1
|
Kamimura T, Kobayashi Y, Tamaki S, Koinuma M. Impact of Prefracture Cognitive Impairment and Postoperative Delirium on Recovery after Hip Fracture Surgery. J Am Med Dir Assoc 2024; 25:104961. [PMID: 38428834 DOI: 10.1016/j.jamda.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES This study aimed to examine the impact of prefracture cognitive impairment (CI) severity and postoperative delirium on recovery after hip fracture surgery in older patients. DESIGN Prospective study with a 1-year follow-up. SETTING AND PARTICIPANTS We included 355 patients aged ≥80 years from 2 acute hospitals in Japan. METHODS Barthel Index (BI) ambulation scores were assessed prefracture and at 1, 3, 6, and 12 months postoperatively. The score at each time point minus the prefracture score was used as the ambulation recovery variable. The 21-item Dementia Assessment Sheet for the Community-based Care System (DASC-21) and Confusion Assessment Method were used to assess CI severity and delirium, respectively. The impacts of CI severity and delirium on recovery at 1 month and by 12 months postoperatively were examined. Linear multiple regression and linear mixed effects models were used. RESULTS BI ambulation scores remained the same or improved from prefracture levels in 26.8%, 34.4%, 33.0%, and 30.4% of patients at 1, 3, 6, and 12 months, respectively. Ten patients (2.8%) had fall-related hip fractures, 20 (5.6%) were rehospitalized, and 43 (12.1%) died during this period. Although DASC-21 CI severity significantly affected the recovery both at 1 month and by 12 months postoperatively [standardized β (Stdβ) = -0.39, P < .0001, and Stdβ = -0.37, P < .0001, respectively], delirium did not. Other variables affecting recovery by 12 months postoperatively included prefracture BI ambulation scores, Mini Mental State Examination scores, age, fracture type, place of residence, and time. CONCLUSIONS AND IMPLICATIONS Postoperative ambulation recovery, excluding the effect of death and other poor outcomes, is influenced by prefracture CI severity, and the presence of delirium itself may not be the moderating variable. These results emphasize the importance of treatment planning based on prefracture CI severity and indicate that assessments such as the DASC-21 may be useful in implementing such a plan.
Collapse
Affiliation(s)
- Tomoko Kamimura
- Department of Medical Sciences, Shinshu University, Matsumoto, Nagano, Japan.
| | - Yuya Kobayashi
- Department of Rehabilitation, Aizawa Hospital, Matsumoto, Nagano, Japan
| | - Satoshi Tamaki
- Department of Rehabilitation, Kamiiida-Daiichi General Hospital, Nagoya, Aichi, Japan
| | - Masayoshi Koinuma
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan
| |
Collapse
|
2
|
Romero Pisonero E, Mora-Fernández J, Queipo Matas R, González Montalvo JI, Neira Álvarez M, Ojeda Thies C, Sáez López P, Malafarina V. Demographic, functional and clinical characteristics in hip fracture patients according to mental status of the Spanish National Hip Fracture Registry. Rev Esp Geriatr Gerontol 2024; 59:101450. [PMID: 38159499 DOI: 10.1016/j.regg.2023.101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To describe the differences according to mental status at admission on the care process and 30-day outcomes in hip fracture patients, mainly regarding the use of rehabilitation resources and anti-osteoporotic medication, by analysing data from the Spanish National Hip Fracture Registry (RNFC, "Registro Nacional de Fracturas de Cadera" in Spanish). METHODS We analysed prospectively collected data from a cohort of patients admitted participating in the Spanish National Hip Fracture Registry (RNFC) in 76 Spanish hospitals between 2017 and 2019. We classified participants using Short Portable Mental Status Questionnaire (SPMSQ), defining two groups: patients with ≤2 SPMSQ score and patients with >2 SPMSQ score. RESULTS Of 21,254 patients was recorded SPMSQ in 17,242 patients, 9052 were >2 SPMSQ score (52.6%). These were older (87.7 vs. 85.3 years; p<0.001), had worse mobility (no-independent walking ability 26.0% vs. 4.5%; p<0.001) and were more likely to be living in nursing homes (35.3% vs. 9.6%; p<0.001). They were more likely to be treated nonoperatively (3.8% vs. 1.5%; p>0.001), less early mobilisation (57.5% vs. 68.9%; p<0.001) and suffered higher in-hospital mortality (5.2% vs. 2.7%; p<0.001). At discharge, they received less anti-osteoporotic medication (37.9% vs. 48.9%; p<0.001) and returned home less often (29.8%% vs. 51.2%; p<0.001). One month after fracture, patients with >2 SPMSQ score had poorer mobility (no-independent walking ability 44.4% vs. 24.9%; p<0.001) and were newly institutionalised in a nursing home more (12.6% vs. 12.0%; p<0.001) and were more likely to die by one-month post-fracture (9.5% vs. 4.6%; p<0.001). CONCLUSION RNFC patients with >2 SPMSQ score were more vulnerable and had poorer outcomes than patients with ≤2 SPMSQ score, suggesting that they need specialised care in-hospital and in the recovery phase.
Collapse
Affiliation(s)
| | - Jesús Mora-Fernández
- Department of Geriatrics, Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Complutense University, Madrid, Spain
| | - Rocío Queipo Matas
- Europea University, Madrid, Spain; La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
| | - Juan Ignacio González Montalvo
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain; Department of Geriatrics, La Paz University Hospital, Madrid, Spain; Department of Medicine, Faculty of Medicine, Autonoma University, Madrid, Spain
| | | | - Cristina Ojeda Thies
- Department of Traumatology and Orthopaedic Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - Pilar Sáez López
- La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain; Geriatrics Unit, Fundación Alcorcón University Hospital, Alcorcón, Madrid, Spain
| | | |
Collapse
|
3
|
Pfeuffer N, Radicke F, Leiz M, Moon K, Hoffmann W, van den Berg N. Outpatient geriatric health care in the German federal state of Mecklenburg-Western Pomerania: a population-based spatial analysis of claims data. BMC Health Serv Res 2024; 24:458. [PMID: 38609972 PMCID: PMC11010346 DOI: 10.1186/s12913-024-10888-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Due to unidentified geriatric needs, elderly patients have a higher risk for developing chronic conditions and acute medical complications. Early geriatric screenings and assessments help to identify geriatric needs. Holistic and coordinated therapeutic approaches addressing those needs maintain the independence of elderly patients and avoid adverse effects. General practitioners are important for the timely identification of geriatric needs. The aims of this study are to examine the spatial distribution of the utilization of outpatient geriatric services in the very rural Federal State of Mecklenburg-Western Pomerania in the Northeast of Germany and to identify regional disparities. METHODS Geographical analysis and cartographic visualization of the spatial distribution of outpatient geriatric services of patients who are eligible to receive basic geriatric care (BGC) or specialized geriatric care (SGC) were carried out. Claims data of the Association of Statutory Health Insurance Physicians in Mecklenburg-Western Pomerania were analysed on the level of postcode areas for the quarter periods between 01/2014 and 04/2017. A Moran's I analysis was carried out to identify clusters of utilization rates. RESULTS Of all patients who were eligible for BGC in 2017, 58.3% (n = 129,283/221,654) received at least one BCG service. 77.2% (n = 73,442/95,171) of the patients who were eligible for SGC, received any geriatric service (BGC or SGC). 0.4% (n = 414/95,171) of the patients eligible for SGC, received SGC services. Among the postcode areas in the study region, the proportion of patients who received a basic geriatric assessment ranged from 3.4 to 86.7%. Several regions with statistically significant Clusters of utilization rates were identified. CONCLUSIONS The widely varying utilization rates and the local segregation of high and low rates indicate that the provision of outpatient geriatric care may depend to a large extent on local structures (e.g., multiprofessional, integrated networks or innovative projects or initiatives). The great overall variation in the provision of BGC services implicates that the identification of geriatric needs in GPs' practices should be more standardized. In order to reduce regional disparities in the provision of BGC and SGC services, innovative solutions and a promotion of specialized geriatric networks or healthcare providers are necessary.
Collapse
Affiliation(s)
- Nils Pfeuffer
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany.
| | - Franziska Radicke
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Maren Leiz
- Jade University of Applied Science, Ofener Straße 16, 26121, Oldenburg, Germany
| | - Kilson Moon
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Wolfgang Hoffmann
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Neeltje van den Berg
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| |
Collapse
|
4
|
Ruggiero C, Baroni M, Xenos D, Parretti L, Macchione IG, Bubba V, Laudisio A, Pedone C, Ferracci M, Magierski R, Boccardi V, Antonelli-Incalzi R, Mecocci P. Dementia, osteoporosis and fragility fractures: Intricate epidemiological relationships, plausible biological connections, and twisted clinical practices. Ageing Res Rev 2024; 93:102130. [PMID: 38030092 DOI: 10.1016/j.arr.2023.102130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
Dementia, osteoporosis, and fragility fractures are chronic diseases, often co-existing in older adults. These conditions pose severe morbidity, long-term disability, and mortality, with relevant socioeconomic implications. While in the research arena, the discussion remains on whether dementia is the cause or the consequence of fragility fractures, healthcare professionals need a better understanding of the interplay between such conditions from epidemiological and physiological standpoints. With this review, we summarized the available literature surrounding the relationship between cognitive impairment, dementia, and both low bone mineral density (BMD) and fragility fractures. Given the strength of the bi-directional associations and their impact on the quality of life, we shed light on the biological connections between brain and bone systems, presenting the main mediators, including gut microbioma, and pathological pathways leading to the dysregulation of bone and brain metabolism. Ultimately, we synthesized the evidence about the impact of available pharmacological treatments for the prevention of fragility fractures on cognitive functions and individuals' outcomes when dementia coexists. Vice versa, the effects of symptomatic treatments for dementia on the risk of falls and fragility fractures are explored. Combining evidence alongside clinical practice, we discuss challenges and opportunities related to the management of older adults affected by cognitive impairment or dementia and at high risk for fragility fracture prevention, which leads to not only an improvement in patient health-related outcomes and survival but also a reduction in healthcare cost and socio-economic burden.
Collapse
Affiliation(s)
- C Ruggiero
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy.
| | - M Baroni
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - D Xenos
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - L Parretti
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - I G Macchione
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - V Bubba
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - A Laudisio
- Department of Medicine, Unit of Geriatrics, Campus Bio-Medico di Roma University, Rome, Italy
| | - C Pedone
- Department of Medicine, Unit of Geriatrics, Campus Bio-Medico di Roma University, Rome, Italy
| | - M Ferracci
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - R Magierski
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - V Boccardi
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| | - R Antonelli-Incalzi
- Department of Medicine, Unit of Geriatrics, Campus Bio-Medico di Roma University, Rome, Italy
| | - P Mecocci
- Department of Medicine, Section of Gerontology and Geriatrics, University of Perugia, Italy
| |
Collapse
|
5
|
Jiao S, Zhou J, Feng Z, Huang J, Chen L, Li Z, Meng Q. The role of neutrophil percentage to albumin ratio in predicting 1-year mortality in elderly patients with hip fracture and external validation. Front Immunol 2023; 14:1223464. [PMID: 37622119 PMCID: PMC10445888 DOI: 10.3389/fimmu.2023.1223464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
Objectives This study aimed to investigate the association between the neutrophil percentage to albumin ratio (NPAR) on the day of admission and mortality 1 year after surgery in elderly patients with hip fractures. Methods Clinical characteristics and blood markers of inflammation were retrospectively collected from October 2016 to January 2022 in elderly patients with hip fractures at two different regional tertiary medical centers. It is divided into a training set and an external validation set. Multivariate Nomogram models such as NPAR were constructed using the least absolute shrinkage and selection operator (LASSO) regression results and multi-factor logistic regression analysis. In addition, multivariate Cox regression analysis and Kaplan-Meier survival curves were used to explore the relationship between NPAR values and mortality within 1 year in elderly patients with hip fractures. The predictive performance of the Nomogram was evaluated using the concordance index (C Index) and receiver operating characteristic curve (ROC) and validated by Bootstrap, Hosmer-Lemesow goodness of fit test, calibration curve, decision curve, and clinical impact curve analysis. Results The study included data from 1179 (mean age, 80.34 ± 8.06 years; 61.4[52.1%] male) patients from the Guangzhou Red Cross Hospital affiliated with Jinan University and 476 (mean age, 81.18 ± 8.33 years; 233 [48.9%] male) patients from the Xiaogan Central Hospital affiliated with Wuhan University of Science and Technology. The results showed that NPAR has good sensitivity and specificity in assessing patients' prognosis 1 year after surgery. Multivariate logistic regression models based on influencing factors such as NPAR have good discrimination and calibration ability (AUC=0.942, 95% CI:0.927-0.955; Hosmer-Lemeshow test: P >0.05). Kaplan-Meier survival curves for the training and validation sets showed that patients in the high NPAR group had a higher mortality rate at 1 year compared to the low NPAR group (P< 0.001). Multivariate Cox regression showed that high NPAR values were an independent risk factor for death within 1 year in elderly hip fracture patients (P< 0.001, HR =2.38,95%CI:1.84-3.08). Conclusion Our study showed that NPAR levels were significantly higher in patients who died within 1 year after surgery in both the training and validation sets. NPAR has good clinical value in assessing 1-year postoperative prognosis in elderly patients with hip fractures.
Collapse
Affiliation(s)
- Songsong Jiao
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Jiangfei Zhou
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Zhencheng Feng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Jian Huang
- Department of Traumatic Orthopaedics, The Central Hospital of Xiaogan, Xiaogan, Hubei, China
| | - Lihong Chen
- Department of Traumatic Orthopaedics, The Central Hospital of Xiaogan, Xiaogan, Hubei, China
| | - Zhiwu Li
- Department of Orthopedics, Bijie Second People’s Hospital, Guizhou, China
| | - Qingqi Meng
- Department of Orthopedics, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| |
Collapse
|
6
|
Preoperative Comorbidities Associated With Early Mortality in Hip Fracture Patients: A Multicenter Study. J Am Acad Orthop Surg 2023; 31:81-86. [PMID: 36580049 DOI: 10.5435/jaaos-d-21-01055] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 08/05/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Multiple comorbidities in hip fracture patients are associated with increased mortality and complications. The goal of this study was to characterize the relationship between specific patient factors including comorbidities and outcomes in geriatric hip fractures, including length of stay, unplanned ICU admission, discharge disposition, complications, and mortality. METHODS This is a retrospective review of a trauma database from five Level 1 and Level 2 trauma centers of patients with hip fractures of the femoral neck and intertrochanteric region who underwent treatment using hip pinning, hemiarthroplasty, total hip arthroplasty, cephalomedullary nailing, or dynamic hip screw fixation. Mortality was the primary outcome variable (including in-hospital mortality, 30-day mortality, 60-day mortality, and 90-day mortality). Secondary outcome variables included in-hospital adverse events, unplanned transfer to the ICU, postoperative length of stay, and discharge disposition. Regression analyses were used for evaluation of relationships between comorbidities as independent variables and primary and secondary outcomes as dependent variables. RESULTS Two thousand three hundred patients were included. The mortality was 1.8%, 7.0%, 10.9%, and 14.1% for in-hospital, 30-day, 60-day, and 90-day mortality, respectively. Diabetes and cognitive impairment present on admission were associated with mortality at all-time intervals. COPD was the only comorbidity that signaled in-hospital adverse event with an odds ratio of 1.67 (P = 0.012). No patient factors, time to surgery, or comorbidities signaled unplanned ICU transfer. Patients with renal failure and COPD had longer hospital stays after surgery. CONCLUSION Geriatric hip fractures continue to have high short-term morbidity and mortality. Identifying patients with increased odds of early mortality and adverse events can help teams optimize care and outcomes. Patients with diabetes, cognitive impairment, renal failure, and COPD may benefit from continued and improved medical optimization during the perioperative period as well as being more closely managed by a medicine team without delaying time to the operating room.
Collapse
|
7
|
Umehara T, Kaneguchi A, Yamasaki T, Katayama N, Kawakami W, Kuwahara D, Kito N. Reduced upper and lower limb muscle strengths without reduced skeletal muscle in elderly patients with heart failure. J Rural Med 2023; 18:8-14. [PMID: 36700128 PMCID: PMC9832311 DOI: 10.2185/jrm.2022-029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/02/2022] [Indexed: 01/06/2023] Open
Abstract
Objective: This study aimed to characterize the muscle strength and skeletal muscle mass of patients with heart failure by investigating hand-grip strength, five times sit-to-stand (5STS) results, and skeletal muscle mass index (SMI). Materials and Methods: Muscle strength was assessed based on hand-grip strength and 5STS, while skeletal muscle mass was assessed using a bioelectrical impedance analyzer. Hierarchical logistic regression analysis was performed to explore the association between patients with heart failure and healthy elderly individuals. Results: Hierarchical logistic regression analysis was performed to examine the muscle strength and skeletal muscle mass characteristics in patients with heart failure. Hand-grip strength and 5STS responses but not SMI outcomes differed significantly between the two groups. The results of the hierarchical logistic regression analysis revealed that the hand-grip strength and 5STS were significant predictors of heart failure. The odds ratios for hand-grip strength and 5STS were 1.44 and 0.53, respectively. Conclusion: Our results suggested that upper and lower limb muscle strengths (handgrip strength and 5STS) in elderly patients with heart failure worsened significantly without a decrease in skeletal muscle mass.
Collapse
Affiliation(s)
- Takuya Umehara
- Department of Rehabilitation, Faculty of Rehabilitation,
Hiroshima International University, Japan
| | - Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation,
Hiroshima International University, Japan
| | - Takahiro Yamasaki
- Department of Rehabilitation, Faculty of Rehabilitation,
Hiroshima International University, Japan
| | | | | | | | - Nobuhiro Kito
- Department of Rehabilitation, Faculty of Rehabilitation,
Hiroshima International University, Japan
| |
Collapse
|
8
|
Araiza-Nava B, Méndez-Sánchez L, Clark P, Peralta-Pedrero ML, Javaid MK, Calo M, Martínez-Hernández BM, Guzmán-Jiménez F. Short- and long-term prognostic factors associated with functional recovery in elderly patients with hip fracture: A systematic review. Osteoporos Int 2022; 33:1429-1444. [PMID: 35247062 DOI: 10.1007/s00198-022-06346-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/10/2022] [Indexed: 01/17/2023]
Abstract
UNLABELLED This systematic review aimed to identify short- and long-term associated factors to functional recovery of elderly hip fracture patients after discharge. We identified 43 studies reporting 74 associated factors to functional recovery; most of them were biological, sociodemographic, or inherent factors to patients' baseline characteristics, including their pre-facture functional capacity. PURPOSE This systematic review aimed to identify short- and long-term associated factors to functional recovery of elderly hip fracture patients after hospital discharge. We assessed the use of the hip fracture core-set and key-performance indicators for secondary fracture reduction. METHODS A search was performed in seven electronic databases. Observational studies reporting predictors after usual care of elderly patients with hip fracture diagnoses receiving surgical or conservative treatment were included. Primary outcomes considered were part of the domains corresponding to functional capacity. RESULTS Of 3873 references identified, and after the screening and selection process, 43 studies were included. Sixty-one functional measures were identified for ten functional outcomes, including BADLs, IADLs, ambulation, and mobility. Biological characteristics such as age, sex, comorbidities, cognitive status, nutritional state, and biochemical parameters are significantly associated. Determinants such as contact and size of social network and those related to institutional care quality are relevant for functional recovery at six and 12 months. Age, pre-fracture function, cognitive status, and complications continue to be associated five years after discharge. We found 74 associated factors to functional recovery of elderly hip fracture patients. Ten of the studies reported rehabilitation programs as suggested in KPI 9; none used the complete hip fracture core-set. CONCLUSION Most of the associated factors for functional recovery of elderly hip fracture were biological, sociodemographic, or inherent factors to patients' baseline characteristics, including their pre-facture functional capacity. For the core-set and KPI's, we found an insufficient use and report. This study reports 61 different instruments to measure functional capacity. REGISTRATION NUMBER PROSPERO (CRD42020149563).
Collapse
Affiliation(s)
- Berenice Araiza-Nava
- Clinical Epidemiology Research Unit, Hospital Infantil de Mexico "Federico Gomez", Mexico city, Mexico. Faculty of Medicine of National Autonomous University of Mexico (Universidad Nacional Autónoma de México), Mexico City, Mexico
| | - Lucia Méndez-Sánchez
- Clinical Epidemiology Research Unit, Hospital Infantil de Mexico "Federico Gomez", Mexico city, Mexico. Faculty of Medicine of National Autonomous University of Mexico (Universidad Nacional Autónoma de México), Mexico City, Mexico.
| | - Patricia Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de Mexico "Federico Gomez", Mexico city, Mexico. Faculty of Medicine of National Autonomous University of Mexico (Universidad Nacional Autónoma de México), Mexico City, Mexico
| | | | - Muhammad Kassim Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mónica Calo
- Regional Manager of IOF Latin America, Buenos Aires, Argentina
| | - Brenda María Martínez-Hernández
- Faculty of Medicine of National Autonomous University of Mexico (Universidad Nacional Autónoma de México), Mexico City, Mexico
| | - Fabiola Guzmán-Jiménez
- Medical Unit of High Specialty Traumatology and Orthopaedics Hospital "Lomas Verdes", Mexican Institute of Social Security (UMAE Hospital de Traumatología Y Ortopedia "Lomas Verdes", Instituto Mexicano del Seguro Social), Naucalpan de Juárez, Mexico. Faculty of Medicine of National Autonomous University of Mexico (Universidad Nacional Autónoma de México), Mexico City, Mexico
| |
Collapse
|
9
|
Hua H, Xu Y, Jiang M, Dai X. Evaluation of Pericapsular Nerve Group (PENG) Block for Analgesic Effect in Elderly Patients with Femoral Neck Fracture Undergoing Hip Arthroplasty. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7452716. [PMID: 35186238 PMCID: PMC8849892 DOI: 10.1155/2022/7452716] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/30/2021] [Accepted: 01/07/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND For evaluating pericapsular nerve group (PENG) block's analgesic effect on elderly patients suffering from femoral neck fracture undergoing hip arthroplasty to provide a basis for optimizing perioperative analgesia in hip arthroplasty. METHODS Forty-eight patients undergoing hip arthroplasty with spinal anesthesia for femoral neck fracture in our hospital were chosen in this study. Based on the random number table method, patients were categorized into the following two groups (n = 24 per group): the hip peripheral nerve group block group (PE group) and the iliac fascia block group (FI group). The fascia iliaca compartment block was used in the FI group, whereas the pericapsular nerve group block in the PE group. When placed in the position for spinal anesthesia (T4), we measured dynamic and static visual analog scale (VAS) scores as well as analgesic satisfaction before blockade (T0), along with at 10 min (T1), 20 min (T2), and 30 min postblockade (T3). Sufentanil dosage and effective analgesic pump press number at 6 h (T5), 12 h (T6), 24 h (T7), and 48 h (T8) postoperatively were recorded. In the meantime, the development of related complications was also recorded. RESULTS Compared with T0, patients in both groups achieved lower static VAS scores at T1-T4 (P < 0.05) and lower dynamic VAS scores at T2-T4 of the FI group (P < 0.05). Relative to the FI group, both static and dynamic VAS scores at T1-T4 were obviously lower in the PE group (P < 0.05), along with increased dynamic analgesic satisfaction (P < 0.05). Weakness of the quadriceps was observed in seven patients in the FI groups (P < 0.05). No delirium, hematoma, puncture site infection, or nerve injury occurred in either group. CONCLUSION The pericapsular nerve group block can provide safe and effective analgesia for elderly patients during the perioperative period of hip arthroplasty, with rapid onset, good analgesic effect, high patient satisfaction, and low complication rate, and is worthy of widespread application. The trial is registered with ChiCTR2100046785.
Collapse
Affiliation(s)
- Hao Hua
- Department of Anesthesiology, Wuxi Ninth People's Hospital, Wuxi 214062, China
| | - Yan Xu
- Department of Anesthesiology, Wuxi Ninth People's Hospital, Wuxi 214062, China
| | - MengLu Jiang
- Department of Anesthesiology, Wuxi Ninth People's Hospital, Wuxi 214062, China
| | - Xu Dai
- Department of Anesthesiology, Wuxi Ninth People's Hospital, Wuxi 214062, China
| |
Collapse
|
10
|
Liu E, Killington M, Cameron ID, Li R, Kurrle S, Crotty M. Life expectancy of older people living in aged care facilities after a hip fracture. Sci Rep 2021; 11:20266. [PMID: 34642410 PMCID: PMC8511118 DOI: 10.1038/s41598-021-99685-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/27/2021] [Indexed: 12/03/2022] Open
Abstract
To the authors’ knowledge, no study has been conducted on life expectancy for aged care facility residents with hip fracture. We assessed life expectancy of 240 residents of aged care facilities in Australia who experienced recent hip fracture treated with surgery. 149 deaths occurred over a mean follow-up of 1.2 years. Being female and having better cognition were associated with longer life expectancy. Increased age was associated with shorter life expectancy. The cumulative mortality rate within three months after hip fracture was 25.0% while the cumulative mortality rate for the whole study period was 62.1%. Life expectancy was 8.2 years, 4.8 years and 2.8 years for 70, 80 and 90-years old female patients. Life expectancy was 3.8 years, 2.2 years and 1.3 years for 70, 80 and 90 years old male patients, respectively. In conclusion, age, gender and cognition level were associated with life expectancy of hip fracture patients living in aged care facilities and their life expectancy was much shorter than that of the general Australian population.
Collapse
Affiliation(s)
- Enwu Liu
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia. .,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
| | - Maggie Killington
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, Kolling Institute, University of Sydney, St Leonards, NSW, Australia
| | - Raymond Li
- Monash School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Susan Kurrle
- Curran Ageing Research Unit, Faculty of Medicine and Health, Hornsby Ku-Ring-Gai Hospital, University of Sydney and, Hornsby, NSW, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| |
Collapse
|
11
|
Schuijt HJ, Lehmann LS, Javedan H, von Keudell AG, Weaver MJ. A Culture Change in Geriatric Traumatology: Holistic and Patient-Tailored Care for Frail Patients with Fractures. J Bone Joint Surg Am 2021; 103:e72. [PMID: 33974580 DOI: 10.2106/jbjs.20.02149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Medical decision-making for frail geriatric trauma patients is complex, especially toward the end of life. The goal of this paper is to review aspects of end-of-life decision-making, such as frailty, cognitive impairment, quality of life, goals of care, and palliative care. Additionally, we make recommendations for composing a patient-tailored treatment plan. In doing so, we seek to initiate the much-needed discussion regarding end-of-life care for frail geriatric patients.
Collapse
Affiliation(s)
- Henk Jan Schuijt
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lisa Soleymani Lehmann
- Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Houman Javedan
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Arvind G von Keudell
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael John Weaver
- Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
12
|
Inui T, Watanabe Y, Kurata Y, Suzuki T, Matsui K, Ishii K, Kurozumi T, Kawano H. Early postoperative Barthel index score and long-term walking ability in patients with trochanteric fractures walking independently before injury: a retrospective cohort study. Arch Orthop Trauma Surg 2021; 141:1283-1290. [PMID: 32705380 DOI: 10.1007/s00402-020-03548-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/15/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Trochanteric fractures are one of the most common fragility fractures, and the number of the patients is increasing worldwide. Identifying prognostic factors is important to manage and minimize the social losses caused by postoperative walking impairment. The purpose of this retrospective study is to clarify the association between early postoperative Barthel index score and postoperative long-term walking ability among patients with trochanteric fractures who could walk independently before injury. MATERIALS AND METHODS Consecutive patients with trochanteric fractures aged ≥ 65 years who were walking independently before injury were included. Patients were divided into two groups according to the Barthel index score measured within 1 week after surgery; the cut-off value was set at 20 points. The prevalence of walking impairment after 1 year was compared between these two groups after adjusting for confounding factors in a complete case analysis and using the data introduced by the multiple imputation method. RESULTS Among the 758 eligible patients, 254 patients (34%) had their walking ability evaluated after 1 year from injury. The patients in the lower Barthel index group showed a significantly impaired walking ability in both analyses (adjusted odds ratio 5.5 and 2.4, 95% confidence intervals 2.4-13 and 1.5-3.8, respectively). CONCLUSIONS The present results suggested that the Barthel index score measured in the early postoperative period after trochanteric fractures was associated with the level of long-term walking impairment in patients who could walk independently before injury.
Collapse
Affiliation(s)
- Takahiro Inui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan. .,Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan.
| | - Yoshinobu Watanabe
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan.,Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| | - Yoshiaki Kurata
- Division of Orthopaedic Trauma, Sapporo Tokushukai Hospital, 1-1-1 Oyachi-higashi, Atsubetsu-ku, Sapporo, Hokkaido, Japan
| | - Takashi Suzuki
- Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| | - Kentaro Matsui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan.,Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| | - Keisuke Ishii
- Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| | - Taketo Kurozumi
- Trauma and Reconstruction Center, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 1738606, Japan
| |
Collapse
|
13
|
Bränsvik V, Granvik E, Minthon L, Nordström P, Nägga K. Mortality in patients with behavioural and psychological symptoms of dementia: a registry-based study. Aging Ment Health 2021; 25:1101-1109. [PMID: 32067466 DOI: 10.1080/13607863.2020.1727848] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Behavioural and psychological symptoms of dementia (BPSD) are common in patients with dementia. In the elderly population, comorbidities frequently coexist with dementia and mortality in dementia is high. The aim of this study was to investigate the impact of BPSD on mortality in severe dementia. METHODS This study of 11,448 individuals was based on linked information from the Swedish BPSD registry, the National Patient Register and the Cause of Death register. BPSD was assessed with the Neuropsychiatric Inventory (NPI). Cox proportional hazards regressions were performed for survival analysis. To study different degrees of BPSD, data was categorized into groups: no (NPI, 0 points), mild (NPI, 1-3 points on ≥1 item), moderate (NPI, 4-8 points on ≥1 item) and severe (NPI, 9-12 points on ≥1 item) BPSD based on the highest score on any of the BPSD assessed (NPI items). RESULTS The presence of moderate or severe BPSD was associated with a stepwise increased risk of mortality (hazard ratio (HR), 1.31; 95% confidence interval (CI), 1.08-1.60 and HR 1.74; 95% CI 1.44-2.12, respectively) compared with individuals with no BPSD. In addition, there was an association between total NPI score and mortality (HR 1.01; 95% CI 1.007-1.010). The results remained significant after multivariable adjustment for age, sex, dementia diagnosis, medication, previous myocardial infarction, hip fracture and stroke. CONCLUSIONS The results show a stepwise increase in mortality risk with increased BPSD, highlighting the importance of adequate management of BPSD to reduce mortality in dementia.
Collapse
Affiliation(s)
- Vanja Bränsvik
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Eva Granvik
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Lennart Minthon
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatrics, Umeå University, Umeå, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Acute Internal Medicine and Geriatrics and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
14
|
Mitsutake S, Ishizaki T, Tsuchiya‐Ito R, Furuta K, Hatakeyama A, Sugiyama M, Toba K, Ito H. Association of cognitive impairment severity with potentially avoidable readmissions: A retrospective cohort study of 8897 older patients. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12147. [PMID: 33816752 PMCID: PMC8012240 DOI: 10.1002/dad2.12147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/11/2020] [Accepted: 12/02/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Understanding the association between cognitive impairment severity and potentially avoidable readmissions (PARs) in older patients may facilitate the identification of at-risk individuals who would benefit from readmission prevention measures. METHODS This retrospective cohort study was conducted using claims data linked with routinely collected cognitive impairment assessment results from a general acute care hospital in Tokyo, Japan. Patients were 65 years or age or older who were discharged from the subject hospital to home or a facility between July 2016 and September 2018. RESULTS A multivariable logistic regression analysis adjusted for covariates showed that the odds of PARs within 90 days to the subject hospital for patients with moderate and severe cognitive impairment were 1.418 times (95% confidence interval: 1.005-2.002) and 2.212 times (95% confidence interval: 1.206-4.058) higher, respectively, that for patients with normal cognition. DISCUSSION Older inpatients with later-stage cognitive impairment may represent a suitable target population for transitional care programs aimed at reducing readmissions.
Collapse
Affiliation(s)
- Seigo Mitsutake
- Human Care Research TeamTokyo Metropolitan Institute of GerontologyTokyoJapan
| | - Tatsuro Ishizaki
- Human Care Research TeamTokyo Metropolitan Institute of GerontologyTokyoJapan
| | - Rumiko Tsuchiya‐Ito
- Human Care Research TeamTokyo Metropolitan Institute of GerontologyTokyoJapan
- Research DepartmentInstitute for Health Economics and PolicyTokyoJapan
| | - Ko Furuta
- Department of PsychiatryTokyo Metropolitan Geriatric HospitalTokyoJapan
| | - Akira Hatakeyama
- Dementia Support CenterTokyo Metropolitan Geriatric HospitalTokyoJapan
| | - Mika Sugiyama
- Research Team for Promoting Independence of the ElderlyTokyo Metropolitan Institute of GerontologyTokyoJapan
| | - Kenji Toba
- Tokyo Metropolitan Geriatric Hospital and Institute of GerontologyTokyoJapan
| | - Hideki Ito
- Tokyo Metropolitan Geriatric Hospital and Institute of GerontologyTokyoJapan
| |
Collapse
|
15
|
Tarazona-Santabalbina FJ, Ojeda-Thies C, Figueroa Rodríguez J, Cassinello-Ogea C, Caeiro JR. Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3049. [PMID: 33809573 PMCID: PMC7999190 DOI: 10.3390/ijerph18063049] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/05/2021] [Accepted: 03/12/2021] [Indexed: 12/13/2022]
Abstract
Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms "hip fracture", "geriatric assessment", "second hip fracture", "surgery", "perioperative management" and "orthogeriatric care", in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.
Collapse
Affiliation(s)
- Francisco José Tarazona-Santabalbina
- Department of Geriatric Medicine, Hospital Universitario de la Ribera, Alzira, 46600 Valencia, Spain
- CIBERFES, Centro de Investigación Biomédica en Red Fragilidad y Envejecimiento Saludable, Instituto Carlos III, 28029 Madrid, Spain
| | - Cristina Ojeda-Thies
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Jesús Figueroa Rodríguez
- Department of Physical Medicine and Rehabilitation, Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| | | | - José Ramón Caeiro
- Department of Orthopaedics and Traumatology, Complejo Hospitalario Universitario de Santiago de Compostela, 15706 Santiago de Compostela, Spain;
| |
Collapse
|
16
|
Umehara T, Tanaka R, Nagao S, Tomiyama D, Kawabata Y, Nagano Y, Takeuchi Y, Kakehashi M. Efficient predictors for the decline of activities of daily living in patients with hip fracture one year after surgery: A multicenter prospective cohort study. J Back Musculoskelet Rehabil 2020; 33:553-560. [PMID: 32444533 DOI: 10.3233/bmr-181126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous studies have examined when activities of daily living (ADL) recovery more than six months after surgery can be predicted, and how much accuracy the predictors have. OBJECTIVE The purpose of this study was to determine the predictors of ADL decline and evaluate their accuracies one year post-operation for hip-fracture patients. METHODS We studied patients who underwent hip fracture surgery and were able to walk independently pre-operatively. The predictors of ADL declined one year post-operation, as analyzed using data of the basic medical attributes of the patients, including pain, 30-s chair-stand test, dementia [using the Revised Hasegawa Dementia Scale (HDS-R)], and walking/mobility style [using Barthel Index (BI)]. Using a receiver operating curve (ROC) curve, the cut-off value for each significant predictor was determined in the logistic regression analysis. To calculate the cut-off values and diagnostic performances of each of the extraction factors. RESULTS The data of 36 patients were collected over a period of one year. The prior probability of ADL decline at one year post-operation was 44.4%. The results of logistic regression analyses showed that the score of HDS-R at admission and the walking/mobility BI score at three weeks post-operation were significant predictors of the one year post-operative decline in ADL. The results of the ROC analyses showed that the cut-off value of the HDS-R score at admission was < 23 points. The posterior probability increased to 62.0%. In contrast, the cut-off value of the walking/mobility BI score was 0 points. The posterior probability increased to 91.0%. CONCLUSION The ADL decline of the patients who underwent hip fracture surgery at one year after surgery can be predicted at three weeks post-operation.
Collapse
Affiliation(s)
- Takuya Umehara
- Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, Japan
| | - Ryo Tanaka
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan
| | - Susumu Nagao
- Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, Japan
| | - Daisuke Tomiyama
- Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, Japan
| | - Yuki Kawabata
- Department of Rehabilitation, Saiseikai Kure Hospital, Hiroshima, Japan
| | - Yoshihiro Nagano
- Department of Rehabilitation, Saiseikai Hiroshima Hospital, Hiroshima, Japan
| | - Yumi Takeuchi
- Department of Rehabilitation, Saiseikai Hiroshima Hospital, Hiroshima, Japan
| | - Masayuki Kakehashi
- Department of Health Informatics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
17
|
Plaza-Carmona M, Requena-Hernández C, Jiménez-Mola S. Good practices in the recovery of ambulation in octogenarian women with hip fractures. Rev Assoc Med Bras (1992) 2020; 66:1417-1422. [PMID: 33174937 DOI: 10.1590/1806-9282.66.10.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 04/21/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Determine good recovery practices for ambulation of octogenarian women after hospital discharge after being operated on for hip fracture. METHODS Prospective study during the second half of 2019, with 192 women (85.95 ± 5.1 years) with hip fracture. A medical history, fracture types, complications, surgical treatment, and assessment of the level of ambulation were recorded before and after six months of hospital discharge. RESULTS 100 patients lived in the family home and 92 in an institutional center, 68.2% provided pertrochanteric fracture and a total of 3.7 comorbidities, all of them received spinal anesthesia and were admitted an average of 11.4 days. After six months, the patients showed a significant loss of functional independence with respect to the situation prior to the fracture, both for the ability to wander and for activities of daily living. It is noteworthy that the worst prognosis in the recovery of ambulation has to do with intermediate levels of ambulation and that the functional level of departure influences to a lesser extent than the place where they perform the recovery. CONCLUSIONS Age is a factor that influences the recovery of hip fracture, but there are other influential factors since patients who remain in the family home have a better functional prognosis than those who recover in institutionalized centers, after six months of hospital discharge.
Collapse
Affiliation(s)
| | | | - Sonia Jiménez-Mola
- Orthogeriatrics Unit, University Assistance Complex of León, León, Spain
| |
Collapse
|
18
|
Petersen JD, Siersma VD, Wehberg S, Nielsen CT, Viberg B, Waldorff FB. Clinical management of hip fractures in elderly patients with dementia and postoperative 30-day mortality: A population-based cohort study. Brain Behav 2020; 10:e01823. [PMID: 32892489 PMCID: PMC7667308 DOI: 10.1002/brb3.1823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/06/2020] [Accepted: 08/10/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Patients with dementia have an increased 30-day mortality after hip fracture. We investigated clinical management including time to surgery, out-of-hours admission and surgery, surgery on weekends, surgery volume per ward, and anesthesia technique for this excess mortality risk. METHOD This register- and population-based study comprised 12,309 older adults (age 70+) admitted to hospital for a first-time hip fracture in 2013-2014, of whom 11,318 underwent hip fracture surgery. Cox proportional hazards regression models were applied for the analysis. RESULTS The overall postoperative 30-day mortality was 11.4%. Patients with dementia had a 1.5 times increased mortality risk than those without (HR = 1.50 [95% CI 1.31-1.72]). We observed no time-to-surgery difference by patient dementia status; additionally, the excess mortality risk in patients with dementia could not be explained by the clinical management factors we examined. CONCLUSIONS Increased mortality in patients with dementia could not be explained by the measured preoperative clinical management. Suboptimal handling of postoperative complication and rehabilitation are to be investigated for their role in the witnessed increased mortality for patients with dementia.
Collapse
Affiliation(s)
- Jindong Ding Petersen
- Research Unit for General Practice, Department of Public Heath, University of Southern Denmark, Odense, Denmark.,Department of Mental Health Vejle, Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Volkert Dirk Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Heath, University of Southern Denmark, Odense, Denmark
| | - Connie Thurøe Nielsen
- Department of Mental Health Vejle, Mental Health Services in the Region of Southern Denmark, Vejle, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Kolding Hospital - Part of Hospital Lillebaelt, Kolding, Denmark
| | - Frans Boch Waldorff
- Research Unit for General Practice, Department of Public Heath, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
19
|
Duaso E, Gamboa-Arango A, Formiga F, Marimón P, Salgado MT, Murga V, Lumbreras C, Tarrida A. [Prognostic factors of mortality one year after a hip fragility fracture. Anoia hip study]. Rev Esp Geriatr Gerontol 2020; 56:18-23. [PMID: 33081979 DOI: 10.1016/j.regg.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Most of the patients who had a hip fragility fracture are characterized by advanced age, frailty, multimorbidity and high mortality rate into the first year. Our aim is to describe the prognostic factors of mortality one year after a hip fragility fracture. MATERIAL AND METHODS Observational prospective study. During the study period we included patients older than 69 years with hip fragility fracture who were admitted to the Acute Geriatric Unit. RESULTS We have followed 364 patients, 100 of them died (27.5%). The independent prognostic factors of mortality one year after a hip fragility fracture had been: have a less basis score in Lawton and Brody Scale 0.603 (0.505-0.721) (p< 0.001); have a higher score in Charlson Comorbidity Index 2.332 (1.308-4.157) p = 0.04); have a surgical waiting time ≥ 3 days 3.013 (1.330-6.829) p = 0.008); finding hydroelectrolytic disorders and/or deterioration of glomerular filtration 1.212 (1.017-1.444) p = 0.031) during hospital stay; discriminatory capacity of the area under the curve (AUC) (± 95%): 0.888 (0.880-0.891). CONCLUSIONS Prognostic predictors of mortality at one year after a hip fragility fracture are those variables that reflect a worse state of health, complications during hospital stay and a longer surgical waiting time.
Collapse
Affiliation(s)
- Enric Duaso
- Unidad Geriátrica de Agudos. Servicio de Geriatría. Hospital de Igualada, Igualada, Barcelona.
| | - Andrés Gamboa-Arango
- Unidad Geriátrica de Agudos. Servicio de Geriatría. Hospital de Igualada, Igualada, Barcelona
| | - Francesc Formiga
- Programa de Geriatría. Medicina Interna. Hospital Universitario de Bellvitge. IDIBELL. L'Hospitalet de Llobregat, Barcelona, España
| | - Patrícia Marimón
- Unidad Geriátrica de Agudos. Servicio de Cirugía Ortopédica y Traumatología. Hospital de Igualada, Igualada, Barcelona
| | - Maria Teresa Salgado
- Servicio de Fisioterapia. Fundación Sociosanitaria Sant Josep de Igualada, Igualada, Barcelona
| | - Victor Murga
- Unidad Geriátrica de Agudos. Servicio de Anestesiología. Hospital de Igualada, Igualada, Barcelona
| | - Célia Lumbreras
- Unidad Geriátrica de Agudos. Servicio de Geriatría. Hospital de Igualada, Igualada, Barcelona
| | - Anna Tarrida
- Unidad Geriátrica de Agudos. Servicio de Geriatría. Hospital de Igualada, Igualada, Barcelona
| |
Collapse
|
20
|
van der Sijp MPL, van Eijk M, Tong WH, Niggebrugge AHP, Schoones JW, Blauw GJ, Achterberg WP. Independent factors associated with long-term functional outcomes in patients with a proximal femoral fracture: A systematic review. Exp Gerontol 2020; 139:111035. [PMID: 32739519 DOI: 10.1016/j.exger.2020.111035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/22/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The current understanding of prognostic factors of functional recovery after a proximal femoral fracture is limited, and enhancements could improve the prognostic accuracy and target subgroups for additional care strategies. This systematic review aims to identify all studied factors with an independent prognostic value for the long-term functional recovery of patients with a proximal femoral fracture. MATERIALS AND METHODS Observational studies with multivariate analyses on prognostic factors of long-term functional outcome after proximal femoral fractures were obtained through an electronic search performed on November 9, 2018. RESULTS In the 31 included articles, thirteen prognostic factors were studied by at least two independent studies and an additional ten by only one study. Age, comorbidity, functionality and cognition were factors for which the majority of studies indicated a significant effect. The majority of studies which included sex as a factor found no significant effect. The level of evidence for the remaining factors was deemed too low to be conclusive on their relevance for long-term functional outcome. CONCLUSION The identified factors showed overlap with prognostic factors of short-term functional outcomes and mortality. The validity and applicability of prognostic models based on these factors may be of interest for future research.
Collapse
Affiliation(s)
- Max P L van der Sijp
- Department of Public Health and Primary Care/LUMC-Campus The Hague, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
| | - Monica van Eijk
- Department of Public Health and Primary Care/LUMC-Campus The Hague, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - Wing H Tong
- Department of Public Health and Primary Care/LUMC-Campus The Hague, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - Arthur H P Niggebrugge
- Department of Surgery, Haaglanden Medical Center, P.O. Box 432, 2501 CK the Hague, the Netherlands
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - Gerard J Blauw
- Department of Internal Medicine, Leiden University Medical Center/Haaglanden Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care/LUMC-Campus The Hague, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| |
Collapse
|
21
|
Karlsson Å, Berggren M, Olofsson B, Stenvall M, Gustafson Y, Nordström P, Lindelöf N. Geriatric Interdisciplinary Home Rehabilitation After Hip Fracture in People with Dementia - A Subgroup Analysis of a Randomized Controlled Trial. Clin Interv Aging 2020; 15:1575-1586. [PMID: 32943858 PMCID: PMC7481284 DOI: 10.2147/cia.s250809] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/08/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To investigate if the effects of geriatric interdisciplinary home rehabilitation after hip fracture were different among people with dementia compared to those without dementia and to describe the overall outcome after hip fracture in people with dementia. PATIENTS AND METHODS A post hoc subgroup analysis of a randomized controlled trial was conducted including 205 people with hip fracture, aged ≥70, living in ordinary housing or residential care facilities. Early discharge followed by individually designed interdisciplinary home rehabilitation for a maximum of 10 weeks was compared to in-hospital geriatric care according to a multifactorial rehabilitation program. Outcomes were hospital length of stay (LOS), readmissions, falls, mortality, performance in activities of daily living (ADL), and walking ability. RESULTS Interdisciplinary home rehabilitation vs in-hospital care had comparable effects on falls and mortality between discharge and 12 months and on ADL and walking ability at 3 and 12 months regardless of whether the participants had dementia or not (P≥0.05 for all). Among participants with dementia, postoperative LOS was a median of 18 days (interquartile range [IQR] 14-30) in the home rehabilitation group vs 23 days (IQR 15-30) in the control group (P=0.254) with comparable numbers of readmissions after discharge. Dementia was associated with increased risk of falling (odds ratio [OR] 3.86; 95% confidence interval [CI]: 2.05-7.27; P<0.001) and increased mortality (OR 4.20; 95% CI 1.79-9.92, P=0.001) between discharge and 12 months and with greater dependence in ADL and walking at 3 and 12 months compared to participants without dementia (P<0.001 for all). CONCLUSION The effects of geriatric interdisciplinary home rehabilitation vs in-hospital geriatric care did not differ in participants with and without dementia. However, the statistical power of this subgroup analysis was likely insufficient to detect differences between the groups. Dementia was associated with a substantial negative impact on the outcomes following the hip fracture. Our findings support offering interdisciplinary home rehabilitation after hip fracture to people with dementia.
Collapse
Affiliation(s)
- Åsa Karlsson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå University, Umeå, Sweden
| | - Monica Berggren
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Birgitta Olofsson
- Department of Nursing and Department of Surgical and Perioperative Science, Orthopedics, Umeå University, Umeå, Sweden
| | - Michael Stenvall
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Nina Lindelöf
- Department of Community Medicine and Rehabilitation, Geriatric Medicine and Physiotherapy, Umeå University, Umeå, Sweden
| |
Collapse
|
22
|
Gan S, Yu Y, Wu J, Tang X, Zheng Y, Wang M, Zhu S. Preoperative assessment of cognitive function and risk assessment of cognitive impairment in elderly patients with orthopedics: a cross-sectional study. BMC Anesthesiol 2020; 20:189. [PMID: 32738902 PMCID: PMC7395982 DOI: 10.1186/s12871-020-01096-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/14/2020] [Indexed: 12/21/2022] Open
Abstract
Background Preexisting cognitive impairment is emerging as a predictor of poor postoperative outcomes in seniors. Nevertheless, cognitive impairment in a large proportion of geriatric patients has not been well identified and diagnosed. Methods This is a cross-sectional study. Mini-mental state examination scale was used to assess the cognitive function of elderly patients aged ≥65 years undergoing orthopedic surgery preoperatively. The baseline, living habits and laboratory examination results of two groups were compared, and a multivariable logistic regression model was used to identify independent predictors of preoperative cognitive impairment. Results A total of 374 elderly patients with orthopedic surgery indications met the inclusion criteria, and 28.61% of them had preoperative cognitive impairment. Multivariable logistic regression analysis showed that age (OR = 1.089, P < 0.001), subjective sleep disorders (OR = 1.996, P = 0.021), atherosclerosis (OR = 2.367, P = 0.017), and high cholesterol level (OR = 1.373, P = 0.028) were independent risk factors for preoperative cognitive impairment, while high education level performed as a protective factor (compared with the illiterate group, primary school group: OR = 0.413, P = 0.009; middle school or above group: OR = 0.120, P < 0.001). Conclusions The prevalence of preoperative cognitive dysfunction in geriatric elective orthopedic surgical patients was high. Our study identified venerable age, low level of education, subjective sleep disorders, atherosclerosis, and high cholesterol level as risk factors for preoperative cognitive impairment in these patients. Understanding these risk factors contributes to assisting in prevention and directed interventions for the high-risk population.
Collapse
Affiliation(s)
- Shuyuan Gan
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, China
| | - Yang Yu
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, China
| | - Jiateng Wu
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, China
| | - Xiaodong Tang
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, China
| | - Yueying Zheng
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, China
| | - Mingcang Wang
- Department of Anesthesiology, Taizhou Hospital, Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Shengmei Zhu
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, Zhejiang, China.
| |
Collapse
|
23
|
Delgado A, Cordero G-G E, Marcos S, Cordero-Ampuero J. Influence of cognitive impairment on mortality, complications and functional outcome after hip fracture: Dementia as a risk factor for sepsis and urinary infection. Injury 2020; 51 Suppl 1:S19-S24. [PMID: 32067771 DOI: 10.1016/j.injury.2020.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/08/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the relation between cognitive impairment on arrival at hospital in patients older than 65 years with a hip fracture, and their mortality, medical and surgical complications, and functional outcomes. PATIENTS AND METHODS Observational study of a single-center prospective consecutive cohort of 955 patients older than 64 years diagnosed of hip fracture from December/2012 to December/2015. Average age was 86±7.2 (65-104) years and 725 (75.9%) were female. Fractures were extracapsular in 538 cases (56.3%) and intracapsular in 417 (43.7%). Patients were controlled clinically and radiographically in outpatient clinic after 1, 3, 6, and 12 months. Data about basal cognitive status, walking ability before the fracture, medical and surgical complications, functional outcomes and mortality were collected for the year following the fracture. STATISTICAL ANALYSIS Bivariate analysis (Pearson, Fisher, Mann-Whitney, Wilcoxon) was applied to study statistically significant relations, and contingence coefficients (CC) were calculated. RESULTS Patients with cognitive impairment showed a higher overall mortality, (p = 0,000; CC=0,197) even after hospital discharge (p = 0.000; CC=0.198). Similarly, patients with dementia presented a higher rate of respiratory infections (p = 0,029; CC=0,093), urinary tract infections (p = 0,008; CC=0,108) and sepsis (p = 0,011; CC=0,105). On the contrary, we found no correlations between mental status and surgical complications, even for prosthesis dislocation (p = 0.136). Patients with dementia started from poorer functional situations (p = 0,000; CC=0,367) and ended follow-up with lower walking ability (p = 0,000; CC=0,43), but cognitive impairment did not relate statistically with a worse functional recovery (p = 0,304): that is, the proportion of patients who maintained their previous ability to walk was similar in both groups, those with altered mental status and those without it. CONCLUSIONS Cognitive impairment is a risk factor for mortality in patients with a hip fracture. It is also a risk factor for suffering respiratory and urinary tract infection and sepsis. These two late risks factors have not been published previously. Functional recovery is not conditioned by cognitive impairment, although further studies need to be developed to evaluate the actual role of cognitive impairment on postoperative progression of patients.
Collapse
Affiliation(s)
- A Delgado
- Department of Orthopaedic Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, 28006 Madrid, Spain
| | - E Cordero G-G
- Department of Orthopaedic Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, 28006 Madrid, Spain
| | - S Marcos
- Department of Orthopaedic Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, 28006 Madrid, Spain
| | - J Cordero-Ampuero
- Department of Orthopaedic Surgery, University Hospital La Princesa, Universidad Autónoma de Madrid, 28006 Madrid, Spain.
| |
Collapse
|
24
|
Tam TL, Tsang KK, Lee KB. Development of a prognostic model to predict post-operative mobility of patients with fragility hip fractures: a retrospective cohort study. Int J Orthop Trauma Nurs 2020; 38:100770. [PMID: 32646759 DOI: 10.1016/j.ijotn.2020.100770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/23/2020] [Accepted: 02/17/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Older adults with fragility hip fractures have high 1-year mortality and significant functional loss. This study aimed to identify the factors that predict the post-operative ambulatory prognosis of patients with fragility hip fracture. METHODS A total of 233 patients who were consecutively admitted with fragility hip fracture to the orthopaedic unit of an acute hospital in Hong Kong between March and July 2016, were included in this retrospective observational cohort study. The outcome variable was the binary classification of whether patients could or could not walk independently without assistance for more than10 m at the time of discharge from hospital to community. The prognostic model was developed by using multivariate logistic regression. RESULTS Eighty-nine (38.2%) patients could walk independently upon discharge. The statistically significant factors that affected walking independence on discharge were age (Odds Ratio [OR] = 0.93), Charlson Comorbidity Index (OR = 0.67), baseline Mini-Mental Status Examination score (OR = 1.15) and pre-fracture mobility (p = 0.012). Patients who walked unaided before the fracture had a better prognosis than patients requiring a stick walker (OR = 0.57), quadripod walker (OR = 0.28) or frame walker (OR = 0.12). The area under the ROC curve was 0.848. CONCLUSIONS The model provides healthcare professionals with evidence to personalize the rehabilitation regime according to the patient's age, comorbidity, baseline cognitive function and pre-fracture mobility.
Collapse
Affiliation(s)
- Tsz-Lok Tam
- Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
| | - Ka-Kit Tsang
- Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| | - Kin-Bong Lee
- Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong
| |
Collapse
|
25
|
Gamboa-Arango A, Duaso E, Formiga F, Marimón P, Sandiumenge M, Salgado M, Escalante E, Lumbreras C, Tarrida A. Prognostic factors of good functionality at 12 months of a hip fracture. Maluc Anoia study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2019.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
26
|
Knauf T, Hack J, Barthel J, Eschbach D, Schoeneberg C, Ruchholtz S, Buecking B, Aigner R. Medical and economic consequences of perioperative complications in older hip fracture patients. Arch Osteoporos 2020; 15:174. [PMID: 33157555 PMCID: PMC7647988 DOI: 10.1007/s11657-020-00843-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023]
Abstract
UNLABELLED Patients suffering from complications during inpatient treatment after hip fracture surgery are associated with a worse mid-term outcome. While surgically treatable complications only delay the healing process, internal complications seem to worsen the outcome in the long run. All complications come with significant increased costs during the hospital stay. PURPOSE Due to the demographic changes, the importance of hip fractures is still increasing nowadays. Not only surgical but also medical complications represent a major challenge in the treatment of those patients. Nevertheless, only few is known about the functional, medical, and economic consequences of complications. METHODS A total of 402 hip fracture patients ≥ 60 years were observed prospectively at a German university hospital. Complications were assessed during the inpatient stay and classified by Clavien and Dindo. Afterwards their influence on acute care costs was examined as well as their influence on the mortality, health-related quality of life (HRQL) (EQ5D), functional capacities (Barthel index), and mobility (Tinetti score) in the follow-up periods of 6 and 12 months. RESULTS Complications that required surgical revision/treatment (type III) were associated with an increased 6 months' mortality, while type II and IV complications did not influence mortality after 6 and 12 months. Six months after surgery, HRQL, Barthel score, and Tinetti score were reduced in patients suffering from all different types of complications. After 12 months however, HRQL, Barthel score, and Tinetti score following type II and IV complications remained reduced, while the scores improved in patients suffering from type III complication. All types of complications led to significantly increased acute care costs. CONCLUSIONS The results of the present study emphasize the crucial role of perioperative complications in older patients with hip fractures. Therefore, special attention has to be given to the prevention of those complications, e.g., with orthogeriatric treatment models, which have been shown to be effective in the reduction of complications.
Collapse
Affiliation(s)
- Tom Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany.
| | - Juliana Hack
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany
| | - Juliane Barthel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany
| | - Carsten Schoeneberg
- Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Alfried-Krupp-Straße 21, 45131, Essen, Germany
| | - Steffen Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany
| | - Benjamin Buecking
- Center for Orthopaedics and Trauma Surgery, DRK-Kliniken Nordhessen, Hansteinstraße 29, 34121, Kassel, Germany
| | - Rene Aigner
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Baldingerstraße 1, 35043, Marburg, Germany
| |
Collapse
|
27
|
Abstract
Dementia management is complicated by neuropsychiatric symptoms such that the longitudinal care of a psychiatrist or other mental health provider is often an essential part of patient care and a major source of family support. Given the importance of end-of-life continuity of care, the involvement of psychiatry in palliative and hospice services affords an important opportunity for growth. Common challenges involve sharing prognostic information with patients and families to aid in advance planning, and management of persistent pain and nutritional issues. Future research will yield important new insights and guidelines for care.
Collapse
Affiliation(s)
- Jaffrey Hashimie
- Psychiatry Service (116A), James A Haley VA Hospital, University of South Florida College of Medicine, 13000 Bruce B Downs Boulevard, Tampa, FL 33612, USA
| | - Susan K Schultz
- Psychiatry Service (116A), James A Haley VA Hospital, University of South Florida College of Medicine, 13000 Bruce B Downs Boulevard, Tampa, FL 33612, USA
| | - Jonathan T Stewart
- Psychiatry Service (116A), James A Haley VA Hospital, University of South Florida College of Medicine, 13000 Bruce B Downs Boulevard, Tampa, FL 33612, USA.
| |
Collapse
|
28
|
Gamboa-Arango A, Duaso E, Formiga F, Marimón P, Sandiumenge M, Salgado MT, Escalante E, Lumbreras C, Tarrida A. Pronostic factors of good functionality at 12 months of a hip fracture. Maluc Anoia study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 64:57-63. [PMID: 31377157 DOI: 10.1016/j.recot.2019.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/24/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Hip fracture usually occurs in frail elderly patients and is associated with an important morbi-mortality in the first year. The objective of the study is to describe the prognostic factors that would allow maintaining functionality at 12 months. METHOD From June 1, 2010 to May 31, 2013, all patients older than 69 years with hip fracture due to bone fragility admitted to the Geriatric Acute Unit of our hospital were included. We define as functional maintenance those patients who have lost between 0-15 points in the Barthel Index with respect to the previous to the fracture. Prospective study of bivariate data analysis for related and multivariate prognostic factors for predictive predictors. RESULTS 271 patients were included, of them, 146 (54.8%), maintained functionality at 12 months and 122 (45.2%) no. Patients who maintain functional status are younger: average age 83.4 vs 85.80 years (P=.002); with better scores in the indexes of: Lawton prior to fracture 4.42 vs 2.40 (P<.001) and Barthel at discharge 34.2 vs. 27.1 (P=.002). There are also differences in the score of the "Geriatric Dementia Scale" 2.59 vs. 3.13 (P=.009), in the score of the "American Society Anesthesiologist"<II 62.2% vs 37.8% (P=0.006) and have presented less delirium during hospitalization 4.7% vs 35.3% (P=.002). In the multivariate analysis they maintained statistical significance, age OR: 1.044 (95% CI: 1.002-1.088) (P=.04) and the Lawton Index OR: 0.869 (95% CI: 0.804-0.940) (P <.001). CONCLUSIONS Prognostic factors of functional maintenance at 12 months are age and the ability to perform instrumental activities of daily life.
Collapse
Affiliation(s)
- A Gamboa-Arango
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España.
| | - E Duaso
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - F Formiga
- Programa de Geriatría, Medicina Interna, Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, España
| | - P Marimón
- Unidad Geriátrica de Agudos, Servicio de Traumatología y Cirugía Ortopédica, Hospital de Igualada, Igualada, España
| | - M Sandiumenge
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - M T Salgado
- Servicio de Fisioterapia, Fundación Sanitaria San José, Igualada, España
| | - E Escalante
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - C Lumbreras
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| | - A Tarrida
- Unidad Geriátrica de Agudos, Servicio de Geriatría, Hospital de Igualada, Igualada, España
| |
Collapse
|
29
|
Lehmann J, Michalowsky B, Kaczynski A, Thyrian JR, Schenk NS, Esser A, Zwingmann I, Hoffmann W. The Impact of Hospitalization on Readmission, Institutionalization, and Mortality of People with Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2019; 64:735-749. [PMID: 29966191 DOI: 10.3233/jad-171128] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with dementia (PwD) are at a high risk of hospitalization. Hospitals are often not adequately equipped for PwD and discharges often come unexpected. Therefore, PwD are at a risk of adverse outcomes. However, information about those outcomes is rare but crucial for the development of preventive strategies. OBJECTIVES To conduct a quantitative systematic review and meta-analyses on the impact of a hospitalization on readmission, institutionalization, and mortality in PwD. To identify factors associated with these outcomes. METHODS PubMed, CENTRAL, and ScienceDirect were searched for studies including terms for dementia, hospital, readmission, institutionalization, and mortality. Relevant were assessed by a quality criteria sheet. Results were summarized in a table. Meta-analysis was conducted with Review Manager 5.3. RESULTS The search yielded 1,108 studies; 20 fulfilled the inclusion criteria and 10 studies were eligible for meta-analyses. The incidence and relative risk (RR) of mortality (RR 1.74 CI95 % 1.50, 2.05) and institutionalization (RR: 2.16 CI95 % 1.31, 3.56) of PwD was significantly higher when compared to people without dementia. Results according to readmission rate were inconsistent. Factors significantly associated with the examined adverse outcomes were severity of dementia, number of medications, and deficits in daily living activities. CONCLUSION Hospitalization of PwD lead to adverse outcomes. An improvement in the identification of and care for PwD in the acute setting as well as in after care in the community setting, especially in the interface between both settings, is required to prevent adverse outcomes in hospitalized PwD.
Collapse
|
30
|
Knauf T, Buecking B, Hack J, Barthel J, Bliemel C, Aigner R, Ruchholtz S, Eschbach D. Development of the Barthel Index 5 years after hip fracture: Results of a prospective study. Geriatr Gerontol Int 2019; 19:809-814. [PMID: 31264331 DOI: 10.1111/ggi.13723] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/21/2019] [Accepted: 05/26/2019] [Indexed: 12/12/2022]
Abstract
AIM The importance of proximal femoral fractures is increasing due to demographic change. Despite appropriate care, these are associated with poor results. We are still lagging behind, and require information on the long-term functional outcome of these patients and the predictive factors involved. METHODS Between 2009 and 2011, 402 patients aged >60 years with hip fractures were included in this prospective observational study. Patients were assessed with the Barthel Index before fracture, at discharge, and 6 months, 1 year and 5 years after surgery. In addition, a variety of parameters (sex, age, fracture type, American Society of Anesthesiologists classification, Mini-Mental State Examination, housing situation, occurrence of complications during inpatient stay and type of care) were collected to identify the possible independent predictive factors using multivariate analysis. RESULTS The lowest Barthel Index was found at discharge (66 ± 24) for patients from an acute hospital. The Barthel Index improved within the first 6 months (86 ± 21) and decreased afterwards. The factors associated with a significantly higher point loss of the Barthel Index in the multivariate analysis were age (P-value 0.020), pre-fracture Barthel Index, (P ≤ 0.001), Mini-Mental State Examination (P ≤ 0.001) and type II complications (P = 0.001). The other values showed no significant influence on the Barthel Index. CONCLUSIONS The present results showed that patients after a hip fracture have a great rehabilitation potential within the first 6 months after the event. More attention should be paid to type II complications and the occurrence of cognitive impairment. Both seem to be a surrogate parameter for the frailty of the patients. Geriatr Gerontol Int 2019; 19: 809-814.
Collapse
Affiliation(s)
- Tom Knauf
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Benjamin Buecking
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Juliana Hack
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Juliane Barthel
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Christopher Bliemel
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Rene Aigner
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - Daphne Eschbach
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| |
Collapse
|
31
|
Malik AT, Quatman-Yates C, Phieffer LS, Ly TV, Khan SN, Quatman CE. Factors Associated With Inability to Bear Weight Following Hip Fracture Surgery: An Analysis of the ACS-NSQIP Hip Fracture Procedure Targeted Database. Geriatr Orthop Surg Rehabil 2019; 10:2151459319837481. [PMID: 31069126 PMCID: PMC6492357 DOI: 10.1177/2151459319837481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/18/2019] [Accepted: 02/16/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction: While the benefits of early mobility for prevention of complications such as pneumonia,
thromboembolic events, and improved mortality have been well studied in postsurgical
patients, it is unclear which patients may struggle to achieve full weight-bearing on
the first postoperative day. Materials and Methods: The 2016 American College of Surgeons National Surgical Quality Improvement Program
(ACS-NSQIP) Targeted Hip Fracture Database was queried regarding the ability to achieve
weight-bearing on first postoperative day for older adults. Cases that occurred
secondary to malignancy were excluded or for which weight-bearing was unachievable on
the first postoperative day due to medical reasons were excluded. Results: A total of 6404 patients met inclusion and exclusion criteria for the study, with 1640
(25.6%) patients unable to bear weight on the first postoperative day. Following
adjusted analysis, nonmodifiable patient factors such as dependent (partial or total)
functional health status, dyspnea with moderate exertion (odds ratio [OR]: 1.31 [95%
confidence interval, CI: 1.04-1.65]), ventilator dependency, and preoperative dementia
on presentation to hospital were associated with lack of achievement of weight-bearing
on the first postoperative day. Modifiable patient factors such as presence of systemic
inflammatory response syndrome (OR: 1.35 [95% CI: 1.11-1.64]), delirium, and low
preoperative hematocrit and modifiable system factors including delayed time to surgery,
total postoperative time >90 minutes, and transfer from an outside emergency
department were also associated with inability to achieve weight-bearing on the first
postoperative day. Discussion: Medical teams can utilize the results from this study to better identify patients
preoperatively who may be at risk of not achieving early mobilization and proactively
employ implement strategies to encourage mobility as soon as possible for hip fracture
patients.
Collapse
Affiliation(s)
- Azeem Tariq Malik
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Catherine Quatman-Yates
- Division of Physical Therapy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Laura S Phieffer
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thuan V Ly
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Safdar N Khan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carmen E Quatman
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
32
|
Dautel A, Eckert T, Gross M, Hauer K, Schäufele M, Lacroix A, Hendlmeier I, Abel B, Pomiersky R, Gugenhan J, Büchele G, Reber KC, Becker C, Pfeiffer K. Multifactorial intervention for hip and pelvic fracture patients with mild to moderate cognitive impairment: study protocol of a dual-centre randomised controlled trial (OF-CARE). BMC Geriatr 2019; 19:125. [PMID: 31039754 PMCID: PMC6492424 DOI: 10.1186/s12877-019-1133-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/09/2019] [Indexed: 01/13/2023] Open
Abstract
Background A hip or pelvic fracture is a major fall-related injury which often causes a decline in mobility performance and physical activity. Over 40% of patients with hip fracture have cognitive impairment or dementia and poorer rehabilitation outcomes than those without cognitive impairment. In this subgroup, there is a lack of evidence on the best practices supporting recovery. The main aim of this study is to investigate the effects of a transitional care intervention after inpatient rehabilitation on physical activity and functional performance in this group of cognitively impaired patients. Methods/design This dual-centre, randomised controlled trial compares a multifactorial intervention with usual care as control condition. Two hundred and forty community-dwellers (≥ 65 years) with a hip or pelvic fracture and mild to moderate cognitive impairment (MMSE 17–26) are recruited at the end of inpatient rehabilitation. The four-month intervention consists of (a) an individually tailored, progressive home exercise program and physical activity promotion delivered by professional instructors and lay instructors (two home visits per week) and (b) a long-term care counselling approach addressing unmet care needs, pleasurable activities, and caregiver issues if needed. Primary outcome parameters are physical activity, measured as daily walking duration with an accelerometer-based activity monitor (activPAL™) over 72 h, and functional performance, assessed with Short Physical Performance Battery sum scores. Secondary outcome parameters are fear of falling, fall related self-efficacy, falls, quality of life, depression and activity of daily living. Data are collected at the end of rehabilitation, before the intervention at the patient’s home (baseline), after four months (post-intervention), and seven months (follow-up). In addition to completer and intent-to-treat analyses of outcomes, economic data and incremental cost-effectiveness are analysed. Discussion Existing service models of volunteer services and legal counselling provided by care counsellors were considered when developing the intervention protocol. Therefore, it should be feasible to translate and deliver the intervention into real-world practice if it has been demonstrated to be effective. Trial registration German Clinical Trials Register, DRKS00008863 (Accessed 17 Apr 2019), ISRCTN registry, ISRCTN69957256 (Accessed 17 Apr 2019).
Collapse
Affiliation(s)
- Anja Dautel
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | | | - Michaela Gross
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Klaus Hauer
- Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Martina Schäufele
- Hochschule Mannheim, University of Applied Science, Mannheim, Germany
| | | | - Ingrid Hendlmeier
- Hochschule Mannheim, University of Applied Science, Mannheim, Germany
| | - Bastian Abel
- Agaplesion Bethanien Hospital, Heidelberg, Germany
| | - Rebekka Pomiersky
- Agaplesion Bethanien Hospital, Heidelberg, Germany.,Hochschule Mannheim, University of Applied Science, Mannheim, Germany
| | - Julia Gugenhan
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Katrin C Reber
- Department of Health Economics and Health Services Research, University Medical Centre Hamburg, Hamburg, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Klaus Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany.
| |
Collapse
|
33
|
Morandi A, Mazzone A, Bernardini B, Suardi T, Prina R, Pozzi C, Gentile S, Trabucchi M, Bellelli G. Association between delirium, adverse clinical events and functional outcomes in older patients admitted to rehabilitation settings after a hip fracture: A multicenter retrospective cohort study. Geriatr Gerontol Int 2019; 19:404-408. [DOI: 10.1111/ggi.13628] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 12/24/2018] [Accepted: 01/10/2019] [Indexed: 01/17/2023]
Affiliation(s)
- Alessandro Morandi
- Department of Rehabilitation and Aged Care; “Fondazione Camplani” Hospital; Cremona Italy
- Geriatric Research Group; Brescia Italy
| | - Andrea Mazzone
- Department of Rehabilitation, Redaelli Geriatric Institute; Milan Italy
| | - Bruno Bernardini
- Department of Neurorehabilitation; IRCCS Humanitas Research Hospital; Milan Italy
| | - Teresa Suardi
- Department of Rehabilitation, Redaelli Geriatric Institute; Milan Italy
| | - Roberto Prina
- Department of Rehabilitation, Redaelli Geriatric Institute; Vimodrone Italy
| | - Christian Pozzi
- University of Applied Sciences and Arts of Southern Switzerland (SUPSI); Manno Switzerland
| | - Simona Gentile
- Department of Rehabilitation and Aged Care; “Fondazione Camplani” Hospital; Cremona Italy
- Geriatric Research Group; Brescia Italy
| | - Marco Trabucchi
- Department of Rehabilitation, University of Tor Vergata; Rome Italy
| | - Giuseppe Bellelli
- Department of Rehabilitation, School of Medicine and Surgery; University of Milano-Bicocca, Acute Geriatric Unit, S. Gerardo Hospital; Monza Italy
| |
Collapse
|
34
|
[Multidisciplinary geriatric rehabilitation in the patient with hip fracture and dementia]. Rev Esp Geriatr Gerontol 2018; 54:220-229. [PMID: 30606498 DOI: 10.1016/j.regg.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 12/14/2022]
Abstract
Hip fracture and dementia rates increase with age, and both groups of patients suffer increased morbidity and mortality and functional impairment. The management of these patients is a challenge for the orthogeriatric and rehabilitation team process, as despite the evidence on the benefit, the results analysed are still worse than in patients without cognitive impairment. For this reason, and due to the limitation in health resources, many of them have problems in accessibility to them, or are limited to a less intense rehabilitation. There are insufficient studies on the best rehabilitation interventions in this group of patients, but it is suggested: 1) to use a multidisciplinary rehabilitation model adapted to the patient with dementia, and 2) to redefine results of the rehabilitation of these patients not only in terms of functional improvement, without highlighting other concepts, such as quality of life, decrease in complications or improved social support.
Collapse
|
35
|
Tedesco D, Gibertoni D, Rucci P, Hernandez-Boussard T, Rosa S, Bianciardi L, Rolli M, Fantini MP. Impact of rehabilitation on mortality and readmissions after surgery for hip fracture. BMC Health Serv Res 2018; 18:701. [PMID: 30200950 PMCID: PMC6131904 DOI: 10.1186/s12913-018-3523-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 09/05/2018] [Indexed: 12/15/2022] Open
Abstract
Background Hip fracture in elderly patients is a rising global public health concern because of population ageing, and increasing frailty. Long-term morbidity related to poor management of hip fracture is associated with decreased quality of life, survival, and increase in healthcare costs. Receiving postoperative rehabilitation is associated with better outcomes and a higher likelihood of returning to pre-existing level of functioning. However little is known about which postoperative rehabilitation pathways are more effective to optimize patient outcomes. Few studies have analyzed postoperative rehabilitation pathways in a universal healthcare system. The aim of this study is to analyze the impact of post-acute rehabilitation pathways on mortality and readmission in elderly patients undergoing surgery for hip fracture in a large metropolitan area in Italy. Methods In this retrospective cohort study, we analyzed 6-month mortality from admission and 6-month readmission after hospital discharge in patients who underwent surgical repair for hip fracture in the hospitals of the Bologna metropolitan area between 1.1.2013 and 30.6.2014. Data were drawn from the regional hospital discharge records database. Kaplan-Meier estimates and multiple Cox regression were used to analyze mortality as a function of rehabilitation pathways. Multiple logistic regression determined predictors of readmission. Results The study population includes 2208 patients, mostly women (n = 1677, 76%), with a median age of 83.8 years. Hospital rehabilitation was provided to 519 patients (23.5%), 907 (41.1%) received rehabilitation in private inpatient rehabilitation facilities (IRF) accredited by the National Health System, and 782 (35.4%) received no post-acute rehabilitation. Compared with patient receiving hospital rehabilitation, the other groups showed significantly higher mortality risks (no rehabilitation, Hazard Ratio (HR) = 2.19, 95%CI = 1.54–3.12, p < 0.001; IRF rehabilitation, HR = 1.66, 95%CI = 1.54–1.79, p < 0.001). The risk of readmission did not differ significantly among rehabilitation pathways. Conclusions Intensive hospital rehabilitation was significantly associated with a lower risk of mortality compared to IRF rehabilitation and no rehabilitation. Our results may help in the development of evidence-based recommendations aimed to improve resource utilization and quality of care in hip fracture patients. Further research is warranted to investigate the impact of the rehabilitation pathway on other outcomes, such as patients’ functional status and quality of life.
Collapse
Affiliation(s)
- Dario Tedesco
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy.
| | - Dino Gibertoni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| | - Tina Hernandez-Boussard
- Department of Medicine, Stanford University, 1265 Welch Road, 94305, Stanford, California, USA
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| | - Luca Bianciardi
- Rizzoli Orthopedic Institute, Via Giulio Cesare Pupilli, 40138, Bologna, Italy
| | - Maurizia Rolli
- Rizzoli Orthopedic Institute, Via Giulio Cesare Pupilli, 40138, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| |
Collapse
|
36
|
Rehabilitation strategy for hip fracture, focused on behavioral psychological symptoms of dementia for older people with cognitive impairment: A nationwide Japan rehabilitation database. PLoS One 2018; 13:e0200143. [PMID: 29975757 PMCID: PMC6033436 DOI: 10.1371/journal.pone.0200143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/20/2018] [Indexed: 11/25/2022] Open
Abstract
The aim is to investigate the relationship between a positive outcome on rehabilitation after hip fracture and behavioral psychological symptoms of dementia (BPSD) transition during rehabilitation. This study is a retrospective cohort study based on the Japan Rehabilitation Database. We recruited 756 subjects 65 years of age or older from 31 hospitals in the database. All subjects were in the hospital as patients undergoing rehabilitation for hip fracture. Functional independence measure (FIM), walking ability, Mini-Mental State Examination (MMSE), and BPSD were measured both at the beginning and at the end of rehabilitation. MMSE for 23 or under was defined as the cognitive-impaired group. MMSE for 24 or over was used as the cognitively intact group. Cognitive impaired participants were divided into four groups: participants presented no BPSD both at the beginning of rehabilitation and at the end of rehabilitation (Group (-/-)), participants presented BPSD at the beginning of rehabilitation but resolved at the end of rehabilitation (Group (+/-)), participants had no BPSD at the beginning of rehabilitation but appeared at the end of rehabilitation (Group (-/+)) and participants had sign of BPSD both at the beginning of rehabilitation and at the end of rehabilitation (Group (+/+)). The endpoints were waking ability, FIM gain. As results, one hundred thirty-seven cognitive-impaired older people patients out of 471 (29.1%) suffered from BPSD at the beginning of rehabilitation. FIM gains in cognitively intact group, Group (-/-), Group (+/-), Group (-/+) and Group (+/+) were 24.8 ± 18.7, 17.5 ± 16.9, 27.3 ± 19.7, 17.8 ± 12.2 and 12.2 ± 17.2, respectively. The Group (+/-) was significantly connected to a positive outcome for rehabilitation. The present study suggested that the management of BPSD can lead to better functional recovery during rehabilitation.
Collapse
|
37
|
Morri M, Chiari P, Forni C, Orlandi Magli A, Gazineo D, Franchini N, Marconato L, Giamboi T, Cotti A. What Factors Are Associated With the Recovery of Autonomy After a Hip Fracture? A Prospective, Multicentric Cohort Study. Arch Phys Med Rehabil 2018; 99:893-899. [DOI: 10.1016/j.apmr.2018.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/10/2018] [Accepted: 01/17/2018] [Indexed: 11/30/2022]
|
38
|
Abstract
With the growing care needs for the older population at the end of their lives, there has been a substantial increase in attention to the management of the patient with dementia in hospice and palliative care services. This article reviews issues in access to care and the optimal management of the patient with dementia, particularly in the context of neuropsychiatric complexities. Special issues such as delirium, cachexia, behavioral symptoms, and pain management are addressed. Future challenges in research such as the development of better prognostic models are noted as well as the importance of attention to access to care.
Collapse
Affiliation(s)
- Jonathan T Stewart
- Psychiatry, James A. Haley Veterans Hospital, University of South Florida College of Medicine, 13000 Bruce B Downs Boulevard, Tampa, FL 33612, USA; Geriatric Medicine, James A. Haley Veterans Hospital, University of South Florida College of Medicine, 13000 Bruce B Downs Boulevard, Tampa, FL 33612, USA.
| | - Susan K Schultz
- Psychiatry, James A. Haley Veterans Hospital, University of South Florida College of Medicine, 13000 Bruce B Downs Boulevard, Tampa, FL 33612, USA
| |
Collapse
|
39
|
Estimate of the Costs Caused by Adverse Effects in Hospitalised Patients Due to Hip Fracture: Design of the Study and Preliminary Results. Geriatrics (Basel) 2018; 3:geriatrics3010007. [PMID: 31011055 PMCID: PMC6371163 DOI: 10.3390/geriatrics3010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 01/02/2023] Open
Abstract
Introduction: Hip fracture is a health problem that presents high morbidity and mortality, negatively influencing the patient’s quality of life and generating high costs. Structured analysis of quality indicators can facilitate decision-making, cost minimization, and improvement of the quality of care. Methods: We studied 1571 patients aged 70 years and over with the diagnosis of hip fracture at Hospital Universitario de la Ribera in the period between 1 January 2012 and 31 December 2016. Demographic, clinical, functional, and quality indicator variables were studied. An indirect analysis of the costs associated with adverse events arising during hospital admission was made. A tool based on the “Minimum Basic Data Set (CMBD)” was designed to monitor the influence of patient risk factors on the incidence of adverse effects (AE) and their associated costs. Results: The average age of the patients analysed was 84.15 years (SD 6.28), with a length of stay of 8.01 days (SD 3.32), a mean preoperative stay of 43.04 h (SD 30.81), and a mortality rate of 4.2%. Likewise, the percentage of patients with AE was 41.44%, and 11.01% of patients changed their cost as a consequence of these AEs suffered during hospital admission. The average cost of patients was €8752 (SD: 1,864) and the average cost increase in patients with adverse events was €2321 (SD: 3,164). Conclusions: Through the analysis of the main clinical characteristics and the indirect estimation of the complexity of the patients, a simple calculation of the average cost of the attention and its adverse events can be designed in patients who are admitted due to hip fracture. Additionally, this tool can fit the welfare quality indicators by severity and cost.
Collapse
|
40
|
Which factors are independent predictors of early recovery of mobility in the older adults' population after hip fracture? A cohort prognostic study. Arch Orthop Trauma Surg 2018; 138:35-41. [PMID: 28956152 DOI: 10.1007/s00402-017-2803-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The aim of the present study was to identify all factors that might influence the short-term recovery of mobility in older adults' patients after hip surgery. METHODS A prospective cohort prognostic study was carried out. The study enrolled all consecutive patients aged 65 years or over admitted for hip fracture due to fragility. Patients were monitored from their admission into the emergency department of the hospital, until their discharge. The level of mobility was measured by the ILOA scale, administered during the 6th day of hospitalisation. The identified variables were divided into baseline patient variables, linked to the patient's characteristics, and, healthcare/hospital variables, linked to the program of care within post-surgery hospitalisation. RESULTS The total number of patients enrolled and examined at discharge was 484. Six days after surgery, the level of mobility achieved by patients, as measured by ILOA Scale, was 42.4 (± 6.0). Increased age (B = 0.111; p = 0,042), pressure sore mattress with a motor used (B = 3.817; p < 0.0005), delay in achieving an upright position (B = 0.509; p < 0.0005), no recovery of walking (b = 2.339; p < 0.0005), prolonged use of diapers (B = 0.004; p < 0.0005) or catheter (B = 0.089; p < 0.0005), indication for no weight bearing (B = 2.023; p = 0.031), and temperature for fewer days (B = 0.040; p = 0.023) are factors able to affect negatively recovery of mobility in the initial post-operative period in patients surgically treated for hip fracture. CONCLUSION Therapy and physiotherapy choices after surgery for hip fracture are significantly associated with early recovery of mobility of older adults' patients, regardless of their baseline conditions. Early removal of supporting devices promoting prolonged bed immobility, such as air mattress, catheter, and incontinence pad, together with achieving an early upright position, are elements to take into account when planning future trials to understand its efficacy in enabling better recovery of mobility.
Collapse
|
41
|
Dawe H. Modernising Hip Fracture Anaesthesia. Open Orthop J 2017; 11:1190-1199. [PMID: 29290856 PMCID: PMC5721325 DOI: 10.2174/1874325001711011190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 12/14/2022] Open
Abstract
Hip fracture carries a 30-day mortality of around 8% in the United Kingdom. This figure has remained relatively unchanged despite modern developments in anaesthetic technique. These range from improvements in perioperative analgesia and mortality scoring systems, changes to intra-operative anaesthetic technique and strategies to reduce the requirement for blood transfusion. In this article, we review the current literature on the perioperative management of patients undergoing hip fracture surgery including some of the current controversies.
Collapse
Affiliation(s)
- Hannah Dawe
- St. Georges Hospital, Tooting, SW170QT, London, UK
| |
Collapse
|
42
|
Lee HB, Oldham MA, Sieber FE, Oh ES. Impact of Delirium After Hip Fracture Surgery on One-Year Mortality in Patients With or Without Dementia: A Case of Effect Modification. Am J Geriatr Psychiatry 2017; 25:308-315. [PMID: 27838314 PMCID: PMC6197860 DOI: 10.1016/j.jagp.2016.10.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We evaluated whether delirium after hip fracture repair modifies the relationship between baseline dementia and one-year mortality after surgery. METHODS Patients age 65 years and older undergoing hip fracture repair surgery at John Hopkins Bayview Medical Center between 1999 and 2009 were eligible for this prospective cohort study. Baseline probable dementia was defined as either preoperatively diagnosed dementia per geriatrician or score less than 24 on the Mini-Mental State Examination. Delirium was assessed using the Confusion Assessment Method. Four cognitive groups were defined: 1) neither probable dementia nor delirium (NDD), 2) probable dementia only, 3) delirium only, or 4) delirium superimposed on dementia (DSD). Primary outcome of mortality was obtained through hospital records, obituaries, the National Death Index, and Social Security Death Index. RESULTS The current sample comprises 466 subjects (average age: 80.8 ± 7.0 years; 73.6% female). Of these, 77 (17%) were categorized as DSD, 68 (15%) probable dementia only, 73 (16%) delirium only, and 248 (53%) NDD. Cox regression revealed that DSD subjects had a significantly higher hazard of one-year mortality than NDD subjects (hazard ratio [HR]: 1.71, 95% CI: 1.06, 2.77) after adjusting for age, sex, medical comorbidity, and surgery duration. Trends toward greater mortality for probable-dementia and delirium only subjects were not significant (HR: 1.42 [95% CI: 0.80, 2.52] and 1.12 [95% CI: 0.64, 1.95], respectively). CONCLUSIONS Delirium after hip fracture repair surgery in patients with preoperative dementia modifies the risk of mortality over the first postoperative year. Patients with DSD have a nearly two-fold greater odds of one-year mortality than those without dementia or delirium.
Collapse
Affiliation(s)
- Hochang B Lee
- From the Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Mark A Oldham
- From the Department of Psychiatry, Yale School of Medicine, New Haven, CT.
| | - Frederick E Sieber
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Esther S Oh
- Department of Medicine (ESO), Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
43
|
Influence of Cognitive Impairment on Mobility Recovery of Patients With Hip Fracture. Am J Phys Med Rehabil 2017; 96:109-115. [DOI: 10.1097/phm.0000000000000550] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
|
44
|
Mortalidade em um ano de pacientes idosos com fratura do quadril tratados cirurgicamente num hospital do Sul do Brasil. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
45
|
Guerra MTE, Viana RD, Feil L, Feron ET, Maboni J, Vargas ASG. One-year mortality of elderly patients with hip fracture surgically treated at a hospital in Southern Brazil. Rev Bras Ortop 2016; 52:17-23. [PMID: 28194376 PMCID: PMC5290128 DOI: 10.1016/j.rboe.2016.11.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/18/2016] [Indexed: 12/22/2022] Open
Abstract
Objective To analyze the mortality rate at one-year follow-up of patients with hip fracture who underwent surgery at the university hospital of this institution. Method The authors reviewed 213 medical records of hospitalized patients aged 65 years or older, following to the order they were admitted to the orthopedics and traumatology service from January 2012 to August 2013. Results One-year mortality rate was 23.6%. Mortality was higher among women, with a 3:1 ratio. Anemia (p = 0.000) and dementia (p = 0.041) were significantly associated with the death group. Patients who remained hospitalized for less than 15 days and who were discharged within seven days after surgery showed increased survival. Conclusion In the present sample of patients with hip fracture who underwent surgery, one-year mortality rate was 23.6%, and the main comorbidities associated with this outcome were anemia and dementia.
Collapse
Affiliation(s)
- Marcelo Teodoro Ezequiel Guerra
- Universidade Luterana do Brasil (ULBRA), Hospital Universitário Mãe de Deus, Serviço de Ortopedia e Traumatologia, Canoas, RS, Brazil
| | - Roberto Deves Viana
- Universidade Luterana do Brasil (ULBRA), Hospital Universitário Mãe de Deus, Serviço de Ortopedia e Traumatologia, Canoas, RS, Brazil
| | - Liégenes Feil
- Universidade Luterana do Brasil (ULBRA), Hospital Universitário Mãe de Deus, Serviço de Ortopedia e Traumatologia, Canoas, RS, Brazil
| | - Eduardo Terra Feron
- Universidade Luterana do Brasil (ULBRA), Hospital Universitário Mãe de Deus, Serviço de Ortopedia e Traumatologia, Canoas, RS, Brazil
| | - Jonathan Maboni
- Universidade Luterana do Brasil (ULBRA), Hospital Universitário Mãe de Deus, Serviço de Ortopedia e Traumatologia, Canoas, RS, Brazil
| | - Alfonso Soria-Galvarro Vargas
- Universidade Luterana do Brasil (ULBRA), Hospital Universitário Mãe de Deus, Serviço de Ortopedia e Traumatologia, Canoas, RS, Brazil
| |
Collapse
|
46
|
Thorne K, Johansen A, Akbari A, Williams JG, Roberts SE. The impact of social deprivation on mortality following hip fracture in England and Wales: a record linkage study. Osteoporos Int 2016; 27:2727-2737. [PMID: 27098537 PMCID: PMC4981619 DOI: 10.1007/s00198-016-3608-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 03/01/2016] [Indexed: 12/02/2022]
Abstract
UNLABELLED We used routine hospital data to investigate whether socially deprived patients had an increased risk of dying following hip fracture compared with affluent patients. We found that the most deprived patients had a significantly increased risk of dying at 30, 90 and 365 days compared with the most affluent patients. INTRODUCTION To identify whether social deprivation has any effect on mortality risk after emergency admission with hip fracture and to determine whether any increased mortality observed among deprived groups was associated with patient and hospital-related factors. METHODS We used routine, linked hospital inpatient and mortality data for emergency admissions with a hip fracture in both England and Wales between 2004 and 2011. Mortality rates at 30, 90 and 365 days were reported. Logistic regression was used to identify any significant increases in mortality with higher levels of social deprivation and the influence of other risk factors on any increased mortality among the most deprived group. RESULTS Mortality rates at 30, 90 and 365 days were 9.3, 17.4 and 29.0 % in England and 8.3, 16.1 and 27.9 % in Wales. Social deprivation was significantly associated with increased mortality in the most deprived quintile compared with the least deprived quintile at 30, 90 and 365 days in England (OR = 1.187, 1.185 and 1.154, respectively) and at 90 and 365 days in Wales (1.135 and 1.203). There was a little interaction between deprivation and other risk factors influencing 30- and 365-day mortality except for patient age, pre-fracture residence and hospital size. CONCLUSIONS We demonstrated a positive association between social deprivation and increased mortality at 30 days post-admission for hip fracture in both England and Wales that was still evident at 90 and 365 days. We found little influence of other factors on social inequalities in mortality risk at 30 and 365 days post-admission.
Collapse
Affiliation(s)
- K Thorne
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
| | - A Johansen
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
- Trauma Unit, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
| | - A Akbari
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - J G Williams
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - S E Roberts
- Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| |
Collapse
|
47
|
Uriz-Otano F, Pla-Vidal J, Tiberio-López G, Malafarina V. Factors associated to institutionalization and mortality over three years, in elderly people with a hip fracture—An observational study. Maturitas 2016; 89:9-15. [DOI: 10.1016/j.maturitas.2016.04.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 12/20/2022]
|
48
|
Tarazona-Santabalbina FJ, Belenguer-Varea Á, Rovira E, Cuesta-Peredó D. Orthogeriatric care: improving patient outcomes. Clin Interv Aging 2016; 11:843-56. [PMID: 27445466 PMCID: PMC4928624 DOI: 10.2147/cia.s72436] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard.
Collapse
Affiliation(s)
- Francisco José Tarazona-Santabalbina
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
| | - Ángel Belenguer-Varea
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
| | - Eduardo Rovira
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
| | - David Cuesta-Peredó
- Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera; Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, Spain
| |
Collapse
|
49
|
Bliemel C, Sielski R, Doering B, Dodel R, Balzer-Geldsetzer M, Ruchholtz S, Buecking B. Pre-fracture quality of life predicts 1-year survival in elderly patients with hip fracture-development of a new scoring system. Osteoporos Int 2016; 27:1979-87. [PMID: 26733375 DOI: 10.1007/s00198-015-3472-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Hip fractures are common in elderly people. Despite great progress in surgical care, the outcome of patients with hip fracture remains disappointing. This study determined four prognostic factors (lower ASA score, higher pre-fracture EQ-5D index, higher MMSE score, and female gender) to predict 1-year survival in patients with hip fracture. INTRODUCTION This study determined the prognostic factors for 1-year survival in patients with hip fracture. Based on these predictors, a scoring system was developed for use upon patients' admission to the hospital. METHODS Hip fracture patients, aged ≥60 years, were prospectively enrolled. Upon admission, patients' sociodemographic data, type of fracture, American Society of Anesthesiologists (ASA) score, health-related quality of life scores (EQ-5D index) and Mini-Mental State Examination (MMSE) scores were recorded, among other parameters. Correlational analysis was performed on all potential variables to identify relevant predictor variables of 1-year survival. Univariate regression analysis was performed on all selected variables, followed by a multivariate analysis for variables that were significant in the univariate analysis. The final score was developed by converting the β-coefficients of each variable from the multivariate analysis into a scoring system. RESULTS For 391 hip fracture patients, complete data were available at the time of the 1-year follow-up. In multivariate regression analysis, independent predictors of 1-year survival were lower ASA score, higher pre-fracture EQ-5D index, higher MMSE score, and female gender. The different variables were weighted according to their β-coefficient to build the prognostic score, which ranged from 0 to 10 points. The ROC curve for 1-year mortality after hip fracture showed an area under the curve of 0.74 (R (2) = 0.272; 95 % CI 0.68-0.79; p < 0.001). CONCLUSIONS With only four instruments, the new score represents a useful tool for estimating 1-year survival in elderly patients with hip fractures. At present, the score is limited due to a lack of validation. A validation study is currently underway to prove its reliability.
Collapse
Affiliation(s)
- C Bliemel
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - R Sielski
- Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany
| | - B Doering
- Department of Clinical Psychology and Psychotherapy, Philipps-University, Marburg, Germany
| | - R Dodel
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - M Balzer-Geldsetzer
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - S Ruchholtz
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - B Buecking
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Baldingerstrasse, 35043, Marburg, Germany
| |
Collapse
|
50
|
Staples JA, Wang J, Zaros MC, Jurkovich GJ, Rivara FP. The application of IMPACT prognostic models to elderly adults with traumatic brain injury: A population-based observational cohort study. Brain Inj 2016; 30:899-907. [DOI: 10.3109/02699052.2016.1146964] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- John A. Staples
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Department of Medicine, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | - Jin Wang
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
| | - Mark C. Zaros
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Frederick P. Rivara
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| |
Collapse
|