jospt.2021.0301.
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12
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Avola M, Mangano GRA, Testa G, Mangano S, Vescio A, Pavone V, Vecchio M. Rehabilitation Strategies for Patients with Femoral Neck Fractures in Sarcopenia: A Narrative Review. J Clin Med 2020; 9:E3115. [PMID: 32993140 PMCID: PMC7600322 DOI: 10.3390/jcm9103115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 12/14/2022] Open
Abstract
Sarcopenia is defined as a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. It has been identified as one of the most common comorbidities associated with femoral neck fracture (FNF). The aim of this review was to evaluate the impact of physical therapy on FNF patients' function and rehabilitation. The selected articles were randomized controlled trials (RCTs), published in the last 10 years. Seven full texts were eligible for this review: three examined the impact of conventional rehabilitation and nutritional supplementation, three evaluated the effects of rehabilitation protocols compared to new methods and a study explored the intervention with erythropoietin (EPO) in sarcopenic patients with FNF and its potential effects on postoperative rehabilitation. Physical activity and dietary supplementation are the basic tools of prevention and rehabilitation of sarcopenia in elderly patients after hip surgery. The most effective physical therapy seems to be exercise of progressive resistance. Occupational therapy should be included in sarcopenic patients for its importance in cognitive rehabilitation. Erythropoietin and bisphosphonates could represent medical therapy resources.
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Affiliation(s)
- Marianna Avola
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University Hospital Policlinico-San Marco University of Catania, 95123 Catania, Italy; (M.A.); (G.R.A.M.); (M.V.)
| | - Giulia Rita Agata Mangano
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University Hospital Policlinico-San Marco University of Catania, 95123 Catania, Italy; (M.A.); (G.R.A.M.); (M.V.)
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, 95123 Catania, Italy; (S.M.); (A.V.); (V.P.)
| | - Sebastiano Mangano
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, 95123 Catania, Italy; (S.M.); (A.V.); (V.P.)
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, 95123 Catania, Italy; (S.M.); (A.V.); (V.P.)
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-San Marco, University of Catania, 95123 Catania, Italy; (S.M.); (A.V.); (V.P.)
| | - Michele Vecchio
- Department of Biomedical and Biotechnological Sciences, Section of Pharmacology, University Hospital Policlinico-San Marco University of Catania, 95123 Catania, Italy; (M.A.); (G.R.A.M.); (M.V.)
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Chou FP, Chang HC, Yeh CC, Wu CH, Cherng YG, Chen TL, Liao CC. Sex differences in fracture outcomes within Taiwan population: A nationwide matched study. PLoS One 2020; 15:e0231374. [PMID: 32271850 PMCID: PMC7144979 DOI: 10.1371/journal.pone.0231374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 02/02/2020] [Indexed: 12/03/2022] Open
Abstract
Background and aims Because the sex difference in outcomes of fracture was incompletely understood, we evaluated the post-fracture complications and mortality of female and male patients. Methods We conducted a nationwide study of 498,586 fracture patients who received inpatient care using Taiwan’s National Health Insurance Research Database 2008–2013 claims data. Female and male fracture patients were selected for comparison by using a propensity-score matching procedure. Age, low income, types of fracture, fracture with surgery, several medical conditions, number of hospitalization and emergency visits were considered as potential confounding factors. Multivariate logistic regressions were used to calculate the adjusted odds ratios (OR), the 95% CI of post-fracture complications and 30-day in-hospital mortality differences between women and men. Results Male patients had a higher risk of post-fracture pneumonia (OR 1.96, 95% CI 1.83–2.11), acute renal failure (OR 1.85, 95% CI 1.60–2.15), deep wound infection (OR 1.63, 95% CI 1.51–1.77), stroke (OR 1.58, 95% CI 1.49–1.67), septicemia (OR 1.51, 95% CI 1.42–1.61), acute myocardial infarction (OR 1.38, 95% CI 1.09–1.75) and 30-day in-hospital mortality (OR 1.69, 95% CI 1.48–1.93) compared with female patients. However, a lower risk of post-fracture urinary tract infection (OR 0.69, 95% CI 0.65–0.72) was found in men than in women. Male patients also had longer hospital stays and higher medical expenditures due to fracture admission than did the female patients. Higher rates of post-fracture adverse events in male patients were noted in all age groups and all types of fractures. Conclusion We raised the possibility that male patients showed more complications and higher mortality rates after fracture admission compared with female patients, with the exception of urinary tract infections.
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Affiliation(s)
- Fang-Pai Chou
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hung-Chi Chang
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of Surgery, University of Illinois, Illinois, Chicago, United States of America
| | - Chih-Hsing Wu
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- * E-mail: ,
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Inoue M, Sakai Y, Oe K, Ueha T, Koga T, Nishimoto H, Akahane S, Harada R, Lee SY, Niikura T, Kuroda R. Transcutaneous carbon dioxide application inhibits muscle atrophy after fracture in rats. J Orthop Sci 2020; 25:338-343. [PMID: 31031109 DOI: 10.1016/j.jos.2019.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/18/2019] [Accepted: 03/26/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Muscle atrophy causes difficulty in resuming daily activities after a fracture. Because transcutaneous carbon dioxide (CO2) application has previously upregulated oxygen pressure in the local tissue, thereby demonstrating its potential in preventing muscle atrophy, here we investigated effects of CO2 application on muscle atrophy after femoral shaft fracture. METHODS Thirty fracture model rats were produced and randomly divided into a no treatment (control group) and treatment (CO2 group) groups. After treatment, the soleus muscle was dissected at post-fracture days 0, 14, and 21. Evaluations were performed by measuring muscle weight and performing histological examination and gene expression analysis. RESULTS Muscle weight was significantly higher in the CO2 group than in the control group. Histological analysis revealed that the muscle fiber cross-sectional area was reduced in both groups. Nevertheless, the extent of atrophy was lesser in the CO2 group. Muscle fibers in the control group tended to change into fast muscle fibers. Vascular staining revealed that more capillary vessels surrounded the muscle fibers in the CO2 group than in the control group. Messenger RNA (mRNA) analysis revealed that the CO2 group had a significantly enhanced expression of genes that were related to muscle synthesis. CONCLUSION Transcutaneous CO2 application may be a novel therapeutic strategy for preventing skeletal muscle atrophy after fracture.
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Affiliation(s)
- Miho Inoue
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Keisuke Oe
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Ueha
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; NeoChemir Inc., Kobe, Japan
| | - Takaaki Koga
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hanako Nishimoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shiho Akahane
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Risa Harada
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sang Yang Lee
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Gender and Musculoskeletal Comorbidity Impact on Physical Functioning in Elderly after Hip Fracture: The Role of Rehabilitation. Healthcare (Basel) 2020; 8:healthcare8010031. [PMID: 32033047 PMCID: PMC7151143 DOI: 10.3390/healthcare8010031] [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: 12/28/2019] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 12/15/2022] Open
Abstract
The study aim was to evaluate the effects of presence and level of musculoskeletal impairment along with gender on physical functioning outcome after the rehabilitation program in aged adults with a hip fracture. We analyzed 203 elderly people with hip fractures above 65 years of age that were treated after the hip surgery. According to the time of examination, patients were tested three times: at admission, discharge, and at three months post-discharge. Musculoskeletal impairments were analyzed, and for the estimation of severity of degree impairment, we used a cumulative index rating scale for geriatrics (CIRS-G). Regarding the gender, we separately analyzed males and females. To evaluate physical functioning of aged adults after a hip fracture, we used the physical functioning component (PFC) from the quality of life (SF-36) questionnaire. For males, on all three occasions we found non-significant differences were found in SF-36 PFC values between different degrees of CIRS-G musculoskeletal impairment. A significant difference was noticed in females three months post-discharge. Effects size of different examination periods for every CIRS-G severity degree of musculoskeletal impairment were high, where males had higher values for severity degrees 1 and 2, and females had higher values for severity degrees 0 and 3. Our findings might suggest that there is a certain degree of different rehabilitation treatment effects for males versus females. Moreover, it might be assumed that other factors could influence different degrees of functional improvement and outcome of individuals after a hip fracture with musculoskeletal impairment.
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Larsson G, Strömberg U, Rogmark C, Nilsdotter A. Cognitive status following a hip fracture and its association with postoperative mortality and activities of daily living: A prospective comparative study of two prehospital emergency care procedures. Int J Orthop Trauma Nurs 2019; 35:100705. [PMID: 31324592 DOI: 10.1016/j.ijotn.2019.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 06/12/2019] [Accepted: 07/01/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Early assessment of hip fracture patients' cognitive function is important for preventing pre- and postoperative complications. The aim of this study was twofold: (1) to assess prehospital cognitive function in hip fracture patients and establish whether cognitive status differs pre- and postoperatively between prehospital fast track care (PFTC) and the traditional emergency department (ED) pathway and (2) whether preoperative cognitive function is associated with postoperative mortality and activities of daily living (ADL) ability. METHODS Three hundred and ninety one hip fracture patients were prospectively included. The Short Portable Mental Status Questionnaire (SPMSQ) was used prehospital, at the orthopaedic ward and three days postoperatively. ADL was followed up after four months. RESULTS No difference in patients' cognitive function was observed between PFTC and ED. Four-month mortality was 37% for patients with dementia, 21% for those with cognitive impairment and 10% for patients without cognitive impariment. Only 26% of patients with dementia and 47% with cognitive impairment had full ADL ability, compared with 70% of patients with intact cognitive function (p < 0.001). CONCLUSION PFTC did not influence hip fracture patients' cognitive function. Patients with prehospital cognitive impairment had a poor outcome in terms of mortality and ADL, indicating the need for special care interventions.
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Affiliation(s)
- Glenn Larsson
- Department of Ambulance and Prehospital Care, Region Halland, Sweden; Department of Orthopaedics, Lund University, Sweden.
| | - Ulf Strömberg
- Department of R&D, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Cecilia Rogmark
- Department of Orthopaedics, Lund University, Sweden; Skane University Hospital, Malmö, Sweden
| | - Anna Nilsdotter
- Department of Orthopaedics, Lund University, Sweden; Department of R&D, Sahlgrenska University Hospital, Göteborg, Sweden
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Andrich S, Ritschel M, Meyer G, Hoffmann F, Stephan A, Baltes M, Blessin J, Jobski K, Fassmer AM, Haastert B, Gontscharuk V, Arend W, Theunissen L, Colley D, Hinze R, Thelen S, Fuhrmann P, Sorg CGG, Windolf J, Rupprecht CJ, Icks A. Healthcare provision, functional ability and quality of life after proximal femoral fracture - 'ProFem': Study protocol of a population-based, prospective study based on individually linked survey and statutory health insurance data. BMJ Open 2019; 9:e028144. [PMID: 31243034 PMCID: PMC6597653 DOI: 10.1136/bmjopen-2018-028144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Proximal femoral fractures (PFF) are among the most frequent fractures in older people. However, the situation of people with a PFF after hospital discharge is poorly understood. Our aim is to (1) analyse healthcare provision, (2) examine clinical and patient-reported outcomes (PROs), (3) describe clinical and sociodemographic predictors of these and (4) develop an algorithm to identify subgroups with poor outcomes and a potential need for more intensive healthcare. METHODS AND ANALYSIS This is a population-based prospective study based on individually linked survey and statutory health insurance (SHI) data. All people aged minimum 60 years who have been continuously insured with the AOK Rheinland/Hamburg and experience a PFF within 1 year will be consecutively included (SHI data analysis). Additionally, 700 people selected randomly from the study population will be consecutively invited to participate in the survey. Questionnaire data will be collected in the participants' private surroundings at 3, 6 and 12 months after hospital discharge. If the insured person considers themselves to be only partially or not at all able to take part in the survey, a proxy person will be interviewed where possible. SHI variables include healthcare provision, healthcare costs and clinical outcomes. Questionnaire variables include information on PROs, lifestyle characteristics and socioeconomic status. We will use multiple regression models to estimate healthcare processes and outcomes including mortality and cost, investigate predictors, perform non-responder analysis and develop an algorithm to identify vulnerable subgroups. ETHICS AND DISSEMINATION The study was approved by the ethics committee of the Faculty of Medicine, Heinrich-Heine-University Düsseldorf (approval reference 6128R). All participants including proxies providing written and informed consent can withdraw from the study at any time. The study findings will be disseminated through scientific journals and public information. TRIAL REGISTRATION NUMBER DRKS00012554.
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Affiliation(s)
- Silke Andrich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Michaela Ritschel
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, Institute for Health and Nursing Sciences, Medical Faculty, Halle (Saale), Germany
| | - Falk Hoffmann
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
| | - Astrid Stephan
- Martin Luther University Halle-Wittenberg, Institute for Health and Nursing Sciences, Medical Faculty, Halle (Saale), Germany
| | - Marion Baltes
- Martin Luther University Halle-Wittenberg, Institute for Health and Nursing Sciences, Medical Faculty, Halle (Saale), Germany
| | - Juliane Blessin
- Martin Luther University Halle-Wittenberg, Institute for Health and Nursing Sciences, Medical Faculty, Halle (Saale), Germany
| | - Kathrin Jobski
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
| | - Alexander M Fassmer
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
| | - Burkhard Haastert
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- mediStatistica, Neuenrade, Germany
| | - Veronika Gontscharuk
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Werner Arend
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Lena Theunissen
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Denise Colley
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Raoul Hinze
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Simon Thelen
- Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Germany
| | - Petra Fuhrmann
- Department Health Policy – Health Economics – Press Relations, AOK Rheinland/Hamburg, Düsseldorf, Germany
| | - Christian G G Sorg
- Department Health Policy – Health Economics – Press Relations, AOK Rheinland/Hamburg, Düsseldorf, Germany
| | - Joachim Windolf
- Department of Trauma and Hand Surgery, University Hospital Düsseldorf, Germany
| | - Christoph J Rupprecht
- Department Health Policy – Health Economics – Press Relations, AOK Rheinland/Hamburg, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Orwig D, Hochberg MC, Gruber-Baldini AL, Resnick B, Miller RR, Hicks GE, Cappola AR, Shardell M, Sterling R, Hebel JR, Johnson R, Magaziner J. Examining Differences in Recovery Outcomes between Male and Female Hip Fracture Patients: Design and Baseline Results of a Prospective Cohort Study from the Baltimore Hip Studies. J Frailty Aging 2019; 7:162-169. [PMID: 30095146 DOI: 10.14283/jfa.2018.15] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Incidence of hip fractures in men is expected to increase, yet little is known about consequences of hip fracture in men compared to women. It is important to investigate differences at time of fracture using the newest technologies and methodology regarding metabolic, physiologic, neuromuscular, functional, and clinical outcomes, with attention to design issues for recruiting frail older adults across numerous settings. OBJECTIVES To determine whether at least moderately-sized sex differences exist across several key outcomes after a hip fracture. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study (Baltimore Hip Studies 7th cohort [BHS-7]) was designed to include equal numbers of male and female hip fracture patients to assess sex differences across various outcomes post-hip fracture. Participants were recruited from eight hospitals in the Baltimore metropolitan area within 15 days of admission and were assessed at baseline, 2, 6 and 12 months post-admission. MEASUREMENTS Assessments included questionnaire, functional performance evaluation, cognitive testing, measures of body composition, and phlebotomy. RESULTS Of 1709 hip fracture patients screened from May 2006 through June 2011, 917 (54%) were eligible and 39% (n=362) provided informed consent. The final analytic sample was 339 (168 men and 171 women). At time of fracture, men were sicker (mean Charlson score= 2.4 vs. 1.6; p<0.001) and had worse cognition (3MS score= 82.3 vs. 86.2; p<0.05), and prior to fracture were less likely to be on bisphosphonates (8% vs. 39%; p<0.001) and less physically active (2426 kilocalories/week vs. 3625; p<0.001). CONCLUSIONS This paper provides the study design and methodology for recruiting and assessing hip fracture patients and evidence of baseline and pre-injury sex differences which may affect eventual recovery one year later.
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Affiliation(s)
- D Orwig
- Denise L. Orwig, PhD, University of Maryland School of Medicine, 660 West Redwood Street, Suite 200, Baltimore, MD 21201, Tel: 410-706-8951; Fax 410-706-4433;
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Short-Term Outcomes of Interdisciplinary Hip Fracture Rehabilitation in Frail Elderly Inpatients. Rehabil Res Pract 2019; 2018:1708272. [PMID: 30693110 PMCID: PMC6332931 DOI: 10.1155/2018/1708272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/13/2018] [Indexed: 11/21/2022] Open
Abstract
Objective To investigate short-term outcomes of an interdisciplinary rehabilitation program for elderly inpatients who underwent surgical treatment for hip fractures. Methods This is a prospective cohort study of fifty older inpatients who were admitted to a geriatric rehabilitation unit. Clinical and functional outcomes were assessed at admission, at discharge, and one month postdischarge. Results Patients mean age was 84.1 ± 4.7 years. Proportions of study population with risk factors of frailty were cognitive impairment (64%), Charlson comorbidity index > 1 (72%), and protein malnutrition (59.2%). Before fracture, Barthel median was 90 (IQR 85, 100), and functional ambulation classification (FAC) score was ≥ 4 for 90% of study participants. One month after concluding rehabilitation, Barthel median was 80, 1 month postdischarge FAC ≥ 4 – prefracture FAC ≥ 4 mean change was – 8% (95% CI, -21.5%, 3.4%), and average for gait speed was 0.48 ± 0.18 m/s (95% CI, 0.43, 0.54). Significant correlation was found between admission Barthel score and 1 month postdischarge Barthel score (ρ= 0.27, p=0.05), and between prefracture FAC score and FAC score 1 month postdischarge (ρ = 0.57, p = 0.05). According to regression analysis, age, cognitive status, prefracture Barthel, prefracture FAC, type of surgery, and length of stay were associated with short-term recovery outcomes. Conclusion An early interdisciplinary rehabilitation management was insufficient to recover prefracture functional status. Future studies should investigate the best therapeutic strategies to optimize functional recovery, according to clinical and prefracture frail conditions of these patients.
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Hip fractures - Treatment and functional outcome. The development over 25 years. Injury 2018; 49:2209-2215. [PMID: 30366830 DOI: 10.1016/j.injury.2018.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 10/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Nearly 18,000 individuals suffer from hip fracture in Sweden each year. The choice in operation method for femoral neck fractures has changed over the years as well as the overall management. Functional outcome after hip fracture is affected by several factors and the overall functional level for old people in Sweden has improved over the last decades. OBJECTIVE To describe and analyse the functional outcome and choice of operation method for hip fracture patients between 1988 and 2012. PATIENTS AND METHODS All patients with cervical or trochanteric hip fracture treated at Lund University Hospital from 1988 until 2012 were collected from the National Quality Register for hip fracture patients, RIKSHÖFT. Patients younger than 50 years and those with pathological fractures were excluded. Data regarding patient characteristics, fracture type, operation method and housing, walking ability and use of walk aids prefracture and at 4-months follow-up was retrieved and analysed. RESULTS For this study 8723 patients were included with a mean age of 81.6 (men 79.3, women 82.5). The mean age significantly increased over the period studied. Sliding hip screw dominates as method of choice for the trochanteric fractures. For the cervical fractures there is a clear shift from osteosynthesis to arthroplasty. There is a significant decrease in functional outcome at follow-up compared to prefracture. No significant trend change can be seen over 25 years. Functional outcome are worse for the patients with trochanteric fracture. CONCLUSION Although there have been changes in operation methods for hip fractures and the management has developed, our study does not show any effect on functional outcome over a 25-year period. The medical condition of these patients with increasing age seems to counteract efforts to improve the care.
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Wei M, Lyu H, Huo K, Su H. Impact of Bone Fracture on Ischemic Stroke Recovery. Int J Mol Sci 2018; 19:ijms19051533. [PMID: 29786644 PMCID: PMC5983742 DOI: 10.3390/ijms19051533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 01/21/2023] Open
Abstract
Stroke is one of the most devastating complications of bone fracture, occurring in up to 4% of patients after surgical repair for hip fracture. Bone fracture and ischemic stroke have many common risk factors. The impact of bone fracture on stroke recovery has not drawn much attention in the research field. Bone fracture could occur in stroke patients at different times during the recovery phase, which steepens the trajectory of cognitive decline, greatly affects the quality of life, and causes a heavy burden on healthcare resources. In this paper, we reviewed the growing information on the pathophysiological mechanisms by which bone fracture may affect ischemic stroke recovery process.
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Affiliation(s)
- Meng Wei
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94110, USA.
| | - Haiyian Lyu
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94110, USA.
| | - Kang Huo
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94110, USA.
| | - Hua Su
- Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94110, USA.
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Ibrahim NI, Ahmad MS, Zulfarina MS, Zaris SNASM, Mohamed IN, Mohamed N, Mokhtar SA, Shuid AN. Activities of Daily Living and Determinant Factors among Older Adult Subjects with Lower Body Fracture after Discharge from Hospital: A Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15051002. [PMID: 29772744 PMCID: PMC5982041 DOI: 10.3390/ijerph15051002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/09/2018] [Accepted: 05/14/2018] [Indexed: 01/06/2023]
Abstract
Fracture is a type of musculoskeletal injury that contributes to an inability to perform daily activities. The objective of this study was to evaluate activities of daily living (ADL) of older adult patients with lower body fracture and to determine factors influencing ADL. Patient's ADL was assessed at pre-fracture, ward admission and post-discharge phases using the Katz ADL questionnaire. There were 129 subjects at pre-fracture and ward phases and 89 subjects at discharge phase. There were four independent variables; age, gender, type of fracture and ability to walk before fracture. Logistic regression models showed that 'age' and 'ability to walk before fracture' were the determinant factors of dependent for 'bathing', 'dressing' and 'toileting'. The 'ability to walk before fracture' was the determinant factor of dependent for 'transferring'. 'Age' and 'gender' were the determinant factors of dependent for 'continence', while 'age' was the determinant factor of dependent for 'feeding'. The ADL score changes were significant across the phases with a reduction in ADL score in the ward admission phase and partial increment during the post-discharge phase. There were improvements in the health outcomes of subjects aged more than 50 years old after 3 months of being discharged from the hospital. In conclusion, age, being female, having a hip fracture and using a walking aid before fracture were the determinants identified in this study.
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Affiliation(s)
- Nurul Izzah Ibrahim
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Mohd Sharkawi Ahmad
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Mohamed S Zulfarina
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Sharifah Nurul Aqilah Sayed Mohd Zaris
- Department of Orthopedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Isa Naina Mohamed
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Norazlina Mohamed
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Sabarul Afian Mokhtar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Ahmad Nazrun Shuid
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
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Alexiou KI, Roushias A, Varitimidis SE, Malizos KN. Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clin Interv Aging 2018; 13:143-150. [PMID: 29416322 PMCID: PMC5790076 DOI: 10.2147/cia.s150067] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Fractures due to fragility of the bone around the hip joint have become a major public health issue, presenting with an increasing incidence due to the growth of the elderly population. The purpose of this review was to evaluate the impact of hip fractures on the quality of life (QoL), health status (HS), functioning, and psychological parameters, and factors influencing the outcome and the appropriate interventions for improvement of elderly patients. A systematic electronic search of the relevant literature was carried out using the CINAHL, Cochrane, EMBASE, Medline (OvidSP), and PubMed databases spanning the time period from their establishment up to January 2017. Forty-nine randomized controlled trials or prospective cohort studies reporting the QoL and psychological outcomes were assessed by using standardized questionnaires. Patients with a hip fracture who were older than 65 years, were included in the analysis. In the majority of elderly patients, the hip fracture seriously affected physical and mental functioning and exerted a severe impact on their HS and health-related QoL (HRQoL). Moreover, most of the patients did not return to prefracture levels of performance regarding both the parameters. The levels of mental, physical, and nutritional status, prior to the fracture, comorbidity, and female gender, in addition to the postoperative pain, complications, and the length of hospital stay, were the factors associated with the outcome. Psychosocial factors and symptoms of depression could increase pain severity and emotional distress. For the displaced femoral neck fractures, the treatment with total hip arthroplasty or hemiarthroplasty, when compared to the treatment with internal fixation, provided a better functional outcome. Supportive rehabilitation programs, complemented by psychotherapy and nutritional supplementation prior to and after surgery, provided beneficial effects on the HS and the psychosocial dimension of the more debilitated patients’ lives. Lack of consensus concerning the most appropriate HRQoL questionnaires to screen and identify those patients with more difficulties in the psychosocial functions, demonstrates the necessity for further research to assess the newer outcome measurement tools, which might improve our understanding for better care of patients with hip fractures.
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Affiliation(s)
- Konstantinos I Alexiou
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Medical School, University of Thessaly, Larissa, Greece
| | - Andreas Roushias
- Orthopaedic Department, Apollonion Private Hospital, Nicosia, Cyprus
| | - Sokratis E Varitimidis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Medical School, University of Thessaly, Larissa, Greece
| | - Konstantinos N Malizos
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Medical School, University of Thessaly, Larissa, Greece
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Ganczak M, Chrobrowski K, Korzeń M. Predictors of a Change and Correlation in Activities of Daily Living after Hip Fracture in Elderly Patients in a Community Hospital in Poland: A Six-Month Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010095. [PMID: 29316721 PMCID: PMC5800194 DOI: 10.3390/ijerph15010095] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/27/2017] [Accepted: 01/07/2018] [Indexed: 01/13/2023]
Abstract
Objectives: The consequences of hip fractures (HFs) in elderly persons include a deterioration in functional capacity to perform activities that enable independent living. Since prior research into this issue in Central Europe is rather scant, this study sought to assess the change in activities and instrumental activities of daily living (ADL/IADL) after HF surgery among Polish patients, to study predictors of regaining pre-fracture functional status three and six months later, and to evaluate the correlation between ADL and IADL limitations over time. Methods: A prospective study was conducted between 2011 and 2013 in a tertiary hospital in Western Poland. ADL/IADL were evaluated using the Katz index and Lawton scale, respectively. Results: About half (50.8%) of 120 patients (mean age 80.1 ± SD 7.59) had cognitive impairment (CI). Patients with CI were older (p = 0.002) and had lower scores for pre-fracture ADL/IADL (p = 0.001 and p < 0.001, respectively). Six months after HF, 33.3% of patients failed to return to their pre-fracture ADL and 62.5% failed to return to pre-fracture IADL; 20% of those who could walk before HF were unable to walk after six months. The pre-fracture Spearman correlation coefficient between ADL and IADL summary scores was 0.46; it increased to 0.70 at three months after HF surgery and 0.77 at six months (p < 0.0001). Regaining ADL after six months was more likely in patients with pre-fracture intact intellectual function and independence in pre-fracture ADL; regaining IADL, in younger patients and those with higher pre-fracture IADL scores. Conclusions: Impairment in functional performance is common after HF surgery. ADL and IADL were strongly correlated in these patients, with this increasing over time. Functional outcomes after HF were more dependent on patient characteristics than treatment-related factors. Therefore, more emphasis should be directed towards the pre-fracture period and, in particular, maintaining cognitive function and preserving functional capacity in older persons at high risk of HF.
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Affiliation(s)
- Maria Ganczak
- Department of Epidemiology and Management, Faculty of Medical Sciences, Pomeranian Medical University, Zolnierska 48, 71-210 Szczecin, Poland.
| | - Krzysztof Chrobrowski
- Orthopedic Surgery and Traumatology Ward, Multidisciplinary District Hospital, Dekerta 1, 66-400 Gorzów Wlkp, Poland.
| | - Marcin Korzeń
- Department of Methods of Artificial Intelligence and Applied Mathematics, Faculty of Computer Science and Information Technology, West Pomeranian University of Technology Szczecin, Zolnierska 46, 71-210 Szczecin, Poland.
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Lee TC, Ho PS, Lin HT, Ho ML, Huang HT, Chang JK. One-Year Readmission Risk and Mortality after Hip Fracture Surgery: A National Population-Based Study in Taiwan. Aging Dis 2017; 8:402-409. [PMID: 28840055 PMCID: PMC5524803 DOI: 10.14336/ad.2016.1228] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/28/2016] [Indexed: 12/19/2022] Open
Abstract
Early readmission following hip fracture (HFx) is associated with high morbidity and mortality. We conducted a survival analysis of patients with readmission within 1 year after HFx to elucidate the trend and predictors for readmission. We used Taiwan National Health Insurance Database to recruit HFx patients who underwent operations between 2000 and 2009. Patients < 60 years; with pathological fractures; involved in major traffic accidents; with previous pelvis, femur, and hip operations; or who died during the index admission were excluded. We used the Chi-square test, logistic regression, Kaplan-Meier method, and Cox proportional hazards model to analyze variables, including age, gender, hospital stay duration, index admission time, and comorbidity on readmission. 5,442 subjects (61.2% female) met the criteria with mean age of 78.8 years. Approximately 15% and 43% HFx patients were readmitted within 30 days (early) and between 30 days and 1 year (late) after discharge, respectively. Highest readmission incidence was observed within the first 30 days. Most common causes of readmission in early and late groups were respiratory system diseases and injuries, respectively. Cox model showed male, old age, hospital stay > 9 days, Charlson Comorbidity Index ≥ 1, index admission during 2000–2003, and internal fixation of HFx were independent predictors of readmission. One-year mortality of the early and the late readmission groups was 44.9% and 32.3%, much higher than overall mortality which was 16.8%. Predictive factors for readmission within 1 year included male, old age, comorbidities, and longer hospital stay. One-year mortality in readmitted patients was significantly higher. HFx patients with these factors need careful follow-up, especially within 30 days after discharge.
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Affiliation(s)
- Tien-Ching Lee
- 1Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital.,2Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Hospital.,8Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Shan Ho
- 4Faculty of Dental Hygiene, College of Dental Medicine
| | - Hui-Tzu Lin
- 5Center of Teaching and Research, Kaohsiung Municipal Ta-Tung Hospital
| | - Mei-Ling Ho
- 1Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital.,6Department of Physiology, College of Medicine.,7Department of Orthopaedics, College of Medicine, Kaohsiung Medical University Hospital
| | - Hsuan-Ti Huang
- 3Department of Orthopaedics, Kaohsiung Medical University Hospital.,7Department of Orthopaedics, College of Medicine, Kaohsiung Medical University Hospital
| | - Je-Ken Chang
- 1Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital.,3Department of Orthopaedics, Kaohsiung Medical University Hospital.,7Department of Orthopaedics, College of Medicine, Kaohsiung Medical University Hospital
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27
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Gruber-Baldini AL, Hosseini M, Orwig D, Grattan L, Chiles Shaffer N, Hochberg M, Magaziner J. Cognitive Differences between Men and Women who Fracture their Hip and Impact on Six-Month Survival. J Am Geriatr Soc 2017; 65:e64-e69. [PMID: 28176306 DOI: 10.1111/jgs.14674] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There is limited research in cognition and its relationship to mortality after hip fracture among men compared to women. Therefore, the goals of this study were to: (1) compare men and women who fractured their hip on cognition after hospital discharge, and (2) examine the impact of cognition on the differential risk of 6-month mortality between men and women post fracture. DESIGN Prospective cohort study. SETTING Eight hospitals in Baltimore, Maryland. PARTICIPANTS Frequency matched 168 male and 171 female hip fracture patients, ages 65 or older, living in the community before fracture. MEASUREMENTS Cognition assed by Modified Mini-Mental State Examination (3MS, and derived MMSE score), Hooper Visual Organization test (HVOT), and Trail-making test (Trails A & B) within 22 days of hospital admission, and 6-month mortality. RESULTS Men had more impaired cognitive scores on 3MS, MMSE, HVOT, and Trails A (P < .05) at baseline. These statistically significant differences between men and women remained on MMSE and HVOT after controlling for pre-fracture dementia, in-hospital delirium, age, education, race, and comorbidity. Men had higher 6-month mortality rates (HR = 4.4, P < .001). Cognitive measures were also significantly associated with mortality, including 3MS, HVOT, and Trails B. Among the cognitive measures, higher 3MS was most protective for mortality (HR = 0.98, P < .001), both unadjusted and adjusted for other cognitive scales, comorbidity, delirium, and pre-existing dementia. The highest mortality was among men with 3MS<78, with 26.3% dying within 6 months. The effects of cognition on mortality did not differ by sex. CONCLUSION Men display greater levels of cognitive impairment within the first 22 days of hip fracture than women, and cognitive limitations increase the risk of mortality in both men and women.
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Affiliation(s)
| | - Mina Hosseini
- Department of Mathematics and Statistics, University of Maryland Baltimore County, Baltimore, Maryland
| | - Denise Orwig
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Lynn Grattan
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Marc Hochberg
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Jay Magaziner
- University of Maryland School of Medicine, Baltimore, Maryland
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28
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Tang VL, Sudore R, Cenzer IS, Boscardin WJ, Smith A, Ritchie C, Wallhagen M, Finlayson E, Petrillo L, Covinsky K. Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study. J Gen Intern Med 2017; 32:153-158. [PMID: 27605004 PMCID: PMC5264672 DOI: 10.1007/s11606-016-3848-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/29/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Knowledge about expected recovery after hip fracture is essential to help patients and families set realistic expectations and plan for the future. OBJECTIVES To determine rates of functional recovery in older adults who sustained a hip fracture based on one's previous function. DESIGN Observational study. PARTICIPANTS We identified subjects who sustained a hip fracture while enrolled in the nationally representative Health and Retirement Study (HRS) using linked Medicare claims. HRS interviews subjects every 2 years. Using information from interviews collected during the interview preceding the fracture and the first interview 6 or more months after the fracture, we determined the proportion of subjects who returned to pre-fracture function. MAIN MEASURES Functional outcomes of interest were: (1) ADL dependency, (2) mobility, and (3) stair-climbing ability. We examined baseline characteristics associated with a return to: (1) ADL independence, (2) walking one block, and (3) climbing a flight of stairs. KEY RESULTS A total of 733 HRS subjects ≥65 years of age sustained a hip fracture (mean age 84 ± 7 years, 77 % female). Thirty-one percent returned to pre-fracture ADL function, 34 % to pre-fracture mobility function, and 41 % to pre-fracture climbing function. Among those who were ADL independent prior to fracture, 36 % returned to independence, 27 % survived but needed ADL assistance, and 37 % died. Return to ADL independence was less likely for those ≥85 years old (26 % vs. 44 %), with dementia (8 % vs. 39 %), and with a Charlson comorbidity score >2 (23 % vs. 44 %). Results were similar for those able to walk a block and for those able to climb a flight of stairs prior to fracture. CONCLUSIONS Recovery rates are low, even among those with higher levels of pre-fracture functional status, and are worse for patients who are older, cognitively impaired, and who have multiple comorbidities.
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Affiliation(s)
- Victoria L Tang
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. .,Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA. .,Division of Hospital Medicine, Department of Medicine, Veterans Affairs Medical Center, 181G, 4150 Clement Street, San Francisco, CA, 94121, USA.
| | - Rebecca Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Irena Stijacic Cenzer
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - W John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Alex Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Christine Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Margaret Wallhagen
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Emily Finlayson
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Laura Petrillo
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Kenneth Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA
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29
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Saletti-Cuesta L, Tutton E, Langstaff D, Willett K. Understanding patient and relative/carer experience of hip fracture in acute care: A qualitative study protocol. Int J Orthop Trauma Nurs 2016; 25:36-41. [PMID: 28274778 DOI: 10.1016/j.ijotn.2016.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 08/31/2016] [Accepted: 09/05/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND This paper presents a qualitative study protocol focusing on older peoples' experience of recovery in acute care following hip fracture and also the experiences of their family or informal carers. There is limited evidence regarding older people and their relatives'/carers' experiences of recovery in acute care. AIM The study had two research questions. First what is the experience of older people who have suffered a fractured hip and secondly what is the relatives'/carers' experience of being alongside a person who has suffered a fractured hip? METHODS The methodology chosen is phenomenology using the methods of interviewing and participant observation. It is planned to recruit a purposive sample of up to 40 patients including those with memory loss who have suffered a fractured hip, and up to 30 of their relative/carers, and up to 20 staff may choose to take part in the observation sessions. Analysis will be through drawing out units of meaning, bringing them together to form categories and themes of experience. CONCLUSION This study will extend knowledge by exploring what is important to patients and their relatives/carers in the early phase of recovery. Practice based principles that can be integrated into the hip fracture pathway and enhance future care will be developed from the study findings.
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Affiliation(s)
- Lorena Saletti-Cuesta
- Culture and Society Research and Study Centre, National Scientific and Technical Research Council (CIECS-CONICET-UNC), Cordola, Argentina
| | - Elizabeth Tutton
- Kadoorie Centre for Critical Care Research and Education, Oxford University Hospitals, NHS Foundation Trust, UK; RCN Research Institute, Warwick Medical School, University of Warwick, West Midlands, CV4 8UW, UK.
| | - Debbie Langstaff
- Trauma Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, UK
| | - Keith Willett
- Kadoorie Centre for Critical Care Research and Education, Oxford University Hospitals, NHS Foundation Trust, UK; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
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30
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Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, Sherrington C. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 2016; 16:158. [PMID: 27590604 PMCID: PMC5010762 DOI: 10.1186/s12877-016-0332-0] [Citation(s) in RCA: 526] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/20/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Hip fractures are an increasingly common consequence of falls in older people that are associated with a high risk of death and reduced function. This review aims to quantify the impact of hip fracture on older people's abilities and quality of life over the long term. METHODS Studies were identified through PubMed and Scopus searches and contact with experts. Cohort studies of hip fracture patients reporting outcomes 3 months post-fracture or longer were included for review. Outcomes of mobility, participation in domestic and community activities, health, accommodation or quality of life were categorised according to the World Health Organization's International Classification of Functioning and synthesised narratively. Risk of bias was assessed according to four items from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. RESULTS Thirty-eight studies from 42 publications were included for review. Most followed a clearly defined sample from the time of fracture. Hip fracture survivors experienced significantly worse mobility, independence in function, health, quality of life and higher rates of institutionalisation than age matched controls. The bulk of recovery of walking ability and activities for daily living occurred within 6 months after fracture. Between 40 and 60 % of study participants recovered their pre-fracture level of mobility and ability to perform instrumental activities of daily living, while 40-70 % regained their level of independence for basic activities of daily living. For people independent in self-care pre-fracture, 20-60 % required assistance for various tasks 1 and 2 years after fracture. Fewer people living in residential care recovered their level of function than those living in the community. In Western nations, 10-20 % of hip fracture patients are institutionalised following fracture. Few studies reported impact on participation in domestic, community, social and civic life. CONCLUSIONS Hip fracture has a substantial impact on older peoples' medium- to longer-term abilities, function, quality of life and accommodation. These studies indicate the range of current outcomes rather than potential improvements with different interventional approaches. Future studies should measure impact on life participation and determine the proportion of people that regain their pre-fracture level of functioning to investigate strategies for improving these important outcomes.
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Affiliation(s)
- Suzanne M. Dyer
- Department of Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, Adelaide, Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, Adelaide, Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia
| | - Nicola Fairhall
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Jay Magaziner
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, USA
| | - Lauren A. Beaupre
- Departments of Physical Therapy and Surgery (Division of Orthopaedic Surgery), University of Alberta, Edmonton, Canada
| | - Ian D. Cameron
- Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, St Leonards, Australia
| | - Catherine Sherrington
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - for the Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group
- Department of Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, Adelaide, Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, USA
- Departments of Physical Therapy and Surgery (Division of Orthopaedic Surgery), University of Alberta, Edmonton, Canada
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, St Leonards, Australia
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31
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Lockwood KJ, Taylor NF, Boyd JN, Harding KE. Pre-discharge home visits by occupational therapists completed for patients following hip fracture. Aust Occup Ther J 2016; 64:41-48. [DOI: 10.1111/1440-1630.12311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Kylee J. Lockwood
- School of Allied Health; La Trobe University; Melbourne Victoria Australia
- Allied Health Clinical Research Office; Eastern Health; Melbourne Victoria Australia
| | - Nicholas F. Taylor
- School of Allied Health; La Trobe University; Melbourne Victoria Australia
- Allied Health Clinical Research Office; Eastern Health; Melbourne Victoria Australia
| | - Jude N. Boyd
- Department of Occupational Therapy; Eastern Health; Melbourne Victoria Australia
| | - Katherine E. Harding
- Allied Health Clinical Research Office; Eastern Health; Melbourne Victoria Australia
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32
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McGilton KS, Chu CH, Naglie G, van Wyk PM, Stewart S, Davis AM. Factors Influencing Outcomes of Older Adults After Undergoing Rehabilitation for Hip Fracture. J Am Geriatr Soc 2016; 64:1601-9. [PMID: 27351370 PMCID: PMC6680258 DOI: 10.1111/jgs.14297] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objectives To determine the contribution of cognitive impairment, prefracture functional impairment, and treatment as predictors of functional status and mobility 6 months after discharge from rehabilitation for older adults with hip fracture. Design Longitudinal. Setting Inpatient rehabilitation units of two community hospitals. Participants Adults with hip fractures aged 65 and older who were discharged from a rehabilitation unit and had been living in the community before the fracture (N = 133). Measurements Mini‐Mental State Examination (MMSE) score at discharge from rehabilitation was used to identify the presence and severity of cognitive impairment. Outcomes were measured using questions from two subscales of the Functional Independence Measure (Self‐Care Function and Functional Mobility) and the New Mobility Scale (NMS). Measurements were made at discharge from a rehabilitation setting and 3 and 6 months after discharge. Results Prefracture functional impairment was associated with worse outcomes throughout the 6 months after discharge and with lower rates of improvement, or in some cases decline, after discharge. Cognitive impairment was associated with worse outcomes throughout the 6 months after discharge but was only weakly associated with lower rates of improvement or decline. The Patient Centered Rehabilitation Model of care targeting persons with cognitive impairment (PCRM‐CI) intervention group had higher NMS scores after discharge than a usual care group. Conclusion Although cognitive impairment and prefracture functional impairment contribute to poor outcomes, prefracture functional impairment was more strongly associated with poor outcomes than cognitive impairment. There is evidence to show that individuals with cognitive impairment are able to regain their mobility, which suggests a need for postdischarge targeted interventions that include a focus on activities of daily living for older adults with cognitive impairment and functional impairment to stabilize gains from inpatient rehabilitation.
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Affiliation(s)
- Katherine S McGilton
- Department of Research, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario
| | - Charlene H Chu
- Department of Research, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario
| | - Gary Naglie
- Department of Research, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario.,Department of Medicine, University of Toronto, Toronto, Ontario.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.,Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario
| | - Paula M van Wyk
- Department of Kinesiology, University of Windsor, Windsor, Ontario
| | - Steven Stewart
- Department of Research, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario
| | - Aileen M Davis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.,Division of Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario.,Department of and Physical Therapy, University of Toronto, Toronto, Ontario.,Rehabilitation Science Institute, University of Toronto, Toronto, Ontario
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33
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Vorontsova TN, Bogopol’skaya AS, Cherny AZ, Shevchenko SB. COHORT STRUCTURE OF PATIENTS WITH PROXIMAL FEMUR FRACTURES AND ESTIMATION OF AVERAGE ANNUAL DEMAND FOR EMERGENCY SURGICAL TREATMENT. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2016. [DOI: 10.21823/2311-2905-2016-0-1-7-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The aim of this study is to examine cohort structure of patients with proximal femoral fractures (PFF) and estimate an average annual demand in emergency surgical treatment for St. Petersburg adult population with mentioned diagnosis. Material and methods. The authors examined case histories and radiographs of 1412 adult patients with proximal femur fractures admitted to three St. Petersburg large general hospitals during one year. Analysis was done using statistical and expert evaluation methods.Results. Cohort structure of patients with PFF demonstrated the following distribution: female – 71,7%, male – 28,3%; Patients of elderly group prevailed: 70 years and older – 70,6%, 60–69 years old – 12%, 50–59 years old – 10,8%; Retirees with various disability status – 80%. Injury structure showed prevalence of femoral neck fractures –52%, pertrochanteric fractures represented 42%, subtrochanteric fractures – 5%. 11,3 days was the average time span from injury till surgery. The authors separately estimated urgent surgical treatment demand for patients with femoral neck fractures and patients with trochanteric fractures. Consequently, both groups results were summed up to generate the total average annual demand for emergency operative treatment for PFF which for adult population of St. Petersburg amounted to 4098 interventions, meaning one surgery per one thousand of adults.Conclusions. Absence of a common consistent approach to treatment of patients with proximal femur fractures as well as significant variance among St. Petersburg hospitals in respect of material, technical and staff resources result in a situation when not every patient with PFF undergoes surgical treatment. There is a strong need to develop and regulate implementation of a standardized treatment algorithm for such injuries, to improve infrastructure and resources of St. Petersburg general hospitals as well as to continuously monitor quality of medical treatment for patients with PFF.
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Kastanis G, Topalidou A, Alpantaki K, Rosiadis M, Balalis K. Is the ASA Score in Geriatric Hip Fractures a Predictive Factor for Complications and Readmission? SCIENTIFICA 2016; 2016:7096245. [PMID: 27293978 PMCID: PMC4880678 DOI: 10.1155/2016/7096245] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 04/19/2016] [Indexed: 05/26/2023]
Abstract
Hip fractures are the second cause of hospitalization in geriatric patients. The American Society of Anesthesiologists (ASA) classification scheme is a scoring system for the evaluation of the patients' health and comorbidities before an operative procedure. The purpose of this study was to determine whether the ASA score is a predictive factor for perioperative and postoperative complications and a cause of readmission of geriatric patients with hip fractures. The study included 198 elderly patients. The mean values of hospitalization were 6.4 ± 2.1 days for the patients with ASA II, 10.4 ± 3.4 days for the patients with ASA III, and 13.5 ± 4.4 days for the patients with ASA IV. The patients with ASA II exhibited minor complications, while patients with ASA III presented cutaneous ulcer and respiratory dysfunction. Five patients with ASA IV had pulmonary embolism, two patients had myocardial infarction, and three patients died. The ASA score seems to have direct correlation with multiple factors, such as the hospitalization days, the severity of the complications, and the total hospitalization costs. The treatment of geriatrics hip fractures in patients with a high ASA score requires a multidisciplinary approach and a special assessment in order to decrease postoperative morbidity and mortality and offer optimal functionality.
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Affiliation(s)
- G. Kastanis
- Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Crete, Greece
| | - A. Topalidou
- Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Crete, Greece
| | - K. Alpantaki
- Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Crete, Greece
| | - M. Rosiadis
- Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Crete, Greece
| | - K. Balalis
- Department of Orthopaedics and Traumatology, University Hospital of Heraklion, Faculty of Medicine, University of Crete, Crete, Greece
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Hayashi H, Iwai M, Matsuoka H, Nakashima D, Nakamura S, Kubo A, Tomiyama N. Factors affecting the discharge destination of hip fracture patients who live alone and have been admitted to an inpatient rehabilitation unit. J Phys Ther Sci 2016; 28:1228-32. [PMID: 27190457 PMCID: PMC4868217 DOI: 10.1589/jpts.28.1228] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 12/26/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] (1) The aim of this study was to examine relations between clinical and
functional assessment and discharge destination and (2) to identify the optimal cutoff
point for estimating discharge to home after inpatient rehabilitation. [Subjects] The
subjects were 54 hip fracture patients (15 males, 39 females; mean age 81.3 ± 7.4 years)
living alone. [Methods] The patients were classified into two groups: those discharged to
home and those admitted to an institution. Age, gender, side of fracture, fracture type,
number of comorbidities, Functional Independence Measure motor score, and Functional
Independence Measure cognitive score were compared between groups. Multiple logistic
regression analysis was conducted with discharge to home as the dependent variable and
age, gender, side of fracture, fracture type, number of comorbidities, Functional
Independence Measure motor score, and Functional Independence Measure cognitive score as
independent variables. A receiver operating characteristic curve analysis was used to
identify a cutoff point for classification of the patients into the two groups. [Results]
Multiple logistic regression analysis showed that the Functional Independence Measure
cognitive score was a significant variable affecting the discharge destination. The
receiver operating characteristic curve analysis revealed that discharge to home was
predicted accurately by a Functional Independence Measure cognitive score of 23.5.
[Conclusion] Information from this study is expected to be useful for determining
discharge plans and for the setting of treatment goals.
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Affiliation(s)
| | - Midori Iwai
- Department of Rehabilitation, Tokai Memorial Hospital, Japan
| | - Hiroka Matsuoka
- Department of Rehabilitation, Tokai Memorial Hospital, Japan
| | - Daiki Nakashima
- Department of Rehabilitation, Tokai Memorial Hospital, Japan
| | - Shugo Nakamura
- Department of Rehabilitation, Tokai Memorial Hospital, Japan
| | - Ayumi Kubo
- Department of Rehabilitation, Tokai Memorial Hospital, Japan
| | - Naoki Tomiyama
- Faculty of Care and Rehabilitation, Seijoh University, Japan
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Flodin L, Cederholm T, Sääf M, Samnegård E, Ekström W, Al-Ani AN, Hedström M. Effects of protein-rich nutritional supplementation and bisphosphonates on body composition, handgrip strength and health-related quality of life after hip fracture: a 12-month randomized controlled study. BMC Geriatr 2015; 15:149. [PMID: 26572609 PMCID: PMC4647612 DOI: 10.1186/s12877-015-0144-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 11/02/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The catabolic state that follows hip fracture contributes to loss of muscle mass and strength, that is sarcopenia, which impacts functional ability and health-related quality of life. Measures to prevent such long-term postoperative consequences are of important concern. The aim of this study was to evaluate the combined effects of protein-rich nutritional supplementation and bisphosphonate on body composition, handgrip strength and health-related quality of life following hip fracture. METHODS The study included 79 men and women with hip fracture, mean age 79 years (SD 9), without severe cognitive impairment, who were ambulatory and living independently before fracture. Patients were randomized postoperatively to receive liquid supplementation that provided 40 g of protein and 600 kcal daily for six months after the fracture, in addition to bisphosphonates once weekly for 12 months (group N, n = 26), or bisphosphonates alone once weekly for 12 months (group B, n = 28). All patients, including the controls (group C, n = 25) received calcium 1 g and vitamin D3 800 IU daily. Body composition as measured by dual-energy X-ray absorptiometry (DXA), handgrip strength (HGS) and health-related quality of life (HRQoL) were registered at baseline, six and 12 months postoperatively. RESULTS There were no differences among the groups regarding change in fat-free mass index (FFMI), HGS, or HRQoL during the study year. Intra-group analyses showed improvement of HGS between baseline and six months in the N group (P = 0.04). HRQoL decreased during the first year in the C and B groups (P = 0.03 and P = 0.01, respectively) but not in the nutritional supplementation N group (P = 0.22). CONCLUSIONS Protein-rich nutritional supplementation was unable to preserve FFMI more effectively than vitamin D and calcium alone, or combined with bisphosphonate, in this relatively healthy group of hip fracture patients. However, trends toward positive effects on both HGS and HRQoL were observed following nutritional supplementation. TRIAL REGISTRATION Clinicaltrials.gov NCT01950169 (Date of registration 23 Sept 2013).
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Affiliation(s)
- Lena Flodin
- Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden. .,Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm, Sweden.
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
| | - Maria Sääf
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden.
| | - Eva Samnegård
- Division of Orthopedics, Department of Clinical Science, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
| | - Wilhelmina Ekström
- Karolinska Institutet, Department of Molecular Medicine and Surgery, Section of Orthopedics and Sports Medicine, Karolinska University Hospital, Stockholm, Sweden.
| | - Amer N Al-Ani
- Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden. .,Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm, Sweden.
| | - Margareta Hedström
- Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden. .,Karolinska Institutet, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm, Sweden.
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The relevance of gender in the care of hip fracture patients. Int J Orthop Trauma Nurs 2015; 22:3-12. [PMID: 27215748 DOI: 10.1016/j.ijotn.2015.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/26/2015] [Accepted: 10/28/2015] [Indexed: 01/10/2023]
Abstract
As in many conditions, gender interplays with other social structures of inequality to impact upon women's and men's health and healthcare. This narrative review examines knowledge about sex, gender and hip fracture and suggests ways of highlighting the influence of gender in hip fracture healthcare. These will be considered in relation to two areas. Firstly the multifactorial dimension of hip fractures which identifies ethnicity, marital status, lifestyle, co-morbidities, environment in relation to falls and osteoporosis as important factors influencing the experience of hip fracture. Secondly the importance of acknowledging gender as a key element within research and management of care. Implications for practice are that we need a raised awareness of gender when we assess and care for patients, to ask critical questions about the gender bias in the evidence we use and reflect on how services and care practices may be biased towards gendered assumptions.
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Jones CA, Jhangri GS, Feeny DH, Beaupre LA. Cognitive Status at Hospital Admission: Postoperative Trajectory of Functional Recovery for Hip Fracture. J Gerontol A Biol Sci Med Sci 2015; 72:61-67. [DOI: 10.1093/gerona/glv138] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 07/20/2015] [Indexed: 11/13/2022] Open
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Ekström W, Samuelsson B, Ponzer S, Cederholm T, Thorngren KG, Hedström M. Sex effects on short-term complications after hip fracture: a prospective cohort study. Clin Interv Aging 2015; 10:1259-66. [PMID: 26347328 PMCID: PMC4531035 DOI: 10.2147/cia.s80100] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives To evaluate potential sex differences and other factors associated with complications within 4 months after a hip fracture. Methods A total of 1,915 patients ≥65 years (480 men) with hip fracture were consecutively included in a prospective multicenter cohort study. A review of medical records and patient interviews according to a study protocol based on the Standardized Audit of Hip Fractures in Europe (SAHFE, RIKSHÖFT) was performed. Sex differences in comorbidity according to the American Society of Anesthesiologists score and complications 4 months after a hip fracture were registered. Multivariate logistic regression analysis was performed to identify factors related to complications. Results Male sex was associated with worse general health according to the American Society of Anesthesiologists classification (P=0.005) and with more comorbidities (P<0.001). Male sex emerged as a risk factor for developing pneumonia (P<0.001), and additionally, 18% of the men suffered from cardiac complications compared with 13% of the females (P=0.018). Female sex was predisposed for urinary tract infections, 30% vs 23% in males (P=0.001). Mortality was higher in the male vs female group, both within 30 days (15% vs 10%, P=0.001) and at 4 months (24% vs 14%, P=0.001). Conditions associated with pneumonia were male sex, pulmonary disease, and cognitive impairment. Cardiac complications were associated with delayed surgery and cardiovascular and pulmonary disease. Conclusion Before surgery, men with hip fracture already have a poorer health status and higher comorbidity rate than women, thus resulting in a twofold increased risk of pneumonia. Cognitive dysfunction and pulmonary disease contributed to pneumonia in men. Delayed surgery seems to increase the risk for cardiac complications. It is important to consider the sex perspective early on together with cardiopulmonary comorbidity and cognitive dysfunction to be able to counteract serious complications that may lead to death.
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Affiliation(s)
- Wilhelmina Ekström
- Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
| | - Bodil Samuelsson
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Södersjukhuset, Stockholm, Sweden
| | - Sari Ponzer
- Department of Clinical Science and Education, Section of Orthopaedics, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Uppsala University Hospital, Uppsala, Sweden ; Department of Geriatrics, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Karl-Göran Thorngren
- Department of Clinical Sciences, Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Margareta Hedström
- Department of Orthopaedics, Institute of Clinical Science, Intervention and Technology (CLINTEC), Karolinska University Hospital, Huddinge, Stockholm, Sweden
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Beaupre LA, Carson JL, Noveck H, Magaziner J. Recovery of Walking Ability and Return to Community Living within 60 Days of Hip Fracture Does Not Differ Between Male and Female Survivors. J Am Geriatr Soc 2015. [PMID: 26200232 DOI: 10.1111/jgs.13535] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare risk-adjusted differences between men and women 30 and 60 days after hip fracture surgery in not walking, ability to return home in a community-dwelling subset, not walking in a nursing home resident subset, and mortality within 60 days. DESIGN Cohort study. SETTING Data were from a randomized clinical trial that compared two blood transfusion protocols after hip fracture. PARTICIPANTS Individuals with hip fracture (N = 2,016; 489 (24%) male). MEASUREMENTS Walking, dwelling, and mortality were determined in telephone follow-up 30 and 60 days after randomization, which occurred within 3 days of surgery. Sex differences for each outcome were compared using univariate and multivariate regression adjusting for potential confounders. RESULTS Men were younger (P < .001) and more likely to have comorbidity (P = .003) than women at the time of hip fracture and to die within 60 days, even after risk adjustment (odds ratio (OR) = 1.76, 95% confidence interval (CI) = 1.15-2.69). After risk adjustment, male survivors were as likely as female survivors not to walk (OR = 1.03, 95% CI = 0.78-1.34) and no less likely to return home (OR = 0.90, 95% CI = 0.69-1.17) 60 days after hip fracture. No differences were noted between male and female nursing home residents in not walking within 60 days (OR = 0.95, 95% CI = 0.32-2.86). CONCLUSION Although men experience higher mortality, male survivors can expect recovery of walking ability similar to that of female survivors and are as likely to return to community living.
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Affiliation(s)
- Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey L Carson
- Rutgers Biomedical Health Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Helaine Noveck
- Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jay Magaziner
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
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Córcoles-Jiménez MP, Villada-Munera A, Del Egido-Fernández MÁ, Candel-Parra E, Moreno-Moreno M, Jiménez-Sánchez MD, Piña-Martínez A. Recovery of activities of daily living among older people one year after hip fracture. Clin Nurs Res 2015; 24:604-23. [PMID: 25796268 DOI: 10.1177/1054773815573261] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article aims to determine the functional recovery of older people, who were previously independent in activities of daily living (ADLs) and without cognitive impairment, in the year following a fall-related hip fracture. A cohort study was carried out among patients admitted to University General Hospital of Albacete (Spain). Consecutive sampling was performed. Variables included demographic, habitual residence, type of hip fracture, mental status (Short Portable Mental Status Questionnaire [SPMSQ] Pfeiffer), and independence in ADLs (according to the Barthel Index [BI]) prior to the fall and after the fracture. For 205 patients, 1 year after surgery, the mean BI score was 78.09 (SD = 25.13); (vs. 90.02 before the hip fracture), 59% showed urinary continence (vs. 79%), and 65% walked without assistance (vs. 82%). Regarding predictors of recovery, results indicate that patients who are older, who suffer complications after hospital discharge, or who reside in nursing homes experience poorer recovery in ADLs. Only 47.9% of the patients regained prior levels of autonomy 1 year after surgery.
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Inngul C, Enocson A. Postoperative periprosthetic fractures in patients with an Exeter stem due to a femoral neck fracture: cumulative incidence and surgical outcome. INTERNATIONAL ORTHOPAEDICS 2014; 39:1683-8. [PMID: 25341951 DOI: 10.1007/s00264-014-2570-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 10/06/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study is to report on the cumulative incidence and the outcome of surgically-treated postoperative PPFs in patients with femoral neck fractures treated with a THA or HA using an Exeter stem. METHODS A consecutive series of patients operated during 1998-2010 due to a non-pathological femoral neck fracture using an Exeter stem were included in this cohort study. Patients were followed until 2012, or death, in order to obtain information about reoperations due to postoperative PPFs, and subsequent re-operations after surgery due to PPFs. In addition to local audit data the Swedish National Board of Health and Welfare's registry was used to identify patients who had been re-operated upon elsewhere in Sweden. RESULTS A total of 2,757 patients (median age 82 years, 2,019 females) were identified and included in the study. Of these patients, 63 (2.3%) sustained a postoperative PPF that was treated surgically. The majority of the Vancouver B1 (n = 21/23) and C (n = 14/14) fractures were treated using open reduction and internal fixation (ORIF), whereas most of the B2 (n = 16/25) fractures and the only B3 fracture were treated with stem revision. Three (4.8%) patients were subsequently re-operated upon due to fracture-related complications, all B2 fractures, and were treated with ORIF (n = 2) or stem revision (n = 1). CONCLUSION The cumulative incidence of surgically treated PPFs was considerable among patients with Exeter stems operated due to a femoral neck fracture. The re-operation rate due to fracture-related complications was highest among patients with B2 fractures.
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Affiliation(s)
- Christian Inngul
- Department of Clinical Science and Education, Section of Orthopaedics, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden,
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Mundi S, Chaudhry H, Bhandari M. Systematic review on the inclusion of patients with cognitive impairment in hip fracture trials: a missed opportunity? Can J Surg 2014; 57:E141-5. [PMID: 25078940 DOI: 10.1503/cjs.023413] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND More than 320 000 hip fractures occur annually in North America. An estimated 30% of this population have cognitive impairment. We sought to determine the extent to which patients with cognitive impairment or dementia have been included in randomized controlled trials (RCTs) assessing hip fracture management. METHODS We conducted a systematic search of 3 electronic journal databases of articles published between January 2000 and June 2010. Studies were screened in duplicate to collect English-language RCTs assessing operative interventions for femoral head, neck or intertrochanteric fractures. We systematically collected descriptive data and used the χ(2) test for comparison between groups as appropriate. RESULTS We screened 1201 abstracts, 72 of which were eligible for inclusion in our review. Femoral neck and intertrochanteric fractures were equally represented. Thirty-three (46%) studies did not report the inclusion or exclusion of patients with cognitive impairment. Nineteen (26%) studies explicitly included cognitively impaired patients, whereas 20 (28%) excluded them. Only 2 trials (3%) reported outcomes specific to cognitively impaired patients. Fourteen trials (19.4%) reported the use of a validated cognitive assessment tool. None of the trials that reported inclusion of cognitively impaired patients were from North American centres. CONCLUSION One in 3 patients with hip fractures have concomitant cognitive impairment, yet 8 of 10 hip fracture trials excluded or ignored this population. The ambiguity or exclusion of these patients misses an opportunity to study outcomes and identify factors associated with improved prognosis.
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Affiliation(s)
- Simran Mundi
- The Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ont
| | - Harman Chaudhry
- The Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ont
| | - Mohit Bhandari
- The Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ont
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Löfgren S, Hedström M, Ekström W, Lindberg L, Flodin L, Ryd L. Power to the patient: care tracks and empowerment a recipe for improving rehabilitation for hip fracture patients. Scand J Caring Sci 2014; 29:462-9. [DOI: 10.1111/scs.12157] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/19/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Susanne Löfgren
- Department of Learning, Informatics, Management and Ethics (LIME); Medical Management Center; Karolinska Institutet; Stockholm Sweden
| | - Margareta Hedström
- Division of Orthopaedics and Biotechnology; Department of Clinical Science, Intervention and Technology (CLINTEC); Karolinska Institutet; Stockholm Sweden
| | - Wilhelmina Ekström
- Division of Orthopedics and Technology; Department of Molecular Medicine and Surgery; Section of Orthopaedics and Sports Medicine; Karolinska Institutet; Stockholm Sweden
| | - Lene Lindberg
- Department of Public Health Science; Karolinska Institutet; Stockholm Sweden
| | - Lena Flodin
- Division of Orthopaedics and Biotechnology; Department of Clinical Science, Intervention and Technology (CLINTEC); Karolinska Institutet; Stockholm Sweden
| | - Leif Ryd
- Department of Learning, Informatics, Management and Ethics (LIME); Medical Management Center; Karolinska Institutet; Stockholm Sweden
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Internal fixation versus cemented hemiarthroplasty for displaced femoral neck fractures in patients with severe cognitive dysfunction: a randomized controlled trial. J Orthop Trauma 2013; 27:690-5. [PMID: 23515127 DOI: 10.1097/bot.0b013e318291f544] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare the outcome of internal fixation (IF) versus a cemented hemiarthroplasty (HA) in patients with a displaced femoral neck fracture and a severe cognitive dysfunction. DESIGN A prospective randomized controlled trial. SETTING A tertiary care university hospital. PATIENTS Sixty patients with a displaced femoral neck fracture were randomized to IF (n = 30) or HA (n = 30). All patients suffered from severe cognitive dysfunction but were able to walk before the fracture. INTERVENTION IF using 2 cannulated screws or HA using a cemented Exeter unipolar arthroplasty. MAIN OUTCOME MEASUREMENTS Patients were reviewed at 4, 12, and 24 months after the fracture. Outcome assessments included complications, reoperations, hip function (Charnley score), and health-related quality of life (EQ-5Dindex score). RESULTS A total of 8 patients were reoperated (14%); 7 in the IF group and 1 in the HA group. The EQ-5Dindex score at the follow-ups were generally lower in the IF group compared with the HA group with a significant difference at 12 months (P = 0.03). No difference was seen in hip function, general complications, or mortality between the groups. CONCLUSIONS HA seems to provide a safe option with better health-related quality of life and less risk for reoperations compared with IF for these patients. LEVEL OF EVIDENCE Therapeutic level II.
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Shyu YIL, Tseng MY, Liang J, Tsai WC, Wu CC, Cheng HS. Interdisciplinary intervention decreases cognitive impairment for older Taiwanese with hip fracture: 2-year follow-up. Int J Geriatr Psychiatry 2013; 28:1222-31. [PMID: 23504666 DOI: 10.1002/gps.3945] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 01/22/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Few studies describe the trajectories of cognitive function for hip-fracture patients following hospital discharge and the treatment effects of interdisciplinary intervention on cognitive outcomes. The purpose of this study was to explore the 2-year postoperative trajectory for cognitive function of older hip-fracture patients and cognitive effects of an interdisciplinary intervention. METHODS Of 160 subjects randomly assigned to groups, 29 (35.8%) in the control group (n = 81) and 30 (38.0%) in the intervention group (n = 79) were cognitively impaired at admission. The intervention group received geriatric consultation, continuous rehabilitation, and discharge planning. Subjects' cognitive function was measured using the mini mental state examination Taiwan version at admission, 6, 12, 18, and 24 months after discharge and analyzed using hierarchical generalized linear models. RESULTS Patients who received the intervention program had 75% less likelihood of being cognitively impaired 6 months following discharge than those who received routine care (odds ratio = 0.25, p < 0.001). The difference between the control and intervention groups was small at admission, peaked at 18 months, and decreased from 18 to 24 months following discharge. CONCLUSIONS Our interdisciplinary intervention improved the long-term postoperative cognitive functioning of older persons with hip fracture in Taiwan.
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Affiliation(s)
- Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
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Mizrahi EH, Arad M, Fleissig Y, Adunsky A. Gender differences in functional outcome of elderly hip fracture patients. Geriatr Gerontol Int 2013; 14:845-50. [DOI: 10.1111/ggi.12178] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Eliyahu-Hayim Mizrahi
- Department of Geriatric Medicine and Rehabilitation; Shmuel Harofe Hospital; Beer-Yaakov Israel
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Marina Arad
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Geriatric Medicine and Rehabilitation; Sheba Medical Center; Ramat-Gan Israel
| | - Yehudit Fleissig
- Department of Geriatric Medicine and Rehabilitation; Shmuel Harofe Hospital; Beer-Yaakov Israel
| | - Abraham Adunsky
- The Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Geriatric Medicine and Rehabilitation; Sheba Medical Center; Ramat-Gan Israel
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48
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Acute confusion states, pain, health, functional status and quality of care among patients with hip fracture during hospital stay. Int J Orthop Trauma Nurs 2013. [DOI: 10.1016/j.ijotn.2012.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Menzies IB, Mendelson DA, Kates SL, Friedman SM. Prevention and clinical management of hip fractures in patients with dementia. Geriatr Orthop Surg Rehabil 2013; 1:63-72. [PMID: 23569664 DOI: 10.1177/2151458510389465] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hip fractures and dementia increase exponentially with age, and patients who are afflicted by both conditions suffer significant morbidity and mortality. The aging of our population heightens the need to recognize the interaction of these conditions in order to improve our efforts to prevent hip fractures, provide acute care that improves outcomes, and provide secondary prevention and rehabilitation that returns patients to their previous level of functioning. Identification and treatment of vitamin D deficiency and osteoporosis and assessment and interventions to reduce falls in patients with dementia can significantly impact the incidence of first and subsequent hip fractures. Acute management of hip fractures that focuses on comanagement by orthopedic surgeons and geriatricians and uses protocol-driven geriatric-focused care has been shown to decrease mortality, length of hospitalization, readmission rates, and complications including delirium. Patients with mild-to-moderate dementia benefit from intensive geriatric rehabilitation to avoid nursing home placement. Recognizing the need to optimize primary and secondary prevention of hip fractures in patients with dementia and educating providers and families will lead to improved quality of life for patients affected by dementia and hip fractures.
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Affiliation(s)
- Isaura B Menzies
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Abstract
SummaryHip fracture is a common and potentially devastating injury that occurs mainly in older people. The incidence is predicted to rise by 30% in the next 10 years alone. Many of those who recover suffer a loss of mobility and independence. There is growing emphasis to improve the care of patients sustaining hip fracture, especially in those with concurrent cognitive impairment. This review focuses on current best practice as well as several key areas of management, including analgesia, anaemia and nutrition. In doing so, we hope to identify interventions that may form the basis of a future Enhanced Recovery Pathway dedicated to hip fracture care.
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