Early Rehabilitation at Home of Elderly Patients with Hip Fractures and Consumption of Resources in Primary Care

Abstract

From 1976 onwards an active rehabilitation programme has been applied to elderly patients with fresh hip fractures at the Department of Orthopaedics in Lund in Southern Sweden. This involves early mobilisation in the hospital (internal fixation and immediate weight-bearing) and at home, rehabilitation in cooperation with primary health care personnel from the time of the patient's admission. The purposes of this investigation were to evaluate the effect of this programme in primary care and to assess the consumption of resources for rehabilitation at home of patients with cervical or trochanteric hip fractures. One hundred of 161 consecutive patients returned home directly on discharge from the hospital and were followed up until four months after the fracture by the home care unit (a primary health care centre). Most patients regained their previous functions within four months of their fractures. Patients with cervical fractures consumed less resources for rehabilitation than patients with trochanteric fractures. The total cost per patient was ten times higher for care at a convalescent-home than for rehabilitation at home through primary care. Early at home rehabilitation of elderly patients with hip fractures gives good results at a minimal cost and is thus of advantage both to the patient and to the community.

Optimal treatment of hip fractures

“…The rehabilitation program only temporarily increases the need for home-help service (7). Before the fracture, 30 percent of the patients had home help, and after the fracture 40 percent had home help.…”

Costs of hip fracture: Rehabilitation of 180 patients in primary health care

“…The rehabilitation scheme has been presented elsewhere (Ceder 1980, Jamlo et al 1984. All the surviving patients were visited in their own home at 1,2, and 4 months postoperatively by primary health care personnel, usually the district physiotherapists.…”

Early prediction of gait ability in patients with hip fracture

“…Choong et al [8] reported that discussion of the treatment process and goals with the patient, the patient's family, and the medical staff led to shortening of the hospitalization period. In addition, early exercise with weight-bearing on the affected leg [9] and shortening of the hospitalization period [10] are effective approaches for functional recovery, as well as being of benefit financially.…”