1
|
Chiang YW, Chang YJ, Huang HJ, Hsieh CP, Lu YH. Does post acute care reduce the mortality of octogenarian and nonagenarian patients undergoing hip fracture surgery? BMC Geriatr 2024; 24:322. [PMID: 38589787 PMCID: PMC11000408 DOI: 10.1186/s12877-024-04936-z] [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: 10/06/2023] [Accepted: 03/30/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND With the increasing number of elderly individuals worldwide, a greater number of people aged 80 years and older sustain fragility fracture due to osteopenia and osteoporosis. METHODS This retrospective study included 158 older adults, with a median age of 85 (range: 80-99) years, who sustained hip fragility fracture and who underwent surgery. The patients were divided into two groups, one including patients who joined the post-acute care (PAC) program after surgery and another comprising patients who did not. The mortality, complication, comorbidity, re-fracture, secondary fracture, and readmission rates and functional status (based on the Barthel index score, numerical rating scale score, and Harris Hip Scale score) between the two groups were compared. RESULTS The patients who presented with fragility hip fracture and who joined the PAC rehabilitation program after the surgery had a lower rate of mortality, readmission rate, fracture (re-fracture and secondary fracture), and complications associated with fragility fracture, such as urinary tract infection, cerebrovascular accident, and pneumonia (acute coronary syndrome, out-of-hospital cardiac arrest, or in-hospital cardiac arrest. CONCLUSIONS PAC is associated with a lower rate of mortality and complications such as urinary tract infection, bed sore, and pneumonia in octogenarian and nonagenarian patients with hip fragility fracture.
Collapse
Affiliation(s)
- Yu-Wei Chiang
- Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
| | - Yu-Jun Chang
- Big Data Center, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
| | - Hui-Jen Huang
- Department of Nursing, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
| | - Cheng-Pu Hsieh
- Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
- Orthopedics & Sports Medicine Laboratory, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C
- Department of Post-Baccalaureate Medicine, National Chung Hsing University, No. 145 Xingda Rd., South District, Taichung, 40227, Taiwan R.O.C
| | - Yueh-Hsiu Lu
- Department of Orthopedics, Changhua Christian Hospital, No. 135, Nanxiao St., Changua City, Changhua County, 500054, Taiwan R.O.C..
- Institute of Biomedical Sciences, National Chung Hsing University, No. 145 Xingda Rd., South District, Taichung, 40227, Taiwan R.O.C..
| |
Collapse
|
2
|
Lin CC, Yang CT, Su PL, Hsu JL, Shyu YIL, Hsu WC. Implementation difficulties and solutions for a smart-clothes assisted home nursing care program for older adults with dementia or recovering from hip fracture. BMC Med Inform Decis Mak 2024; 24:71. [PMID: 38475812 DOI: 10.1186/s12911-024-02468-5] [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: 01/15/2023] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Wearable devices have the advantage of always being with individuals, enabling easy detection of their movements. Smart clothing can provide feedback to family caregivers of older adults with disabilities who require in-home care. METHODS This study describes the process of setting up a smart technology-assisted (STA) home-nursing care program, the difficulties encountered, and strategies applied to improve the program. The STA program utilized a smart-vest, designed specifically for older persons with dementia or recovering from hip-fracture surgery. The smart-vest facilitated nurses' and family caregivers' detection of a care receiver's movements via a remote-monitoring system. Movements included getting up at night, time spent in the bathroom, duration of daytime immobility, leaving the house, and daily activity. Twelve caregivers of older adults and their care receiver participated; care receivers included persons recovering from hip fracture (n = 5) and persons living with dementia (n = 7). Data about installation of the individual STA in-home systems, monitoring, and technical difficulties encountered were obtained from researchers' reports. Qualitative data about the caregivers' and care receivers' use of the system were obtained from homecare nurses' reports, which were explored with thematic analysis. RESULTS Compiled reports from the research team identified three areas of difficulty with the system: incompatibility with the home environment, which caused extra hours of manpower and added to the cost of set-up and maintenance; interruptions in data transmissions, due to system malfunctions; and inaccuracies in data transmissions, due to sensors on the smart-vest. These difficulties contributed to frustration experienced by caregivers and care receivers. CONCLUSIONS The difficulties encountered impeded implementation of the STA home nursing care. Each of these difficulties had their own unique problems and strategies to resolve them. Our findings can provide a reference for future implementation of similar smart-home systems, which could facilitate ease-of-use for family caregivers.
Collapse
Affiliation(s)
- Chung-Chih Lin
- Department of Computer Science and Information Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Ching-Tzu Yang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Pei-Ling Su
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Jung-Ling Hsu
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
- College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| | - Yea-Ing L Shyu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.).
- Dementia Center, Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.).
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan (R.O.C.).
- Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan (R.O.C.).
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan (R.O.C.).
| | - Wen-Chuin Hsu
- Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (R.O.C.)
- College of Medicine, Chang Gung University, Taoyuan, Taiwan (R.O.C.)
| |
Collapse
|
3
|
Geng F, Liu Z, Yan R, Zhi M, Grabowski DC, Hu L. Post-Acute Care in China: Development, Challenges, and Path Forward. J Am Med Dir Assoc 2024; 25:61-68. [PMID: 37935380 DOI: 10.1016/j.jamda.2023.09.034] [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: 04/17/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES To evaluate the evolution and challenges of China's post-acute care (PAC) system over the past 20 years and suggest actionable policy recommendations for its improvement. DESIGN A retrospective review of policies and initiatives aimed at PAC system development, analyzed alongside unsolved challenges in light of global PAC practices, informed by literature reviews and collaborative discussion. SETTING AND PARTICIPANTS PAC in China involves diverse settings such as general hospitals, inpatient rehabilitation centers, skilled nursing facilities, community health centers, and homes. The patients are mainly those discharged from acute hospitals with functional impairment and in need of continuous care. METHOD An extensive search of government policy documents, statistical sources, peer-reviewed studies, and the gray literature. The research team conducted literature reviews and discussions regularly to shape the findings. RESULTS China has strengthened its PAC system through improved rehabilitation and nursing infrastructure, establishment of tiered rehabilitation networks, and adoption of innovative payment methods. However, challenges persist, including a lack of clinical consensus, resource constraints in PAC facilities and among professionals, the need for integrated care coordination, and the unification of PAC assessment tools and payment mechanisms. CONCLUSIONS AND IMPLICATIONS Although China has made substantial progress in its PAC system over 2 decades, continued efforts are needed to address its lingering challenges. Elevating awareness of PAC's significance and instituting policy adjustments targeting these challenges are essential for the system's optimization.
Collapse
Affiliation(s)
- Fangli Geng
- PhD program of Health Policy, Harvard Graduate School of Art and Science, Cambridge, MA, USA; Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Zhanqin Liu
- MS program in Global Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Runnan Yan
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng District, Beijing, China
| | - Mengjia Zhi
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng District, Beijing, China
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Linlin Hu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Dongcheng District, Beijing, China.
| |
Collapse
|
4
|
Lee MC, Woung LC, Tsauo JY, Shih SL, Chen HM, Chu DC, Huang SJ. Comparison of Highly Intensive Home-Based Post-acute Care to Inpatient Program for Patients With Fragility Fractures After Surgery. Geriatr Orthop Surg Rehabil 2022; 13:21514593221081376. [PMID: 35479650 PMCID: PMC9036330 DOI: 10.1177/21514593221081376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction Evidence suggests that patients with fragility fractures would benefit from post-acute care (PAC); however, they have been subjected to varying PAC programs. This study aimed to compare the effectiveness of home-based PAC (HPAC) to inpatient PAC (IPAC) programs for patients with fragility fractures in Taiwan. Materials and methods This is a retrospective study that reviewed the medical records of patients who received HPAC or IPAC within three weeks after hip, knee, or spine fragility fractures in the Taipei City Hospital from September 1, 2017, to August 31, 2018. Results The mean age (78.9 ± 10.8 years) showed significant difference between the HPAC (age = 80.6 ± 11.1, n = 83) and the IPAC (age = 78.2 ± 10.6, n = 185) groups (P = .049). After PAC, both HPAC and IPAC groups showed improvement on Barthel index, numerical pain rating scale, and Harris hip score (all P < .001). Patients in the HPAC group displayed greater improvement than the IPAC group on Barthel Index for activities of daily living (ADLs) by 5.8 (95% confidence interval, 3.0 to 8.5). The IPAC group had a significant longer length of PAC than the HPAC group (12.4 ± 3.0 vs. 11.1 ± 2.7, P < .001). Conclusion Both PAC programs could significantly improve functional performance and reduce pain in patients with fragility fractures. Patients treated in the HPAC group had better ADLs, and less length of PAC.
Collapse
Affiliation(s)
- Min-Chang Lee
- Center for Athletic Health Management, Taipei City Hospital Renai Branch, Taipei, Taiwan.,School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | - Jau-Yih Tsauo
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Liang Shih
- Department of Orthopaedic, Taipei City Hospital Zhongxing Branch, Taipei, Taiwan
| | - Hung-Ming Chen
- Center for Athletic Health Management, Taipei City Hospital Renai Branch, Taipei, Taiwan.,Department of Orthopaedic, Taipei City Hospital Renai Branch, Taipei, Taiwan
| | - Da-Chen Chu
- Taipei City Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Jean Huang
- Taipei City Hospital, Taipei, Taiwan.,Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
5
|
Connelly DM. Recovery in Mobility by Community-Living Older Adults following Fragility Hip Fracture. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2021.2008086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Denise M. Connelly
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario London Ontario, Canada
| |
Collapse
|
6
|
Efficacy and cost-effectiveness analysis of post-acute care for elderly patients with hip fractures. J Formos Med Assoc 2022; 121:1596-1604. [DOI: 10.1016/j.jfma.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/28/2021] [Accepted: 01/03/2022] [Indexed: 12/24/2022] Open
|
7
|
Malik AT, Jain N, Frantz TL, Quatman CE, Phieffer LS, Ly TV, Khan SN. Discharge to inpatient care facilities following hip fracture surgery: incidence, risk factors, and 30-day post-discharge outcomes. Hip Int 2022; 32:131-139. [PMID: 32538154 DOI: 10.1177/1120700020920814] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Discharge to an inpatient care facility (skilled-care or rehabilitation) has been shown to be associated with adverse outcomes following elective total joint arthroplasties. Current evidence with regard to hip fracture surgeries remains limited. METHODS The 2015-2016 ACS-NSQIP database was used to query for patients undergoing total hip arthroplasty, hemiarthroplasty and open reduction internal fixation for hip fractures. A total of 15,655 patients undergoing hip fracture surgery were retrieved from the database. Inpatient facility discharge included discharges to skilled-care facilities and inpatient rehabilitation units. Multi-variate regression analysis was used to assess for differences in 30-day post-discharge outcomes between home-discharge versus inpatient care facility discharge, while adjusting for baseline differences between the 2 study populations. RESULTS A total of 12,568 (80.3%) patients were discharged to an inpatient care facility. Discharge to an inpatient care facility was associated with higher odds of any complication (OR 2.03 [95% CI, 1.61-2.55]; p < 0.001), wound complications (OR 1.79 [95% CI, 1.10-2.91]; p = 0.019), cardiac complications (OR 4.49 [95% CI, 1.40-14.40]; p = 0.012), respiratory complication (OR 2.29 [95% CI, 1.39-3.77]; p = 0.001), stroke (OR 7.67 [95% CI, 1.05-56.29]; p = 0.045, urinary tract infections (OR 2.30 [95% CI, 1.52-3.48]; p < 0.001), unplanned re-operations (OR 1.37 [95% CI, 1.03-1.82]; p = 0.029) and readmissions (OR 1.38 [95% CI, 1.16-1.63]; p < 0.001) following discharge. CONCLUSION Discharge to inpatient care facilities versus home following hip fracture surgery is associated with higher odds of post-discharge complications, re-operations and readmissions. These results stress the importance of careful patient selection prior to discharge to inpatient care facilities to minimise the risk of complications.
Collapse
Affiliation(s)
- Azeem Tariq Malik
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nikhil Jain
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Travis L Frantz
- 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
| | - 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
| |
Collapse
|
8
|
The effects of falls on the prediction of osteoporotic fractures: epidemiological cohort study. Arch Osteoporos 2021; 16:110. [PMID: 34245374 DOI: 10.1007/s11657-021-00977-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/18/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Fall is the major risk factor of fracture that has not been included in FRAX®. Whether different age may determine the effect of falls on FRAX® is still uncertain. This epidemiological cohort study reveals that history of fall is a significant predictor of incident fracture independent of FRAX probability, especially in subjects < 75 years old. INTRODUCTION The Fracture Risk Assessment Tool (FRAX) calculates 10-year fracture risk using 11 clinical risk factors and bone mineral density (BMD); however, it does not include fall history in its risk assessment. Here, we investigated whether fall history is an independent risk factor on fracture prediction after adjustment of FRAX scores in two age subgroups (40-75 and ≥ 75 years). METHODS Beginning in 2009 to 2010, 1975 people (914 men) from Taiwan were followed for 6.8 ± 1.1 years by matching them with their records in the 2008-2016 National Health Insurance databank. We validated FRAX predictive accuracy with or without fall history by Cox proportional hazards regression. RESULTS After adjusting for FRAX risk, a history of falling was still a significant predictor of major osteoporotic fractures (MOFs) (using BMD, hazard ratio [HR], 1.47; p = 0.03; without using BMD, HR, 1.54; p = 0.01). A history of recurrent falls was also a significant predictor of both incident MOFs and hip fractures. However, when the subjects were stratified based on age group, a history of falling and recurrent falls were strong predictors of MOFs and hip fractures in the younger but not the older subgroup. CONCLUSION A fall history can predict incident fracture independently of FRAX probability, particularly in subjects younger than 75 years old.
Collapse
|
9
|
Yang JL, Ou YH, Liu SY, Lin CH, Chang SW, Lu YH, Shen T, Hsieh CP, Lin CM, Lei RL. Exploring the Effectiveness of PAC Rehabilitation for Elders with Hip Surgery: A Retrospective Study. Ther Clin Risk Manag 2021; 17:641-648. [PMID: 34188477 PMCID: PMC8236282 DOI: 10.2147/tcrm.s317218] [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: 04/23/2021] [Accepted: 06/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Hip fractures are high risk and high-impact events in the elderly population; despite orthopedic hip surgery, the disability and mortality rate remains significant. The National Health Insurance Agency in Taiwan established a fragility fracture PAC rehabilitation program to provide functional recovery for these patients after the surgery. However, the current literature on PAC rehabilitation is outdated, and there is an urgent need for the re-evaluation of the program. Methods This is a retrospective cohort study that enrolled 159 patients in the PAC rehabilitation program, followed by hip repair surgery. Outcome measures were the differences in participants’ pre- and post-PAC scores in 1) Barthel index, 2) Numerical Rating Scale (NRS), and 3) Harris Hip Scores (HHS) as surrogate indicators of the functional status, followed by the analysis of subgroups, including sex, age, site of the fracture, type of procedure, and the number of comorbidities. Results After completing PAC rehabilitation, 86.2% of the patients successfully returned to the community with either home or out-patient rehabilitation. The re-admission rate was 3.1% and 3.8% in 14-days and in 30-days follow up, respectively. The difference in pre- and post-Barthel index, NRS, and HHS showed significant improvement (p<0.001), without significant variations between the subgroups. Additionally, the Barthel index showed a positive correlation to HHS and a negative correlation to NRS. Conclusion This study revealed that the current form of post-surgery fragility fracture PAC program effectively improves functional status, reduces the re-admission rate, and facilitates the patient transition back to the community. The results should improve patients’ and physicians’ confidence in such a program.
Collapse
Affiliation(s)
- Ju-Lan Yang
- Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan.,Department of Nursing, College of Nursing, Hungkuang University, Taichung, Taiwan
| | - Yang-Hao Ou
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Sen-Yung Liu
- Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan
| | - Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.,Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan.,Department of Recreation and Holistic Wellness, MingDao University, Changhua, Taiwan
| | - Shu-Wei Chang
- Department of Medicinal Botanicals and Health Applications, Dayeh University, Changhua, Taiwan
| | - Yueh-Hsiu Lu
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Taishan Shen
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Cheng-Pu Hsieh
- Department of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chih-Ming Lin
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan
| | - Ruoh-Lih Lei
- Department of Nursing, College of Nursing, Hungkuang University, Taichung, Taiwan
| |
Collapse
|
10
|
Chao YP, Kao TW, Chen WL, Peng TC, Wu LW. Mid-arm muscle circumference as an indicator of osteoporosis in community-dwelling older men. Arch Gerontol Geriatr 2019; 87:103998. [PMID: 31877529 DOI: 10.1016/j.archger.2019.103998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/21/2019] [Accepted: 12/11/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Osteoporosis is an underdiagnosed disease and is lack of convenient and cost-efficient screening tool. We undertook a study to determine whether mid-arm muscle circumference (MAMC) was associated with osteoporosis. DESIGN Data were retrieved from the National Health and Nutrition Examination Survey (NHANES) III participants (aged 40-90 years). We divided the MAMC into tertile groups (T1, T2, and T3). Femoral neck bone density was analyzed because it was the reference skeletal site for defining osteoporosis in epidemiological studies. Participants with T- scores ≤ -2.5 were categorized as having osteoporosis. Multivariate logistic regression models were used to evaluate the associations between the MAMC tertiles and osteoporosis. RESULTS After adjustment for multiple covariates, osteoporosis was significantly inversely associated with the MAMC tertiles in the male group (T2/T1: OR 0.47, 95 % CI 0.30-0.75 and T3/T1: OR 0.34, 95 % CI 0.18-0.64), whereas nonsignificant association was found in the female group (T2/T1: OR 0.92, 95 % CI 0.70-1.20 and T3/T1: OR 0.84, 95 % CI 0.47-1.53). Subgroup analyses (40-64 and ≥65 years old; BMI <25 and ≥25 kg/m2) revealed consistent results. CONCLUSION The MAMC is an economical and practical tool that may assist in screening and early diagnosis of osteoporosis for the older men.
Collapse
Affiliation(s)
- Yuan-Ping Chao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tung-Wei Kao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tao-Chun Peng
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Li-Wei Wu
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, and School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC.
| |
Collapse
|
11
|
Wang YC, Chou MY, Liang CK, Peng LN, Chen LK, Loh CH. Post-Acute Care as a Key Component in a Healthcare System for Older Adults. Ann Geriatr Med Res 2019; 23:54-62. [PMID: 32743289 PMCID: PMC7387590 DOI: 10.4235/agmr.19.0009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 03/23/2019] [Accepted: 03/26/2019] [Indexed: 11/30/2022] Open
Abstract
Older adults often experience functional decline following acute medical care. This functional decline may lead to permanent disability, which will increase the burden on the medical and long-term care systems, families, and society as a whole. Post-acute care aims to promote the functional recovery of older adults, prevent unnecessary hospital readmission, and avoid premature admission to a long-term care facility. Research has shown that post-acute care is a cost-effective service model, with both the hospital-at-home and community hospital post-acute care models being highly effective. This paper describes the post-acute care models of the United States and the United Kingdom and uses the example of Taiwan’s highly effective post-acute care system to explain the benefits and importance of post-acute care. In the face of rapid demographic aging and smaller household size, a post-acute care system can lower medical costs and improve the health of older adults after hospitalization.
Collapse
Affiliation(s)
- Yu-Chun Wang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University, Taipei, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.,Department of Geriatric Medicine, National Yang Ming University, Taipei, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Hui Loh
- Department of Geriatric Medicine, National Yang Ming University, Taipei, Taiwan.,Center for Aging and Community Health, Hualien Tzu Chi Hospital, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
12
|
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
|
13
|
Wu CH, Chen CH, Chen PH, Yang JJ, Chang PC, Huang TC, Bagga S, Sharma Y, Lin RM, Chan DC. Identifying characteristics of an effective fracture liaison service: systematic literature review. Osteoporos Int 2018. [PMID: 29525971 DOI: 10.1007/s00198-017-4370-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fracture liaison services (FLS) have been demonstrated to improve outcomes following osteoporotic fracture. The aim of this systematic literature review (SLR) was to determine the characteristics of an FLS that lead to improved patient outcomes. We conducted a SLR, including articles published between 2000 and February 2017, using global (Medline, EMBASE, PubMed and Cochrane Library) and local databases. Studies including patients aged ≥ 50 years with osteoporotic fractures enrolled in an FLS were assessed. Information extracted from each article included key person coordinating the FLS (physician, nurse or other healthcare professional), setting (hospital vs community), intensity (single vs multiple), duration (long vs short term), fracture type and gender. A meta-analysis of randomised controlled trials was conducted based on the key person coordinating the FLS. Out of 7236 articles, 57 were considered to be high quality and identified for further analysis. The SLR identified several components which contributed to FLS success, including multidisciplinary involvement, driven by a dedicated case manager, regular assessment and follow-up, multifaceted interventions and patient education. Meta-analytic data confirm the effectiveness of an FLS following an osteoporotic fracture: approximate 27% increase in the likelihood of BMD testing and up to 21% increase in the likelihood of treatment initiation compared with usual care. The balance of evidence indicates that the multifaceted FLS and dedicated coordination are important success factors that contribute to effective FLS interventions which reduce fracture-related morbidity and mortality.
Collapse
Affiliation(s)
- C-H Wu
- Department of Family Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
- Institute of Gerontology, National Cheng Kung University College of Medicine, Tainan, Taiwan
| | - C-H Chen
- Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopaedics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Adult Reconstruction Surgery, Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - P-H Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - J-J Yang
- Department of Internal Medicine, Po Jen General Hospital, Taipei City, Taiwan
| | - P-C Chang
- Department of Orthopedics, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - T-C Huang
- National Taiwan University Hospital Chu-Tung Branch, Hsinchu, Taiwan
| | - S Bagga
- Complete HEOR Solutions LLC, 1046 Knapp Road, North Wales, PA, 19454, USA
| | - Y Sharma
- Complete HEOR Solutions LLC, 1046 Knapp Road, North Wales, PA, 19454, USA
| | - R-M Lin
- Tainan Municipal An-Nan Hospital-China Medical University, Tainan, Taiwan
| | - D-C Chan
- National Taiwan University Hospital Chu-Tung Branch, Hsinchu, Taiwan.
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
14
|
Chang YF, Huang CF, Hwang JS, Kuo JF, Lin KM, Huang HC, Bagga S, Kumar A, Chen FP, Wu CH. Fracture liaison services for osteoporosis in the Asia-Pacific region: current unmet needs and systematic literature review. Osteoporos Int 2018; 29:779-792. [PMID: 29285627 DOI: 10.1007/s00198-017-4347-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
The analysis aimed to identify the treatment gaps in current fracture liaison services (FLS) and to provide recommendations for best practice establishment of future FLS across the Asia-Pacific region. The findings emphasize the unmet need for the implementation of new programs and provide recommendations for the refinement of existing ones. The study's objectives were to evaluate fracture liaison service (FLS) programs in the Asia-Pacific region and provide recommendations for establishment of future FLS programs. A systematic literature review (SLR) of Medline, PubMed, EMBASE, and Cochrane Library (2000-2017 inclusive) was performed using the following keywords: osteoporosis, fractures, liaison, and service. Inclusion criteria included the following: patients ≥ 50 years with osteoporosis-related fractures; randomized controlled trials or observational studies with control groups (prospective or retrospective), pre-post, cross-sectional and economic evaluation studies. Success of direct or indirect interventions was assessed based on patients' understanding of risk, bone mineral density assessment, calcium intake, osteoporosis treatment, re-fracture rates, adherence, and mortality, in addition to cost-effectiveness. Overall, 5663 unique citations were identified and the SLR identified 159 publications, reporting 37 studies in Asia-Pacific. These studies revealed the unmet need for public health education, adequate funding, and staff resourcing, along with greater cooperation between departments and physicians. These actions can help to overcome therapeutic inertia with sufficient follow-up to ensure adherence to recommendations and compliance with treatment. The findings also emphasize the importance of primary care physicians continuing to prescribe treatment and ensure service remains convenient. These findings highlight the limited evidence supporting FLS across the Asia-Pacific region, emphasizing the unmet need for new programs and/or refinement of existing ones to improve outcomes. With the continued increase in burden of fractures in Asia-Pacific, establishment of new FLS and assessment of existing services are warranted to determine the impact of FLS for healthcare professionals, patients, family/caregivers, and society.
Collapse
Affiliation(s)
- Y -F Chang
- Department of Family Medicine, National Cheng Kung University College of Medicine and Hospital, 138 Sheng-Li Road, Tainan, 70428, Taiwan
| | - C -F Huang
- Department of Family Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
| | - J -S Hwang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - J -F Kuo
- Division of Endocrinology and Metabolism, Changhua Christian Hospital, Changhua, Taiwan
| | - K -M Lin
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - H -C Huang
- Department of Orthopaedics, Tainan Municipal Hospital, Tainan, Taiwan
| | - S Bagga
- Complete HEOR Solutions LLC, 1046 Knapp Road, North Wales, PA, 19454, USA
| | - A Kumar
- Complete HEOR Solutions LLC, 1046 Knapp Road, North Wales, PA, 19454, USA
| | - F -P Chen
- Keelung Chang Gung Memorial Hospital, Chang Gung University, Keelung, Taiwan
| | - C -H Wu
- Department of Family Medicine, National Cheng Kung University College of Medicine and Hospital, 138 Sheng-Li Road, Tainan, 70428, Taiwan.
- Institute of Gerontology, National Cheng Kung University College of Medicine, Tainan, Taiwan.
| |
Collapse
|
15
|
Pitzul KB, Wodchis WP, Kreder HJ, Carter MW, Jaglal SB. Discharge destination following hip fracture: comparative effectiveness and cost analyses. Arch Osteoporos 2017; 12:87. [PMID: 28965297 DOI: 10.1007/s11657-017-0382-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 09/20/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study determines outcomes and costs of similar hip fracture patients that were discharged from hospital to a rehabilitation facility or to the community within 1 year. Community patients had worse outcomes and lower costs compared to rehabilitation facility patients. This study contributes to understanding hip fracture quality of care. PURPOSE The purpose of this study is to determine the impact on mortality and rehospitalization, as well as health system cost, of similar hip fracture patients being discharged to an inpatient rehabilitation facility or directly to the community within 1 year in Ontario, Canada. METHODS This was a retrospective study of a propensity-matched cohort completed from the health system perspective. Administrative databases were used to identify and match two groups of older adults (total n = 18,773) discharged alive from acute care for hip fracture repair: patients discharged to inpatient rehabilitation were matched to patients discharged to the community. RESULTS A higher proportion of patients discharged to the community (27-42%) died or were rehospitalized (SDhighipr = 0.21, SDlowipr = 0.33) and had substantially lower health system costs (SDhighipr = 0.65, SDlowipr = 0.42) up to 1 year post-acute discharge compared to similar patients discharged to inpatient rehabilitation facilities (IPR) (10-11%). CONCLUSIONS This study demonstrates that similar hip fracture patients are discharged to different post-acute settings (i.e., home-based rehabilitation and inpatient rehabilitation) and have different outcomes, thereby calling into question the appropriateness of post-acute rehabilitation delivery in Ontario, Canada. Future research should focus on determining how trade-offs in resource allocation between settings would impact patient outcomes.
Collapse
Affiliation(s)
- Kristen B Pitzul
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, M5T2M6, Canada.
| | - Walter P Wodchis
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, M5T2M6, Canada.,Institute for Clinical Evaluative Sciences, G1 06 2075 Bayview Avenue, Toronto, Ontario, M4N3M5, Canada.,Toronto Rehabilitation Institute-University Health Network, 190 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada
| | - Hans J Kreder
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, M5T2M6, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N3M5, Canada
| | - Michael W Carter
- Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, Ontario, M5S3G8, Canada
| | - Susan B Jaglal
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, M5T2M6, Canada.,Institute for Clinical Evaluative Sciences, G1 06 2075 Bayview Avenue, Toronto, Ontario, M4N3M5, Canada.,Toronto Rehabilitation Institute-University Health Network, 190 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada.,Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G1V7, Canada
| |
Collapse
|
16
|
Brodie MA, Coppens MJ, Ejupi A, Gschwind YJ, Annegarn J, Schoene D, Wieching R, Lord SR, Delbaere K. Comparison between clinical gait and daily-life gait assessments of fall risk in older people. Geriatr Gerontol Int 2017; 17:2274-2282. [DOI: 10.1111/ggi.12979] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 10/19/2016] [Accepted: 11/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Milou J. Coppens
- Center for Human Movement Sciences, University Medical Center Groningen; University of Groningen; the Netherlands
| | - Andreas Ejupi
- Assistive Healthcare Information Technology Group; Austrian Institute of Technology; Vienna Austria
| | - Yves J. Gschwind
- Neuroscience Research Australia; UNSW; Randwick, Sydney Australia
| | - Janneke Annegarn
- Department of Personal Health, Philips Research; High Tech Campus 34, 5656AE Eindhoven the Netherlands
| | - Daniel Schoene
- Neuroscience Research Australia; UNSW; Randwick, Sydney Australia
- Institute for Biomedicine of Aging; Friedrich-Alexander University; Nuremberg Germany
| | - Rainer Wieching
- Institute for Information Systems; University Siegen; Siegen Germany
| | - Stephen R. Lord
- Neuroscience Research Australia; UNSW; Randwick, Sydney Australia
| | - Kim Delbaere
- Neuroscience Research Australia; UNSW; Randwick, Sydney Australia
| |
Collapse
|