Older Adults With Hip Arthroplasty: An Individualized Transitional Care Program

Discharge transitional care programme for older adults after hip fracture surgery: a quasi-experimental study

Background

Hip fractures require extended periods of recovery and rehabilitation, subjecting older adults to discontinuous care. Discharge transition is a critical point of heightened vulnerability for older adults.

Aims

This study aimed to evaluate the effectiveness of a transitional care programme on the physical functions and quality of life (QOL) of older adults after hip fracture surgery.

Methods

Seventy-five older adults were assessed from pre-discharge to 6 weeks after hip surgery, and their physical functions, including walking status and activities of daily living, were measured. The QOL was measured using the European Quality of life-5 Dimensions-5 Levels (EQ 5D 5L).

Results

There was a significant strong effect of time (B = 10.565; 95% CI = 2.584-18.547; p = 0.009) on the EuroQol Visual Analog Scale (EQ-VAS) for the experimental group. However, there were no significant effects of time on physical functions and EQ-5D-5L scores.

Conclusions

The discharge transitional care programme improved the EQ-VAS of older adults following hip fracture surgery 6 weeks post-surgery. However, there were no significant differences in physical functions and EQ-5D between the groups.

Long-term health-related quality of life of total hip arthroplasty patients and cost-effectiveness analysis in the Japanese universal health insurance system

AIM

Total hip arthroplasty can effectively improve patients' motility with end-stage osteoarthritis. This study aimed to: (1) compare gradual changes in utility values with total hip arthroplasty and estimated values without; (2) evaluate total hip arthroplasty cost-effectiveness; and (3) evaluate cost-effectiveness by age, diagnosis, and comorbidity.

METHODS

Patients who underwent total hip arthroplasty between January 2008 and December 2009 were included. Patients completed the EuroQol preoperatively and at 1, 3, 5 and 7 years postoperatively. To derive the quality-adjusted life years gained, a utility score was obtained from the EuroQol item scores and combined with 7 years, and estimates were obtained by discounting the postoperative 1-year utility value at an annual rate of 2%-4%. Mixed-effects regression models were used to compare the estimated and the measured utility values.

RESULTS

Mean total cost was 1,921,849 yen, and quality-adjusted life years gain score was 1.746 with per cost as 1,100,715 yen. Compared with actual measurements, the estimated values from 1 to 7 years post-surgery differed significantly, and interaction was observed. Regarding age, the older the patient, the higher the cost per quality-adjusted life years. Patients with lower preoperative physical function had higher quality-adjusted life years gains, while the cost per quality-adjusted life years was lower.

CONCLUSIONS

Total hip arthroplasty was cost-effective. Compared with actual measurements, the estimated utility values from 1 to 7 years post-surgery significantly differed. Even among older patients and those with impaired preoperative physical functions, its cost was lower than patients' willingness to pay in Japan.

Educational Intervention in Rehabilitation to Improve Functional Capacity after Hip Arthroplasty: A Scoping Review

(1) Background: The prevalence of coxarthrosis associated with ageing is one of the main reasons for the increase in hip arthroplasty. Educational intervention in the pre- and postoperative period of hip arthroplasty can improve functionality and, consequently, quality of life. Therefore, we intend to map the educational interventions that improve the functional capacity of people undergoing hip arthroplasty on their rehabilitation process. (2) Methods: Scoping review. The search was carried out in the databases: CINAHL complete, MEDLINE Complete, Nursing and Allied Health Collection: Comprehensive, Cochrane Methodology Register, Library, Information Science and Technology Abstracts, MedcLatina, and Google Academic. We included studies that evaluated the implementation of educational rehabilitation interventions that enable the empowerment and teaching of people undergoing hip arthroplasty. (3) Results: Thirteen studies were analysed that met the eligibility criteria and allowed the research question to be answered. Education in the perioperative period promotes training to perform rehabilitation exercises, improves the hospitalisation experience, increases participation in the rehabilitation process, allows early mobilisation, and increases the functional potential, thus enabling faster reintegration into society. (4) Conclusion: Early mobilisation plays a very important role in a person′s functional recovery, as well as in the prevention of thromboembolic complications. Exercise produces benefits in relation to physical function, namely, in improving strength, balance, facilitating functional activities, and preventing complications.

Discharge transition experienced by older Korean women after hip fracture surgery: a qualitative study

BACKGROUND

This study aimed to explore older Korean women's discharge transition experiences after hip fracture surgery.

METHODS

This was a descriptive qualitative study. Face-to-face interviews following hip fracture surgery were conducted on 12 women aged 65-87 years. Data were collected 1 to 2 days before discharge and again 4 weeks after discharge following hip fracture surgery, and were analyzed using qualitative content analysis.

RESULTS

Four main themes were identified: (1) challenge of discharge transition: unprepared discharge, transfer into other care settings, and eagerness for recovery; (2) physical and psychological distress against recovery: frail physical state and psychological difficulties; (3) dependent compliance: absolute trust in healthcare providers, indispensable support from the family, and passive participation in care; and (4) walking for things they took for granted: hope of walking and poor walking ability.

CONCLUSIONS

After their hip fracture surgeries, older women hoped to be able to walk and perform simple daily chores they previously took for granted. Considering the physical and psychological frailty of older women undergoing hip surgery, systematic nursing interventions including collaboration and coordination with other healthcare professionals and settings are necessary to ensure the quality of continuous care during their post-surgery discharge transition. Encouraging partial weight bearing and initiating intervention to reduce fear of falling at the earliest possible time are essential to attain a stable discharge transition. Additionally, older women should be invited to participate in their care, and family involvement should be encouraged during the discharge transition period in South Korea.