Health visitor risk assessment for preventing falls in elderly people

Mobility and functional outcomes after femoral neck fracture surgery in elderly patients: a comparison between hemiarthroplasty and internal fixation

PURPOSE

To find out whether patients with femoral neck fracture treated with hemiarthroplasty differ from those treated with internal fixation regarding functional outcome, walking ability, pain or short-term mortality.

METHOD

Sixty-six patients aged 64 years or more with femoral neck fracture were included in a prospective non-randomised trial with two equal-sized groups recruited consecutively within each group. All patients were treated operatively and encouraged to pursue an active rehabilitation. They were reviewed at admission, before discharge and 3 months after surgery. Assessments included demographic data, length of hospitalisation, post-operative medical complications, activities of daily living, walking ability, pain and mortality.

RESULTS

There were no significant differences between the two groups in terms of age, gender, ability to walk, functional status or at admission. The patients treated with hemiarthroplasty had a longer total hospital stay due to longer waiting time to operation. They started to walk sooner after operation and walked better during hospitalisation. Their walking distance at discharge was longer; their improvement in functional independence, as measured by the Functional Independence Measure, was also higher, but this difference was not statistically significant. Observed mortality in the hemiarthroplasty group was lower.

CONCLUSION

A longer follow-up would be necessary to determine whether the preferable outcomes of hemiarthroplasty persist in the long-term.

Impact of community care in enabling older people with complex needs to remain at home

Aim.  This aim of the study was to explore the impact of community care in enabling older people with complex needs to remain at home. Background.  Changing demographic trends and successive government policies have led to an increase in the number of older people with complex needs residing in the community. Design.  A qualitative approach using semi-structured interviews was used to collect data from older people (n = 17) and carers (n = 14). Method.  Social workers were asked to identify community dwelling older people (65+ years) with multiple needs requiring interventions from a range of health and social care practitioners. Results.  Community care enabled older people with complex needs who would otherwise have required residential or nursing home care to remain in their own homes. This was the expressed wish of both the older people and carers interviewed. Conclusions.  The provision of high-quality community care for older people is a globally significant challenge and one that requires creative solutions, both at a local and strategic level. Relevance to clinical practice.  Nurses and other health and social care professionals need to understand the significance of 'home' for older people and take steps to ensure that additional and appropriate resources are targeted towards community care.