Challenges in discharging elderly patients post hip fracture – Functional outcomes

Abstract

The purpose of this study is to realize the challenges experienced by elderly patients with hip fracture and their caregivers after discharge. A total of 65 files of elderly hip fracture operated patients were assessed and out of them responses from 53 patients collected through telephonic conversation over a period of 3 weeks. The responses received from the patient and their attendants were evaluated using the EQ-5D quality of life tool and their challenges noted. The most common fractures reported in the elderly are at the wrist, spine and hip. Hip fractures in elderly generally occur after a simple fall. If timely medical attention is not provided or appropriate care not taken the future of the patient after a hip fracture is certain – a dramatic reduction in the quality of life and possibly the beginning of the end of life. The purpose of this study is to evaluate the outcomes of elderly patients with hip fracture following surgery and the challenges they experienced after discharge from the hospital. A total of 53 patients were selected for the study who underwent hip surgery at Indian Spinal Injuries Centre. This is a descriptive study carried over a period of 13 months from August 2019 to August 2020. EQ-5D is used to characterize current health status of the patients. It consists of five domains and a visual analogue score. Feedback was collected from the patients and their attendants over telephone with a minimum follow up of 3 months. VAS score was calculated for every patient individually. Collected data was entered in MS Excel sheet. Challenges faced by the patients and their caregivers were documented. Out of 53 patients, 12 had died (22.6%), 07 patients responded themselves to the call and 34 calls were responded by the care givers. Most of the patients had intertrochanteric fractures 56.6% (30 patients) followed by neck femur fracture 24.5% (13 patients). On average every patient was suffering from a minimum of two comorbidities. The average length of hospitalization was 6.8 days. : This study suggests that integrated care involving geriatricians in pre-operative optimization of the patient should come in immediate practice. The role of post-surgery rehabilitation is invaluable but often an underestimated modality. The concerns of the patients and their family members regarding home care after discharge are genuine and need to be addressed. Information sharing is the key to reducing anxiety. Consideration for a cost-effective step-down facility must be considered by private institutes and government authorities.