1
|
Schroeder HS, Israeli A, Liebergall M(I, Or O, Abu Ahmed W, Paltiel O, Justo D, Zimlichman E. Home Versus Hospital Rehabilitation of Older Adults Following Hip Fracture Yields Similar Patient-Reported Outcome Measures. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241230293. [PMID: 38491840 PMCID: PMC10943717 DOI: 10.1177/00469580241230293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 03/18/2024]
Abstract
The increase in hip fractures (HF) due to aging of the population and the rise in attractiveness of services provided at home following the COVID-19 pandemic, emphasize the need to compare outcomes of home versus hospital HF rehabilitation. To date, studies comparing the 2 services have focused primarily on clinical outcomes rather than patient-reported outcomes (PROs). This longitudinal observational study evaluated PROs of older adults with HF in the 2 settings. The SF36 questionnaire was used to measure PROs 3 times after surgery. The first PRO was retrospective and reflected pre-fracture health status. Descriptive statistics and mixed-effect logistic regression were used. Of 86 patients participating in the study, 41 had home rehabilitation and 45 had hospital rehabilitation. In both groups, the mental and physical scores plummeted 2 weeks after the HF, compared to pre-fracture status. The difference in improvement from pre-fracture status to recovery in both groups, were not significantly (P < .05) different, except for the pain domain. PROs of home versus hospital rehabilitation were similar, suggesting that rehabilitation at home can be as effective as hospital rehabilitation for suitable patients. This knowledge can improve quality of care in an aging global population.
Collapse
Affiliation(s)
- Hanna S. Schroeder
- Hebrew University of Jerusalem, Jerusalem, Israel
- Israeli Ministry of Health, Israel
| | - Avi Israeli
- Israeli Ministry of Health, Israel
- Dr. Julien Rozan Professor of Healthcare, Hebrew University – Hadassah Medical School
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Omer Or
- Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Ora Paltiel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Justo
- Sheba Medical Center, Ramat-Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Zimlichman
- Sheba Medical Center, Ramat-Gan, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
2
|
Xue TM, Pan W, Tsumura H, Wei S, Lee C, McConnell ES. Impact of Dementia on Long-Term Hip Fracture Surgery Outcomes: An Electronic Health Record Analysis. J Am Med Dir Assoc 2023; 24:235-241.e2. [PMID: 36525987 DOI: 10.1016/j.jamda.2022.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/03/2022] [Accepted: 11/05/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Older adults with dementia are at higher risk for sustaining hip fracture and their long-term health outcomes after surgery are usually worse than those without dementia. Widespread adoption of electronic health records (EHRs) may allow hospitals to better monitor long-term health outcomes in patients with dementia after hospitalization. This study aimed to (1) estimate how dementia influences discharge location, mortality, and readmission 180 days and 1 year after hip fracture surgery in older adults, and (2) demonstrate the feasibility of using selection-bias reduced EHR data for research and long-term health outcomes monitoring. DESIGN Retrospective observational cohort study using EHRs. SETTING AND PARTICIPANTS A cohort of 1171 patients over age 65 years who had an initial hip fracture surgery between October 2015 and December 2018 was extracted from EHRs of one health system; 376 of these patients had dementia. METHODS Logistic regression was applied to estimate influences of dementia on discharge disposition and Cox proportional hazards model for mortality. The Fine and Gray regression model was used to analyze readmission, accounting for the competing risk of death. To reduce selection bias in EHRs, inverse probability of treatment weighting using propensity scores was implemented before modeling. RESULTS Dementia had significant impacts on all outcomes: being discharged to facilities [odds ratio (OR) = 2.11, 95% confidence interval (CI) 1.19-3.74], 180-day mortality [hazard ratio (HR) = 1.69, 95% CI 1.20-2.38], 1-year mortality (HR = 1.78, 95% CI 1.33-2.38), 180-day readmission (HR = 1.62, 95% CI 1.39-1.89), and 1 year readmission (HR = 1.39, 95% CI 1.21-1.58). CONCLUSIONS AND IMPLICATIONS Dementia was a significant risk factor for worse long-term outcomes. The inverse probability of treatment weighting approach can be used to reduce selection bias in EHR data for research and monitoring long-term health outcomes in the target population. Such monitoring could foster collaborations with post-acute and long-term health care services to improve recovery outcomes in patients with dementia after hip fracture surgery.
Collapse
Affiliation(s)
- Tingzhong Michelle Xue
- Duke University School of Nursing, Durham, NC, USA; Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, NC, USA.
| | - Wei Pan
- Duke University School of Nursing, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | - Sijia Wei
- Center for Education in Health Sciences, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Chiyoung Lee
- University of Washington Bothell, School of Nursing and Health Studies, Bothell, WA, USA
| | - Eleanor S McConnell
- Duke University School of Nursing, Durham, NC, USA; Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, NC, USA
| |
Collapse
|
3
|
Appleton E, Maeir T, Kaufman Y, Karni S, Gilboa Y. Cognitive Orientation to daily Occupational Performance (CO-OP) for Older Adults After a Hip Fracture: A Pilot Study. Am J Occup Ther 2023; 77:24038. [PMID: 36779978 PMCID: PMC9969984 DOI: 10.5014/ajot.2023.050073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
IMPORTANCE In-home therapy provides the opportunity for rehabilitation intervention to be completed in the context of the patient's natural environment. However, most studies have focused on the effects of physical exercise, leaving a gap in understanding the effectiveness of a more task-oriented intervention that addresses individual preferences. OBJECTIVE To assess the feasibility and preliminary efficacy of the Cognitive Orientation to daily Occupational PerformanceTM (CO-OP) approach, delivered at home with older adults after a hip fracture to improve functional outcomes. DESIGN Single-arm quasi-experimental design. SETTING Patients' home. PARTICIPANTS Nine participants (age ≥60 yr) being discharged home from an inpatient rehabilitation ward in a geriatric hospital in a central city in Israel. INTERVENTION Up to 10 1-hr weekly face-to-face sessions in using the CO-OP approach. OUTCOMES AND MEASURES The Canadian Occupational Performance Measure was used to measure performance and satisfaction with the patients' level of participation in daily functioning. RESULTS A 30% recruitment rate, an 81% retention rate, were observed, with 88% of the participants expressing high to very high overall satisfaction with the intervention. Friedman test results indicated statistically significant improvements in occupational performance and satisfaction on trained and untrained goals (p < .01). CONCLUSIONS AND RELEVANCE The findings suggest that a home-based CO-OP intervention is feasible and potentially beneficial for older adults who are returning home after a hip fracture. What This Article Adds: This study shows that a task-oriented intervention can be effective in helping older adults return home successfully after a hip fracture.
Collapse
Affiliation(s)
- Esther Appleton
- Esther Appleton, OT, MSc, is Occupational Therapist, Palace Medical, Tel Aviv, Israel
| | - Talia Maeir
- Talia Maeir, OT, MSC, is PhD Candidate, School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yakir Kaufman
- Yakir Kaufman, MD, MP, is Behavioral Neurologist and Head, Professional Standards Department, Division of General Medicine, Medical Directorate, Jerusalem, Israel Health Ministry, Israel
| | - Sharon Karni
- Sharon Karni, OT, MSc, is Head of Occupational Therapy Services, Herzog Hospital, Jerusalem, Israel
| | - Yafit Gilboa
- Yafit Gilboa, OT, PhD, is Senior Lecturer, School of Occupational Therapy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel;
| |
Collapse
|
4
|
Jørgensen TSH, Meyer AC, Hedström M, Fors S, Modig K. The importance of close next of kin for independent living and readmissions among older Swedish hip fracture patients. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e727-e738. [PMID: 34032333 DOI: 10.1111/hsc.13443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/24/2021] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
We investigate the importance of adult children and/or cohabitation with a partner for older hip fracture patients' probability of independent living, public home care use and hospital readmission. Data from 35,066 Swedish hip fracture patients between 2012 and 2017, aged 65 years, and living at home at the time of the fracture in the Swedish Registry for Hip Fracture Patients and Treatment were linked with national registers. We applied adjusted logistic regression models and Cox proportional hazard models. In total, 959 (4.0%) women and 817 (7.3%) men had no adult children, 13,384 (56.0%) women and 3,623 (32.5%) men had no cohabiting partner and 2,780 (11.6%) women and 1,389 (12.5%) men neither had a cohabiting partner nor adult children. In comparison with women and men who had both a cohabiting partner and adult children, those without a cohabiting partner (i.e. only adult children) and those who neither had a cohabiting partner nor adult children had significantly lower probabilities of returning home (at discharge and after 4 months). They also had a greater probability of both receiving home care and having an increase in the amount of home care they receive. Having a close next of kin and hospital readmission were not associated. In conclusion, absence of a close next of kin, specifically a cohabiting partner, reduces the chance of return to independent living and increases the use of home care after a hip fracture hospitalisation. The findings highlight the importance of family support for older adults living situation after a hip fracture.
Collapse
Affiliation(s)
- Terese Sara Høj Jørgensen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anna C Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Margareta Hedström
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Karolinska Hospital Stockholm, Stockholm, Sweden
| | - Stefan Fors
- Aging Research Centre, Karolinska Institutet/Stockholm University, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
5
|
Houwen T, de Munter L, Lansink KWW, de Jongh MAC. There are more things in physical function and pain: a systematic review on physical, mental and social health within the orthopedic fracture population using PROMIS. J Patient Rep Outcomes 2022; 6:34. [PMID: 35384568 PMCID: PMC8986932 DOI: 10.1186/s41687-022-00440-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background The Patient-Reported Outcomes Information System (PROMIS®) is more and more extensively being used in medical literature in patients with an orthopedic fracture. Yet, many articles studied heterogeneous groups with chronic orthopedic disorders in which fracture patients were included as well. At this moment, there is no systematic overview of the exact use of PROMIS measures in the orthopedic fracture population. Therefore this review aimed to provide an overview of the PROMIS health domains physical health, mental health and social health in patients suffering an orthopedic fracture.
Methods This systematic review was documented according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. We searched Embase, Medline, Web of Science Core Collection, and Cochrane Central Register of controlled Trials, CINAHL and Google Scholar in December 2020 using a combination of MeSH terms and specific index terms related to orthopedic fractures and PROMIS questionnaires. Inclusion criteria were available full text articles that were describing the use of any PROMIS questionnaires in both the adult and pediatric extremity fracture population. Results We included 51 relevant articles of which most were observational studies (n = 47, 92.2%). A single fracture population was included in 47 studies of which 9 involved ankle fractures (9/51; 17.6%), followed by humeral fractures (8/51; 15.7%), tibia fractures (6/51; 11.8%) and radial -or ulnar fractures (5/51; 9.8%). PROMIS Physical Function (n = 32, 32/51 = 62.7%) and PROMIS Pain Interference (n = 21, 21/51 = 41.2%) were most frequently used questionnaires. PROMIS measures concerning social (n = 5/51 = 9.8%) and mental health (10/51 = 19.6%) were much less often used as outcome measures in the fracture population. A gradually increasing use of PROMIS questionnaires in the orthopedic fracture population was seen since 2017. Conclusion Many different PROMIS measures on multiple domains are available and used in previous articles with orthopedic fracture patients. With physical function and pain interference as most popular PROMIS measures, it is important to emphasize that other health-domains such as mental and social health can also be essential to fracture patients. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-022-00440-3.
Collapse
Affiliation(s)
- Thymen Houwen
- Network Emergency Care Brabant, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands. .,Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Leonie de Munter
- Department of Traumatology, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Hilvarenbeekseweg 60, 5022 GC, Tilburg, the Netherlands
| | - Koen W W Lansink
- Department of Surgery, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Hilvarenbeekseweg 60, 5022 GC, Tilburg, the Netherlands
| | - Mariska A C de Jongh
- Network Emergency Care Brabant, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| |
Collapse
|
6
|
Silva TLD, Motta VVD, Garcia WJ, Arreguy-Sena C, Pinto PF, Parreira PMSD, Paiva EPD. Quality of life and falls in elderly people: a mixed methods study. Rev Bras Enferm 2021; 74:e20200400. [PMID: 34037191 DOI: 10.1590/0034-7167-2020-0400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/18/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to assess elderly people's quality of life, understanding the social representations of falls. METHODS a convergent mixed methods research carried out at homes, with a sample of 134 elderly people. A structured questionnaire was used, covering sociodemographic variables and factors that indicated frailty and risk of falling. For quality of life assessment, Medical Outcomes Study Short-Form 36 and Theory of Social Representations, Abric's structural approach were used, with data treated by dictionary of equivalent terms, processed in Evoc 2000, converging analytically according to Neuman. RESULTS quality of life impairment was identified in terms of physical, emotional and functional capacity. The elements of the possible central nucleus were fall, fear, and bruised-broken-bone. FINAL CONSIDERATIONS quality of life impairment can contribute to increase the number of falls, which has been shown to be an event present in elderly people's lives through evocations. Understanding elderly people's individual demands allows planning actions.
Collapse
|
7
|
Meyer AC, Modig K. The role of having children for the incidence of and survival after hip fracture - A nationwide cohort study. Bone 2021; 145:115873. [PMID: 33548574 DOI: 10.1016/j.bone.2021.115873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Childless older women have a higher risk of sustaining a hip fracture than mothers. Several biological mechanisms linking parity to bone health among women have been proposed but it remains unclear whether a similar association exists among men. Adult children may also support their ageing parents with hip fracture, thereby potentially increasing survival chances. AIM To investigate how having children is related to the incidence of and survival after hip fracture among Swedish men and women over the age of 70. METHODS This nation-wide cohort study is based on data from several administrative population registers and a clinical hip fracture register. During 2013 to 2017, we estimated multivariable-adjusted incidence rate ratios to examine the association between number of children and incidence of first hip fracture and hazard ratios to examine survival after first hip fracture. RESULTS More than two million individuals were followed for hip fracture incidence and 45,991 patients for survival. Women had a higher risk of sustaining a hip fracture, but men had substantially higher mortality than women. Adjusting for education, comorbidity level, and further covariates, having children was associated with a lower risk of sustaining a hip fracture and a longer survival after hip fracture. CONCLUSIONS Older childless individuals may constitute risk groups for both the incidence of and mortality after hip fracture. Mechanisms linking parity to hip fracture risk are likely complex and not limited to biological mechanisms related to pregnancy, childbirth, or breastfeeding among women.
Collapse
Affiliation(s)
- Anna C Meyer
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
8
|
Sammut R, Azzopardi C, Camilleri L. Spiritual coping strategies and quality of life in older adults who have sustained a hip fracture: A cross-sectional survey. Nurs Open 2021; 8:572-581. [PMID: 33570284 PMCID: PMC7877164 DOI: 10.1002/nop2.662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/20/2020] [Accepted: 09/10/2020] [Indexed: 01/16/2023] Open
Abstract
AIMS To investigate the relationship between spiritual coping strategies and quality of life in persons with a hip fracture. DESIGN A correlational, cross-sectional survey design. METHODS The total population of Maltese-speaking adults over 65 years (N = 299), with a hip fracture receiving treatment in a public hospital in Malta in 2015, were invited. The WHOQOL-BREF questionnaire and the Spiritual Coping Strategies Scale were used. RESULTS A response rate of 51% (n = 147) was achieved. The poorest quality of life was for the physical and psychological domains. Spiritual coping strategies were associated with better quality of life with the exception of physical quality of life. Non-religious coping strategies were the stronger predictor of quality of life compared with religious coping strategies. The former predicted physical, psychological, environmental, social and overall quality of life. CONCLUSION Hip fractures have serious implications on quality of life which could be improved by promoting non-religious spiritual coping strategies.
Collapse
Affiliation(s)
| | | | - Liberato Camilleri
- Statistics and Operations ResearchFaculty of ScienceUniversity of MaltaMsidaMalta
| |
Collapse
|
9
|
Odonkor CA, Esparza R, Flores LE, Verduzco-Gutierrez M, Escalon MX, Solinsky R, Silver JK. Disparities in Health Care for Black Patients in Physical Medicine and Rehabilitation in the United States: A Narrative Review. PM R 2020; 13:180-203. [PMID: 33090686 DOI: 10.1002/pmrj.12509] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/18/2020] [Accepted: 09/28/2020] [Indexed: 01/18/2023]
Abstract
Racial health disparities continue to disproportionately affect Black persons in the United States. Black individuals also have increased risk of worse outcomes associated with social determinants of health including socioeconomic factors such as income, education, and employment. This narrative review included studies originally spanning a period of approximately one decade (December 2009-December 2019) from online databases and with subsequent updates though June 2020. The findings to date suggest pervasive inequities across common conditions and injuries in physical medicine and rehabilitation for this group compared to other racial/ethnic groups. We found health disparities across several domains for Black persons with stroke, traumatic brain injury, spinal cord injury, hip/knee osteoarthritis, and fractures, as well as cardiovascular and pulmonary disease. Although more research is needed, some contributing factors include low access to rehabilitation care, fewer referrals, lower utilization rates, perceived bias, and more self-reliance, even after adjusting for hospital characteristics, age, disease severity, and relevant socioeconomic variables. Some studies found that Black individuals were less likely to receive care that was concordant with clinical guidelines per the reported literature. Our review highlights many gaps in the literature on racial disparities that are particularly notable in cardiac, pulmonary, and critical care rehabilitation. Clinicians, researchers, and policy makers should therefore consider race and ethnicity as important factors as we strive to optimize rehabilitation care for an increasingly diverse U.S. population.
Collapse
Affiliation(s)
- Charles A Odonkor
- Department of Orthopaedics and Rehabilitation, Division of Physiatry, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Rachel Esparza
- Yale School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Laura E Flores
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Miguel X Escalon
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryan Solinsky
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Charlestown, MA, USA.,Massachusetts General Hospital, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|