Early interdisciplinary hospital intervention for elderly patients with hip fractures – functional outcome and mortality

Abstract

OBJECTIVES:Hip fractures are associated with high levels of co-morbidity and mortality. Orthogeriatric units have been shown to be effective with respect to functional recovery and mortality reduction. The aim of this study is to document the natural history of early multidisciplinary intervention in elderly patients with hip fractures and to establish the prognostic factors of mortality and walking ability after discharge.METHODS:This observational, retrospective study was performed in an orthogeriatric care unit on patients aged ≥70 years with a diagnosis of hip fracture between 2004 and 2008. This study included 1363 patients with a mean age of 82.7±6.4 years.RESULTS:On admission to the unit, the average Barthel score of these patients was 77.2±27.8 points, and the average Charlson index score was 2.14±2.05. The mean length of stay was 8.9±4.26 days, and the readmission rate was 2.3%. The in-hospital mortality rate was 4.7%, and the mortality rates at one, six, and 12 months after discharge were 8.7%, 16.9%, and 25.9%, respectively. The Cox proportional hazards model estimated that male sex, Barthel scale, heart failure, and cognitive impairment were associated with an increased risk of death. With regard to functionality, 63.7% of the patients were able to walk at the time of discharge, whereas 77.4% and 80.1% were able to walk at one month and six months post-discharge, respectively. The factors associated with a worse functional recovery included cognitive impairment, performance status, age, stroke, Charlson score, and delirium during the hospital stay.CONCLUSIONS:Early multidisciplinary intervention appears to be effective for the management of hip fracture. Age, male sex, baseline function, cognitive impairment and previous comorbidities are associated with a higher mortality rate and worse functional recovery.

The elderly recognizing themselves as vulnerable to falls in the concreteness of the femoral fracture

“…Moreover, in a study conducted in the city of Niterói (RJ), it was observed that 78.2% of the fractures in the elderly had occurred in lower limbs (12) . Although these data indicate a higher risk for certain groups, falls in the elderly and resulting fractures are common events around the world, associated with significant mortality and variations as to consequences (13) . This may be related to presence of comorbidities, longer hospitalization time, and complications arising from surgical procedures, such as general anesthesia (14) .…”

Evaluation of Functional Recovery by Motor Functional Independence Measure Test of Elderly After Hip Fracture in Serbia

“…1,2 The main goal of rehabilitation in geriatric population after the hip fracture is achievement and maintaining pre-fracture level of functional independence in movement and every day activities. 3,4 For this purpose different rehabilitation protocols are used for the treatment of these patients and there are efforts to identify specific factors that could point out whether rehabilitation goal is achievable and in what capacity. [5][6][7] It is known that improvement in functional independence is different for different patients, but however, we still lack the consensus concerning the factors that could be of great significance (age, gender, comorbidity, race, prefracture functional level, etc.).…”

Effect of balneo-physical therapy on quality of life of patients with surgically treated hip

“…Tim mora održavati redovne sastanke na kojima razmenjuje iskustva u radu sa pacijentom, zabeleženi napredak i diskutuje probleme. Rad rehabilitacionog tima mora podrazumevati i rad sa porodicom bolesnika, njihovo redovno informisanje o stanju pacijenta i daljim opcijama, kao i pripremu za resocijalizaciju bolesnika koja odgovara njemu ali i njegovom okruženju (87,88).…”

“…Poznato je da godine starosti predstavljaju jedan od glavnih faktora rizika za prelom kuka ali i negativni prediktivni faktor za oporavak nakon preloma kuka, kao i povećani mortalitet (86,87). U našem ispitivanom uzorku prosečne godine starosti ispitanika su bile 77,72 godine, a u praćenim grupama po vrsti rehabilitacionog tretmana, u grupi 1 koja je imala rehabilitacioni tretman koji uključuje i hidroterapiju prosečne gdine starosti su bile 74,80, dok su u grupi 2 koja nije imala rehabilitacioni tretman sa hidroterapijom, prosečna starost ispitanika bila 80.08 godina.Ovakva prosečna raspodela prema godinama starosti za celu grupu konzistentna je sa godinama starosti ipitanika u populaciji starijih u ostalim studijama (85,86,87,88). Upoređivanjem prosečne starosti pacijenata u dve posmatrane grupe nalazimo postojnje visoko statistički značajne razlike između grupe 1 i grupe 2 (Tabela br.3) što znači da su pacijenti uključeni u program bez hidroterapije bili značajno stariji od onih u grupi 1 uključenih u program koji podrazumeva i hidroterapiju.…”

“…U svim radovima koji se bave prelomom kuka navedna je činejnica da su prelomi kuka znatno češći u ženskoj populaciji (85)(86)(87)(88)(89)(90)(91), kako zbog dužeg životnog veka tako i zbog veće učestalosti osteoporoze koja je jedan od dominantnih rizikofaktora za prelome kuka (92). U sprovedenoj studiji odnos ženskog prema muškom polu je 3:1 što je konzistentno sa podacima iz drugih radova (92,93) .…”