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Jaatinen R, Luukkaala T, Helminen H, Hongisto MT, Viitanen M, Nuotio MS. Prevalence and prognostic significance of depressive symptoms in a geriatric post-hip fracture assessment. Aging Ment Health 2022; 26:1837-1844. [PMID: 34727812 DOI: 10.1080/13607863.2021.1998357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate the prevalence and prognostic significance of post-hip fracture depressive symptoms. METHODS A naturalistic clinical cohort study. Data were collected on admission to hospital, geriatric assessment 4-6 months post-fracture and by telephone interview one-year post fracture. Depressive symptoms were assessed at the geriatric assessment using the 15-item Geriatric Depression Scale (GDS-15). Logistic regression analyses with multivariable models were conducted to examine the association of depressive symptoms with changes in mobility and living arrangements and Cox proportional hazards models for mortality between the geriatric assessment and one-year follow-up. RESULTS Of the 1070 patients, 22% (n = 238) had mild and 6% (n = 67) moderate to severe depressive symptoms. Patients with depressive symptoms had poorer nutritional status at baseline, lower scores on the cognitive and physical performance tests and poorer functional abilities in the geriatric assessment than those without. No association was observed between depressive symptoms and any of the outcomes at one-year follow-up. Poor nutritional status and physical functioning remained significant prognostic indicators. CONCLUSION Post-hip fracture depressive symptoms are common and deserve attention during post-hip fracture recovery and rehabilitation. Nonetheless, depressive symptoms have no impact on the change in mobility or living arrangements or mortality. These latter outcomes are mainly explained by poor nutritional status and functioning.
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Affiliation(s)
- Roope Jaatinen
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Department of Clinical Medicine, Division of Geriatric Medicine, University of Turku, Turku, Finland
| | - Tiina Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland.,Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Heli Helminen
- Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Markus T Hongisto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Orthopaedics, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Matti Viitanen
- Department of Clinical Geriatrics, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,Welfare Division of the City of Turku, Turku, Finland.,Research Services and Department of Clinical Medicine, Turku University Hospital, Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Department of Clinical Medicine, Division of Geriatric Medicine, University of Turku, Turku, Finland.,Welfare Division of the City of Turku, Turku, Finland.,Research Services and Department of Clinical Medicine, Turku University Hospital, Turku, Finland
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de Mul N, van den Bos LMEC, Kant IMJ, van Montfort SJT, Schellekens WJM, Cremer OL, Slooter AJC. Delirium and long-term psychopathology following surgery in older adults. J Psychosom Res 2022; 155:110746. [PMID: 35158180 DOI: 10.1016/j.jpsychores.2022.110746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the risk of postoperative delirium and long-term psychopathology (depression, anxiety or post-traumatic stress syndrome (PTSS)) in older adults. METHODS 255 elderly patients (≥ 65 years) undergoing major surgery (planned surgical time > 60 min) in a tertiary hospital were compared to 76 non-surgical controls from general practice. Patients were assessed twice daily for postoperative delirium using the Confusion Assessment Method (CAM(-ICU)), nursing delirium screening scale (NuDESC) and validated chart review. Before surgery and 3 and 12 months thereafter, the participants filled in the Hospital Anxiety and Depression Scale (HADS), the Geriatric Depression Scale (GDS-15) and the Post-Traumatic Stress Syndrome-14-Questions Inventory (PTSS-14). Non-surgical controls filled in the same questionnaires with similar follow-up. RESULTS Patients were more often male, had higher American Society of Anesthesiologists scores and more often had a spouse compared to controls (p < 0.005). Forty-three patients (18%) developed postoperative delirium, who were significantly older, had higher ASA scores and lower estimated IQ scores compared to the patients who did not develop delirium (p < 0.05). There were no differences in psychopathology at baseline and 3-month follow-up between patients and controls. At 12-months, surgical patients less frequently scored positive for depression (7% versus 16%) and anxiety (2% versus 10%) compared to nonsurgical controls (p < 0.05). We did not observe differences in occurrence of psychopathology between patients who had and had not developed postoperative delirium. CONCLUSION Our results suggest that the older surgical population, with or without postoperative delirium, does not appear to be at greater risk of developing psychopathology. WHY DOES THIS PAPER MATTER?: The older surgical population does not appear to be at greater risk of developing psychopathology, neither seems this risk influenced by the occurrence of postoperative delirium.
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Affiliation(s)
- Nikki de Mul
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Lisa M E C van den Bos
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands
| | - Ilse M J Kant
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Simone J T van Montfort
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Willem-Jan M Schellekens
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Anesthesiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Arjen J C Slooter
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
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Qin HC, Luo ZW, Chou HY, Zhu YL. New-onset depression after hip fracture surgery among older patients: Effects on associated clinical outcomes and what can we do? World J Psychiatry 2021; 11:1129-1146. [PMID: 34888179 PMCID: PMC8613761 DOI: 10.5498/wjp.v11.i11.1129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/25/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hip fracture in the elderly is a worldwide medical problem. New-onset depression after hip fracture has also received attention because of its increasing incidence and negative impact on recovery.
AIM To provide a synthesis of the literature addressing two very important questions arising from postoperative hip fracture depression (PHFD) research: the risk factors and associated clinical outcomes of PHFD, and the optimal options for intervention in PHFD.
METHODS We searched the PubMed, Web of Science, EMBASE, and PsycINFO databases for English papers published from 2000 to 2021.
RESULTS Our results showed that PHFD may result in poor clinical outcomes, such as poor physical function and more medical support. In addition, the risk factors for PHFD were summarized, which made it possible to assess patients preoperatively. Moreover, our work preliminarily suggested that comprehensive care may be the optimal treatment option for PHFDs, while interdisciplinary intervention can also be clinically useful.
CONCLUSION We suggest that clinicians should assess risk factors for PHFDs preoperatively, and future research should further validate current treatment methods in more countries and regions and explore more advanced solutions.
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Affiliation(s)
- Hao-Cheng Qin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhi-Wen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Heng-Yi Chou
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yu-Lian Zhu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
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Milton-Cole R, Ayis S, Lambe K, O'Connell MDL, Sackley C, Sheehan KJ. Prognostic factors of depression and depressive symptoms after hip fracture surgery: systematic review. BMC Geriatr 2021; 21:537. [PMID: 34627160 PMCID: PMC8502369 DOI: 10.1186/s12877-021-02514-1] [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: 05/14/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Patients with hip fracture and depression are less likely to recover functional ability. This review sought to identify prognostic factors of depression or depressive symptoms up to 1 year after hip fracture surgery in adults. This review also sought to describe proposed underlying mechanisms for their association with depression or depressive symptoms. Methods We searched for published (MEDLINE, Embase, PsychInfo, CINAHL and Web of Science Core Collection) and unpublished (OpenGrey, Greynet, BASE, conference proceedings) studies. We did not impose any date, geographical, or language limitations. Screening (Covidence), extraction (Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies, adapted for use with prognostic factors studies Checklist), and quality appraisal (Quality in Prognosis Studies tool) were completed in duplicate. Results were summarised narratively. Results In total, 37 prognostic factors were identified from 12 studies included in this review. The quality of the underlying evidence was poor, with all studies at high risk of bias in at least one domain. Most factors did not have a proposed mechanism for the association. Where factors were investigated by more than one study, the evidence was often conflicting. Conclusion Due to conflicting and low quality of available evidence it is not possible to make clinical recommendations based on factors prognostic of depression or depressive symptoms after hip fracture. Further high-quality research investigating prognostic factors is warranted to inform future intervention and/or stratified approaches to care after hip fracture. Trial registration Prospero registration: CRD42019138690. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02514-1.
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Affiliation(s)
- R Milton-Cole
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK.
| | - S Ayis
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
| | - K Lambe
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
| | - M D L O'Connell
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
| | - C Sackley
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK.,Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - K J Sheehan
- Department of Population Health Sciences, King's College London, School of Population Health and Environmental Sciences, Guy's Campus, London, SE1 1UL, UK
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5
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Schwartz AM, Wilson JM, Farley KX, Bradbury TL, Guild GN. New-Onset Depression After Total Knee Arthroplasty: Consideration of the At-Risk Patient. J Arthroplasty 2021; 36:3131-3136. [PMID: 33934951 DOI: 10.1016/j.arth.2021.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Postoperative new-onset depression (NOD) has gained recent attention as a previously unrecognized complication which may put patients at risk for poor outcomes after elective total hip arthroplasty. We aimed to investigate risk factors for the development of NOD after total knee arthroplasty (TKA) and assess its association with postoperative complications. METHODS This is a retrospective, population-level investigation of elective TKA patients. Patients with a preoperative diagnosis of depression were excluded from this study. Two groups were compared: patients who were diagnosed with depression within one year after TKA (NOD) and those who did not (control). The association of both preoperative patient factors and postoperative surgical and medical complications with NOD was then determined using multivariate and univariate analyses. RESULTS Of 196,728 unique TKA patients in our cohort, 5351 (2.72%) were diagnosed with NOD within one year of TKA. Age <54 year old, female gender, preoperative anxiety disorder, drug, alcohol, and/or tobacco use, multiple comorbidities, and opioid use before TKA were all associated with a diagnosis of NOD postoperatively (all P < .001). Postoperative NOD was associated with periprosthetic fracture (OR 2.11; 95% CI 1.29-3.52; P = .033), aseptic failure (OR 1.61; 95% CI 1.24-2.07; P = .020), prosthetic joint infection (OR 1.55, 95% CI 1.30-1.85; P < .001), stroke (OR 1.24; 95% CI 1.09-1.42; P = .006), and venous thromboembolism (OR 1.24; 95% CI 1.12-1.37; P < .001). CONCLUSION Post-TKA NOD is common and is associated with poor outcomes. This may aid surgeons in developing both anticipatory measures and institute preventative measures for patients at risk for developing NOD.
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Wilson JM, Schwartz AM, Farley KX, Bradbury TL, Guild GN. Preoperative Patient Factors and Postoperative Complications as Risk Factors for New-Onset Depression Following Total Hip Arthroplasty. J Arthroplasty 2021; 36:1120-1125. [PMID: 33127239 DOI: 10.1016/j.arth.2020.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/29/2020] [Accepted: 10/09/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Depression is known to be a risk factor for complication following primary total hip arthroplasty (THA), but little is known about new-onset depression (NOD) following THA. The purpose of this study is to determine the incidence of NOD and identify risk factors for its occurrence after THA. METHODS This is a retrospective cohort study of the Truven MarketScan database. Patients undergoing primary THA were identified and separated into cohorts based on the presence or not of NOD. Patients with preoperative depression or a diagnosis of fracture were excluded. Patient demographic and comorbid data were queried, and postoperative complications were collected. Univariate and multivariate regression analysis was then performed to assess the association of NOD with patient-specific factors and postoperative complications. RESULTS In total, 111,838 patients undergoing THA were identified and 2517 (2.25%) patients had NOD in the first postoperative year. Multivariate analysis demonstrated that preoperative opioid use, female gender, higher Elixhauser comorbidity index, preoperative anxiety disorder, drug or alcohol use disorder, and preoperative smoking were associated with the occurrence of NOD (P ≤ .001). The following postoperative complications were associated with increased odds of NOD: prosthetic joint infection (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.42-2.34, P < .001), aseptic revision surgery (OR 1.47, 95% CI 1.06-2.04, P = .019), periprosthetic fracture (OR 1.72, 95% CI 1.13-2.61, P = .01), and non-home discharge (OR 1.59, 95% CI 1.42-1.77, P < .001). CONCLUSIONS NOD is common following THA and there are multiple patient-specific factors and postoperative complications which increase the odds of its occurrence. Providers should use this information to identify at-risk patients so that pre-emptive prevention strategies may be employed.
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Affiliation(s)
- Jacob M Wilson
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA
| | | | - Kevin X Farley
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA
| | | | - George N Guild
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA
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7
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van de Ree CLP, de Munter L, Biesbroeck BHH, Kruithof N, Gosens T, de Jongh MAC. The prevalence and prognostic factors of psychological distress in older patients with a hip fracture: A longitudinal cohort study. Injury 2020; 51:2668-2675. [PMID: 32741607 DOI: 10.1016/j.injury.2020.07.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/01/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION A hip fracture can be experienced as a traumatic event that can induce psychological distress. The aim of this study is to give more insight into the prevalence of symptoms of psychological distress in older patients following the first year after a hip fracture. In addition, prognostic factors were determined for psychological distress after hip fracture. MATERIALS AND METHODS This hip fracture cohort data was derived from the Brabant Injury Outcome Surveillance, a multicenter longitudinal prospective cohort study. Hip fracture patients (≥65years) admitted to a hospital between August 2015 and November 2016 were asked to complete a questionnaire at 1 week, and 1, 3, 6 and 12 months. The Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety and depression and the Impact of Event Scale (IES) was used to assess symptoms of posttraumatic stress (PTS). Prognostic factors were assessed with multivariable logistic mixed models. RESULTS In total 570 patients (inclusion rate: 69.7%) were included. The prevalence of psychological distress ranged from 36% at 1 week to 31% at 1 year after hip fracture. Frailty at onset of hip fracture was the most important prognostic factor of symptoms of depression (Odds ratio (OR), 2.74; 95% Confidence interval (CI) 1.41 to 5.34) and anxiety (OR, 2.60; 95% CI 1.15 to 5.85) on average in the year following hip fracture. Frailty was not a prognostic factor of symptoms of PTS (OR, 1.97; 95% CI 0.42 to 9.23). CONCLUSIONS The prevalence of psychological distress is high in the first year after a hip fracture. Frailty at onset of a hip fracture is the most important prognostic factor of symptoms of depression and anxiety. These findings have important implications for strategies with early identification of frail patients with a hip fracture at high risk of psychological distress.
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Affiliation(s)
- C L P van de Ree
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands.
| | - L de Munter
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands
| | - B H H Biesbroeck
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands
| | - N Kruithof
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands
| | - T Gosens
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands; Department of Orthopaedic Surgery, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - M A C de Jongh
- Department Trauma TopCare, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, Netherlands; Brabant Trauma Registry, Network Emergency Care Brabant, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
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Taraldsen K, Thingstad P, Døhl Ø, Follestad T, Helbostad JL, Lamb SE, Saltvedt I, Sletvold O, Halsteinli V. Short and long-term clinical effectiveness and cost-effectiveness of a late-phase community-based balance and gait exercise program following hip fracture. The EVA-Hip Randomised Controlled Trial. PLoS One 2019; 14:e0224971. [PMID: 31738792 PMCID: PMC6860934 DOI: 10.1371/journal.pone.0224971] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/15/2019] [Indexed: 11/26/2022] Open
Abstract
The aim of this trial was to evaluate the clinical effectiveness and cost-effectiveness of a home-based exercise program delivered four months following hip-fracture surgery. In the two-armed randomized, single blinded clinical trial we included persons who lived in the catchment area, were 70 years or older, and community-dwelling at time of the fracture. We excluded persons who were unable to walk ten meters prior to the fracture, and those who were bedridden or had medical contraindications for exercise at baseline (ie. four months after the fracture). All participants underwent routine treatment and rehabilitation. The intervention group received additional 20 sessions (10 weeks) structured, home exercise targeting gait and balance, delivered by physiotherapists in primary health care. Gait speed was the primary outcome. Secondary outcomes included physical activity, gait characteristics, cognitive function, activities of daily living, health-related quality of life, and health care costs extracted from hospital and municipality records. In total, 223 participants were included. Four months post surgery 143 were randomized for the exercise trial (70% women, mean age 83.4 (SD 6.1) years, mean gait speed 0.6 (SD 0.2) m/sec). Estimated between group difference in gait speed was 0.09 m/sec (95% CI: 0.04 to 0.14, p<0.001) at posttest and 0.07 m/sec (95% CI: 0.02 to 0.12, p = 0.009) 12 months post surgery. The mean between-group QALY difference was -0.009 (95% CI: -0.061 to 0.038). The mean between-group total cost difference was +242.9 EUR (95% CI: -8397 to 8584). Our findings suggest that gait recovery after hip fracture can be improved by introducing a home-based balance and gait exercise program four months post surgery, without increasing total health care costs. Future research should focus on how to implement gait and balance exercise in comprehensive interventions that increase adherence among the most vulnerable persons and have an effect on daily life activities and patient-centred outcomes. Trial registration: ClinicalTrials.gov NCT01379456.
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Affiliation(s)
- Kristin Taraldsen
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine and Health Sciences, Trondheim, Norway
- * E-mail:
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine and Health Sciences, Trondheim, Norway
| | - Øystein Døhl
- Trondheim Municipality, Trondheim, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU, Trondheim, Norway
| | - Turid Follestad
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU, Trondheim, Norway
| | - Jorunn L. Helbostad
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine and Health Sciences, Trondheim, Norway
| | | | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine and Health Sciences, Trondheim, Norway
- Department of Geriatrics, St.Olavs University Hospital, Trondheim, Norway
| | - Olav Sletvold
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine and Health Sciences, Trondheim, Norway
| | - Vidar Halsteinli
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU, Trondheim, Norway
- Regional Center for Health Care Improvement, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Bernstein J, Weintraub S, Hume E, Neuman MD, Kates SL, Ahn J. The New APGAR SCORE: A Checklist to Enhance Quality of Life in Geriatric Patients with Hip Fracture. J Bone Joint Surg Am 2017; 99:e77. [PMID: 28719564 DOI: 10.2106/jbjs.16.01149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
For geriatric patients with hip fractures, the broken bone is the reason for admission, but only part of the overall disease. Indeed, it may be more helpful to consider the patient having geriatric hip fracture syndrome or sustaining a hip attack, as there are many associated medical, social, psychological, and other problems to which attention must be paid. To that end, we have identified a series of 10 steps, collected into a checklist, that can be undertaken for all patients with geriatric hip fracture. In homage to the maxim "we come into the world under the brim of the pelvis and go out through the neck of the femur," we defined our checklist by the acronym APGAR SCORE, named after the classic checklist of the same name used to assess a newborn child. The 10 elements include attending to problems of Alimentation and nutrition, Polypharmacy, and Gait; initiating a discussion about Advance care planning; correcting any Reversible cognitive impairment; maximizing Social support; checking for and remediating Cataracts or other impairments of vision; assessing for and addressing Osteoporosis; and last, ensuring that Referrals are made and that the patient has a safe Environment after discharge. For the newborn, the Apgar score has been criticized as an imperfect tool, and likewise the problem of geriatric hip fracture will not be solved with this new Apgar score either. Nonetheless, a score of 10 here,1 point for each item, may help to optimize the outcome for this difficult disease.
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Affiliation(s)
- Joseph Bernstein
- 1Departments of Orthopaedic Surgery (J.B., S.W., E.H., and J.A.) and Anesthesiology and Critical Care (M.D.N.), University of Pennsylvania, Philadelphia, Pennsylvania 2Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
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10
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Abstract
BACKGROUND Hip hemiarthroplasty and dynamic hip screw (DHS) fixation are common procedures performed in trauma units, but there is little information regarding perioperative pain experience with respect to these treatment modalities. PURPOSE To evaluate the relationship between pain, analgesia requirements, and type of procedure for hip fracture surgery. METHODS An analysis was performed on consecutive patients presenting with a hip fracture in 2 hospitals over 2 years. Patients with a diagnosis of dementia were excluded because of the limitations of pain assessment. Postoperative pain scores were taken from standardized patient observation charts. Perioperative opiate consumption was calculated from inpatient drug charts. RESULTS A total of 357 patients were studied; 205 patients (53%) underwent a cemented hemiarthroplasty and 152 (47%) had fixation with a DHS. Patients who underwent a DHS fixation had more pain than those who had a hemiarthroplasty and required almost double the amount of opiates. CONCLUSION The reason for the elevated pain scores and higher morphine requirement in the DHS group (DG) remains unclear. It could be related to highly sensitive periosteum reaction in the DG. It is important to recognize the difference in pain experienced between the groups, and analgesia should be tailored toward the individual based upon clinical assessment and knowledge of the surgery performed. A comprehensive understanding of this principle will allow for improved perioperative surgical care and patient experience.
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Abstract
BACKGROUND Hip fracture is often complicated by depressive symptoms in older adults. We sought to characterize trajectories of depressive symptoms arising after hip fracture and examine their relationship with functional outcomes and walking ability. We also investigated clinical and psychosocial predictors of these trajectories. METHOD We enrolled 482 inpatients, aged ⩾60 years, who were admitted for hip fracture repair at eight St Louis, MO area hospitals between 2008 and 2012. Participants with current depression diagnosis and/or notable cognitive impairment were excluded. Depressive symptoms and functional recovery were assessed with the Montgomery-Asberg Depression Rating Scale and Functional Recovery Score, respectively, for 52 weeks after fracture. Health, cognitive, and psychosocial variables were gathered at baseline. We modeled depressive symptoms using group-based trajectory analysis and subsequently identified correlates of trajectory group membership. RESULTS Three trajectories emerged according to the course of depressive symptoms, which we termed 'resilient', 'distressed', and 'depressed'. The depressed trajectory (10% of participants) experienced a persistently high level of depressive symptoms and a slower time to recover mobility than the other trajectory groups. Stressful life events prior to the fracture, current smoking, higher anxiety, less social support, antidepressant use, past depression, and type of implant predicted membership of the depressed trajectory. CONCLUSIONS Depressive symptoms arising after hip fracture are associated with poorer functional status. Clinical and psychosocial variables predicted membership of the depression trajectory. Early identification and intervention of patients in a depressive trajectory may improve functional outcomes after hip fracture.
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Affiliation(s)
- P. Cristancho
- Department of Psychiatry, Healthy Mind Lab, Washington University School of Medicine, St Louis, MO, USA
| | - E. J. Lenze
- Department of Psychiatry, Healthy Mind Lab, Washington University School of Medicine, St Louis, MO, USA
| | - M. S. Avidan
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
| | - K. S. Rawson
- Department of Psychiatry, Healthy Mind Lab, Washington University School of Medicine, St Louis, MO, USA
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Radinovic KS, Markovic-Denic L, Dubljanin-Raspopovic E, Marinkovic J, Jovanovic LB, Bumbasirevic V. Effect of the overlap syndrome of depressive symptoms and delirium on outcomes in elderly adults with hip fracture: a prospective cohort study. J Am Geriatr Soc 2014; 62:1640-8. [PMID: 25243678 DOI: 10.1111/jgs.12992] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyze the incidence of the overlap syndrome of depressive symptoms and delirium, risk factors, and independent and dose-response effect of the overlap syndrome on outcomes in elderly adults with hip fracture. DESIGN Prospective cohort study. SETTING University hospital. PARTICIPANTS Individuals with hip fracture without delirium (N = 277; aged 78.0 ± 8.2) consequently enrolled in a prospective cohort study. MEASUREMENTS Depressive symptoms were assessed using the Geriatric Depression Scale and cognitive status using the Short Portable Mental Status Questionnaire upon hospital admission. Incident delirium was assessed daily during the hospital stay using the Confusion Assessment Method. Information on complications acquired in the hospital, severity of complications, re-interventions, length of hospital stay, and 1-month mortality was recorded. RESULTS Thirty (10.8%) participants had depressive symptoms alone, 88 (31.8%) delirium alone, 60 (21.7%) overlap syndrome, and 99 (35.7%) neither condition. According to multivariate regression analysis, participants with the overlap syndrome had significantly higher incidence of vision impairment (P = .02), longer time-to-surgery (P = .03), and lower cognitive function (P < .001) than participants with no depressive symptoms and no delirium. In the adjusted regression analysis, participants with neither condition were at lower risk of complications than those with the overlap syndrome (P = .03). After adjustment, participants with the overlap syndrome were at higher risk of longer hospital stay independently (P = .003) and in a dose-response manner in the following order: no depression and no delirium, depressive symptoms alone, delirium alone, and the overlap syndrome (P = .002). CONCLUSION Depressive symptoms and delirium increase the likelihood of adverse outcomes after hip fracture in a step-wise manner when they coexist. To reduce the risk of adverse outcome in individuals with hip fracture, efforts to identify, prevent, and treat this condition need to be increased.
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Neuropsychiatric symptoms and rehabilitation outcomes in patients with hip fracture. Am J Phys Med Rehabil 2014; 93:562-9. [PMID: 24508934 DOI: 10.1097/phm.0000000000000062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the association between functional recovery and neuropsychiatric symptoms in hip fracture patients undergoing in-hospital rehabilitation. Very few studies have extensively evaluated neuropsychiatric symptoms in hip fracture patients, and the relationship between these symptoms and rehabilitation outcome is not yet clearly defined. DESIGN This study was conducted on 200 patients with hip fracture who underwent a rehabilitation program. The Neuropsychiatric Inventory was used to identify neuropsychiatric symptoms. Efficiency and effectiveness in terms of the motor-Functional Independence Measure and length of stay were considered as outcome measures. RESULTS At admission, 74% of the patients had neuropsychiatric symptoms. At the end of rehabilitation, the patients with neuropsychiatric symptoms had a lower motor-Functional Independence Measure effectiveness (P = 0.015) and efficiency (P = 0.002) and a longer length of stay (P = 0.008) than those without neuropsychiatric symptoms. However, after adjustment for the Mini-Mental State Examination, the patients with neuropsychiatric symptoms differed from those without symptoms only in terms of longer length of stay (P = 0.006) and lower motor-Functional Independence Measure efficiency (P = 0.008). CONCLUSIONS Neuropsychiatric symptoms make the rehabilitation process slower and less efficient in hip fracture patients. Understanding the relationship between neuropsychiatric symptoms and outcome may be useful to physicians for the management of hip fracture patients.
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Burns A, Younger J, Morris J, Baldwin R, Tarrier N, Pendleton N, Cohen P, Horan M, Banerjee S. Outcomes following hip fracture surgery: a 2-year prospective study. Am J Geriatr Psychiatry 2014; 22:838-44. [PMID: 23567372 DOI: 10.1016/j.jagp.2013.01.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 05/30/2012] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To describe the health outcomes in older people following hip fracture surgery. DESIGN, SETTING, AND PARTICIPANTS A naturalistic prospective study of people who had undergone hip fracture surgery undertaken in three specialist inpatient orthopaedic units in Manchester, England, with follow-up for 2 years in primary care. One hundred forty-two people, age 60 and older who had undergone hip fracture surgery of whom 74 were interviewed at follow-up. MEASUREMENTS Assessment of mood (using the Geriatric Depression Scale and Hospital Anxiety and Depression Scale), cognitive function (Mini-Mental State Examination), pain (Wong-Baker and McGill scales), tests of function (Up and Go Test, Gait Test and Functional Reach), and Sickness Impact Profile. RESULTS Twenty-six percent of the original group had died by the time of the 2-year follow-up and associated with increasing age, poorer mobility, and higher levels of support. Sixteen percent of the group were found to be depressed, the only robust predictor of this being depression at entry to the study. There was a consistency in the presence or absence of depressive symptoms over the duration of the study. Forty-nine percent were able to walk independently at 2 years. CONCLUSION The presence of depressive symptoms is associated with poor outcomes at 2 years. Few people recover from, or develop, depression over 2 years.
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Affiliation(s)
- Alistair Burns
- Faculty of Medical and Human Sciences, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England.
| | - Jane Younger
- Department of Psycho-Oncology, The Christie NHS Foundation Trust, Manchester, England
| | - Julie Morris
- Department of Medical Statistics, Wythenshawe Hospital, Manchester, England
| | - Robert Baldwin
- Faculty of Medical and Human Sciences, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England
| | - Nicholas Tarrier
- Department of Psychology, Institute of Psychiatry, King's College London, London, England
| | - Neil Pendleton
- Faculty of Medical and Human Sciences, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England
| | - Paul Cohen
- Department of Old Age Psychiatry, Pennine Care NHS Foundation Trust, Lancashire, England
| | - Mike Horan
- Faculty of Medical and Human Sciences, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England
| | - Sube Banerjee
- Section of Mental Health and Aging, Institute of Psychiatry, King's College London, London, England
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Gialanella B, Ferlucci C, Monguzzi V, Prometti P. Determinants of functional outcome in hip fracture patients: the role of specific neuropsychiatric symptoms. Disabil Rehabil 2014; 37:517-22. [PMID: 24963835 DOI: 10.3109/09638288.2014.932446] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bernardo Gialanella
- Operative Unit for Recovery and Functional Rehabilitation, Scientific Institute of Lumezzane , Fondazione Salvatore Maugeri, IRCCS, Lumezzane , Italy
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Dubljanin Raspopović E, Marić N, Nedeljković U, Ilić N, Tomanović Vujadinović S, Bumbaširević M. Do depressive symptoms on hospital admission impact early functional outcome in elderly patients with hip fracture? Psychogeriatrics 2014; 14:118-23. [PMID: 24954835 DOI: 10.1111/psyg.12049] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 02/23/2014] [Accepted: 04/28/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Depression is the most common mood disorder in elderly people and one of the most prevalent comorbidities in older people with hip fracture. While several authors have confirmed that depressive symptoms assessed at a later stage after hip fracture impact functional outcome and mortality, the role of depressive symptoms identified at an earlier stage after hip fracture remains understudied. The aim of the present study was to determine if depressive symptoms assessed on hospital admission impact early functional outcome after hip fracture surgery. METHODS We studied 112 patients who underwent surgery for hip fracture during a 6-month period. Depressive symptoms were assessed using the 30-item Geriatric Depression Scale on admission to the acute setting. Multidimensional assessment included sociodemographic characteristics, general health status, cognitive status, functional status prior to injury, and perioperative variables. The primary outcome measure was motor Functional Independence Measure at discharge. RESULTS Adjusted multivariate regression analysis revealed that the presence of moderate to severe depressive symptoms (Geriatric Depression Scale ≥ 20), older age, and female gender were independently related to motor Functional Independence Measure at discharge. CONCLUSION Increasing levels of depressive symptoms in elderly hip fracture patients influence short-term functional outcome. We strongly support the introduction of routine assessment of this baseline comorbidity, especially in female patients. Failure to identify such patients is a missed opportunity for possible improvement of early functional outcome after hip fracture in elderly.
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Affiliation(s)
- Emilija Dubljanin Raspopović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Physical Medicine and Rehabilitation, Clinical Center Serbia, Belgrade, Serbia
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17
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Al-Maqbali MA. Nursing intervention in discharge planning for elderly patients with hip fractures. Int J Orthop Trauma Nurs 2014. [DOI: 10.1016/j.ijotn.2013.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Phillips AC, Upton J, Duggal NA, Carroll D, Lord JM. Depression following hip fracture is associated with increased physical frailty in older adults: the role of the cortisol: dehydroepiandrosterone sulphate ratio. BMC Geriatr 2013; 13:60. [PMID: 23773910 PMCID: PMC3698022 DOI: 10.1186/1471-2318-13-60] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 06/13/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hip fracture in older adults is associated with depression and frailty. This study examined the synergistic effects of depression and hip fracture on physical frailty, and the mediating role of the cortisol:dehydroepiandrosterone sulphate (DHEAS) ratio. METHODS This was an observational longitudinal study of patients with a hip fracture carried out in a hospital setting and with follow up in the community. Participants were 101 patients aged 60+ years (81 female) with a fractured neck of femur. Measurements of the ability to carry out activities of daily living (ADL), cognitive function, physical frailty and assays for serum cortisol and DHEAS were performed six weeks and six months post-hip fracture. Depressed and non-depressed groups were compared by ANOVA at each time point. RESULTS Hip fracture patients who developed depression by week six (n = 38) had significantly poorer scores on ADL and walking indices of frailty at both week six and month six, and poorer balance at week six. The association with slower walking speed was mediated by a higher cortisol:DHEAS ratio in the depressed group. CONCLUSION Depression following hip fracture is associated with greater physical frailty and poorer long term recovery post-injury. Our data indicate that the underlying mechanisms may include an increased cortisol:DHEAS ratio and suggest that correcting this ratio for example with DHEA supplementation could benefit this patient population.
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Affiliation(s)
- Anna C Phillips
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jane Upton
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Niharika Arora Duggal
- School of Immunity and Infection, University of Birmingham, Birmingham, B15 2TT, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Douglas Carroll
- School of Sport and Exercise Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Janet M Lord
- School of Immunity and Infection, University of Birmingham, Birmingham, B15 2TT, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT, UK
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Mak JCS, Lattouf I, Narushevich A, Lai C, O'Rourke F, Shen Q, Chan DKY, Cameron ID. A prospective review of hip fracture subtypes, surgical procedure, cognitive status, and analgesia use across 4 Australian hospitals. Geriatr Orthop Surg Rehabil 2013; 2:45-50. [PMID: 23569669 DOI: 10.1177/2151458510394655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To correlate analgesia use among patients with hip fracture requiring surgery with hip fracture subtype, cognitive status, and type of surgery in the postacute period. DESIGN AND PARTICIPANTS Prospective review of patients with hip fractures requiring surgical intervention. A total of 415 patients (mean age: 81.2 ± 9.1 years, 74.3% women) presented with 195 subcapital fractures (39 undisplaced, 156 displaced) and 220 trochanteric fractures (136 stable, 84 unstable) requiring surgery. SETTING Inpatient orthopedic units in 4 Australian hospitals. MEASUREMENTS The primary outcome measures were mean analgesia usage (oral morphine equivalent) for 4 defined time intervals and total amount 36 hours following surgery. RESULTS Patients with subtrochanteric fractures required more analgesia compared with displaced-subcapital, undisplaced-subcapital, basicervical, stable-pertrochanteric, and unstable-pertrochanteric fractures in the 24 to 36 hours following operation (24.7 vs 11.3 vs 8.8 vs 12.1 vs 7.6 vs 9.7, P = .001). Total analgesia requirements were higher in patients treated with an intramedullary nail, increasing by 1.3- to 3.3-fold in the 36 hours postsurgery. Patients with cognitive impairment utilized markedly less analgesia at all time periods measured. At 24 to 36 hours, higher levels of analgesia were noted in patients with higher premorbid level of mobility (P = .015) and activities of daily living function (P = .007). CONCLUSION Important differences in utilization of analgesia following hip fracture across readily defined clinical groups exist. Proactive pain management for those with cognitive impairment, certain hip fracture subtypes, and surgical procedures may enable early functional mobility and other activities.
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Affiliation(s)
- Jenson C S Mak
- Department of Geriatric Medicine, Northern Sydney Central Coast Area Health Service, Gosford Hospital, NSW, Australia ; Department of General Medicine, Mater Hospital, Sydney, NSW, Australia ; Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, NSW, Australia
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Crotty M, Unroe K, Cameron ID, Miller M, Ramirez G, Couzner L. Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people. Cochrane Database Syst Rev 2010:CD007624. [PMID: 20091644 DOI: 10.1002/14651858.cd007624.pub3] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Social and psychological factors such as fear of falling, self-efficacy and coping strategies are thought to be important in the recovery from hip fracture in older people. OBJECTIVES To evaluate the effects of interventions aimed at improving physical and psychosocial functioning after hip fracture. SEARCH STRATEGY We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (September 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 4), MEDLINE and EMBASE (to December 2008), other databases and reference lists of related articles. SELECTION CRITERIA Randomised and quasi-randomised trials of rehabilitation interventions applied in inpatient or ambulatory settings to improve physical or psychosocial functioning in older adults with hip fracture. Primary outcomes were physical and psychosocial function and 'poor outcome' (composite of mortality, failure to return to independent living and/or readmission). DATA COLLECTION AND ANALYSIS Two authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. Disagreements were moderated by a third author. MAIN RESULTS Nine small heterogeneous trials (involving 1400 participants) were included. The trials had differing interventions, including 'usual care' comparators, providers, settings and outcome assessment. Although most trials appeared well conducted, poor reporting hindered assessment of their risk of bias.Three trials testing interventions (reorientation measures, intensive occupational therapy, cognitive behavioural therapy) delivered in inpatient settings found no significant differences in outcomes. Two trials tested specialist-nurse led care, which was predominantly post-discharge but included discharge planning in one trial: this trial found some benefits at three months but the other trial found no differences at 12 months. Coaching (educational and motivational interventions) was examined in two very different trials: one trial found no effect on function at six months; and the other showed coaching improved self-efficacy expectations at six months, although not when combined with exercise. Two trials testing interventions (home rehabilitation; group learning program) started several weeks after hip fracture found no significant differences in outcomes at 12 months. AUTHORS' CONCLUSIONS Some outcomes may be amenable to psychosocial treatments; however, there is insufficient evidence to recommend practice changes. Further research on interventions described in this review is required, including attention to timing, duration, setting and administering discipline(s), as well as treatment across care settings. To facilitate future evaluations, a core outcome set, including patient-reported outcomes such as quality of life and compliance, should be established for hip fracture trials.
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Affiliation(s)
- Maria Crotty
- Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park, South Australia, Australia, 5041
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Shyu YIL, Cheng HS, Teng HC, Chen MC, Wu CC, Tsai WC. Older people with hip fracture: depression in the postoperative first year. J Adv Nurs 2009; 65:2514-22. [DOI: 10.1111/j.1365-2648.2009.05125.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Cremeans-Smith JK, Soehlen S, Greene K, Alexander T, Delahanty DL. In-hospital levels of C-reactive protein and IL-6 predict post-operative depressive symptoms among patients undergoing total knee replacement surgery. Brain Behav Immun 2009; 23:1096-103. [PMID: 19559081 DOI: 10.1016/j.bbi.2009.06.148] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 05/18/2009] [Accepted: 06/14/2009] [Indexed: 11/19/2022] Open
Abstract
Behavioral changes observed following immune system activation are similar to many of the hallmark symptoms of major depressive disorder (MDD), including appetite change, lethargy, fatigue, negative mood and anhedonia. Acute phase proteins, such as interleukin-6 (IL-6) and C-reactive protein (CRP) have been implicated in the production of sickness behavior, and research has revealed significant differences in the levels of these acute phase proteins between depressed and non-depressed individuals. The current study examined whether early post-operative IL-6 and CRP levels predicted subsequent depressive symptoms in 110 patients undergoing total knee replacement surgery (TKR). In-hospital levels of IL-6 and CRP predicted depressive symptoms at three-months following surgery, as indicated by significant main effects and a significant interaction term. Specifically, lower levels of in-hospital CRP and higher levels of IL-6 in-hospital predicted more depressive symptoms three-months following surgery. The finding that levels of acute phase proteins soon after surgery predict subsequent depressive symptoms, if replicated, extends prior research on the relationships between IL-6, CRP, and depression. Further, this predictive relationship suggests the possibility of early identification of individuals at risk for the subsequent development of post-operative depression.
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Karp JF, Skidmore E, Lotz M, Lenze E, Dew MA, Reynolds CF. Use of the late-life function and disability instrument to assess disability in major depression. J Am Geriatr Soc 2009; 57:1612-9. [PMID: 19682111 DOI: 10.1111/j.1532-5415.2009.02398.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether there was greater disability in subjects with depression than in those without, the correlation between disability and depression severity and quality of life, and whether improvement in disability after antidepressant pharmacotherapy was greater in those who responded to antidepressant treatment. DESIGN Disability in subjects with and without depression from two different studies was compared for 22 weeks. Correlations were performed for the subjects with depression between disability and depression, anxiety, health-related quality of life (HRQOL), and medical comorbidity. T-tests were used to compare disability between subjects who did and did not respond to antidepressant treatment and change in disability after pharmacotherapy. SETTING Late-life depression research clinic. PARTICIPANTS The 313 subjects were recruited from primary care and the community and were aged 60 and older; 244 subjects were participants in a depression treatment protocol, and 69 subjects without depression participated in a separate longitudinal observational study of the mental and cognitive health of depression-free older adults. MEASUREMENTS The Late-Life Function and Disability Instrument (LL-FDI), a measure of instrumental activity of daily living, personal role, and social role functioning. RESULTS Subjects with depression scored lower than controls for domains measuring limitation (can do) and frequency (does do) of activities. Both disability domains correlated with depression severity, anxiety, HRQOL, and cognition. Disability improved with antidepressant treatment; for partial responders who continued to receive higher-dose antidepressant treatment out to 22 weeks, there was continued improvement, although not to the level of comparison subjects without depression. CONCLUSION The LL-FDI appears to discriminate subjects with depression from those without, correlates with depression severity, and demonstrates sensitivity to antidepressant treatment response. We recommend further investigation of the LL-FDI and similar disability instruments for assessing depression-related disability.
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Affiliation(s)
- Jordan F Karp
- Advanced Center for Intervention and Services Research for Late Life Mood Disorders, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Courier/Office: 100 North Bellefield Avenue, Room 766, Pittsburgh, PA 15213, USA.
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Frihagen F. On the diagnosis and treatment of femoral neck fractures. ACTA ORTHOPAEDICA. SUPPLEMENTUM 2009; 80:1-26. [PMID: 19919380 DOI: 10.1080/17453690610046611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Colleen W, Pryor J, Jeeawody B. The concerns of older women during inpatient rehabilitation after fractured neck of femur. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2009. [DOI: 10.12968/ijtr.2009.16.5.42103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Wykes Colleen
- Wellington Aboriginal Corporation Health Service, 68 Maughan Street, Wellington, New South Wales
| | - Julie Pryor
- Rehabilitation Nursing Research and Development Unit, Royal Rehabilitation Centre Sydney, PO Box 6, Ryde, New South Wales; 1680, Australia and Associate Professor, Charles Sturt University, New South Wales,
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Zidén L, Wenestam CG, Hansson-Scherman M. A life-breaking event: early experiences of the consequences of a hip fracture for elderly people. Clin Rehabil 2008; 22:801-11. [DOI: 10.1177/0269215508090204] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To explore and describe the consequences of an acute hip fracture as experienced by home-dwelling elderly people shortly after discharge from hospital. Design: Semi-structured interviews using the phenomenographic method. Subjects and setting: Eighteen subjects were interviewed in their own homes one month after discharge. Results: The interviewees described experiences of changes in their relation to the body, themselves, to others and to their whole life situation. These experiences were described as being limited in movement, having lost confidence in the body, becoming humble and grateful, respecting oneself and one's own needs, becoming more dependent on others, gaining more human contact and being treated in a friendly way by others, being secluded and trapped at home, feeling old, closer to death and having lost their zest for life, and taking one day at a time and being uncertain about the future. Conclusion: Experienced consequences of a hip fracture were multidimensional and involved dramatic changes in the interviewees' life situation, including existential thoughts and reappraisal of the years of life that remained. The results indicate that the fracture seemed not only to break the bone but also to cause social and existential cracks, as experienced in the early phase after the injury.
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Affiliation(s)
- Lena Zidén
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg,
| | | | - Marianne Hansson-Scherman
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
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