Factors affecting mortality of frail hip-fractured elderly patients

Hershkovitz, Avital; Polatov, Irena; Beloosesky, Yichayaou; Brill, Shai

doi:10.1016/j.archger.2009.09.003

Cited by 60 publications

(42 citation statements)

References 15 publications

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“…A 5-study by Khan et al 49 of hip fractures revealed a 1-year mortality rate of 28% of patients with severe dementia versus 12% without. A study by Hershkovitz et al 56 of 376 patients with hip fractures revealed a 2-year mortality rate of 26.4% in patients with dementia versus 6.5% with those without dementia.…”

Section: Discussionmentioning

confidence: 99%

The 1-Year Mortality of Patients Treated in a Hip Fracture Program for Elders

Schnell

Friedman

Mendelson

et al. 2010

Geriatr Orthop Surg Rehabil

366

231

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Comanagement of geriatric hip fracture patients with standardized protocols has been shown to improve short-term outcomes after surgery. A standardized, patient-centered, comanaged Hip Fracture Program for Elders is examined for 1-year mortality. Patients 60 years of age who were treated in the Hip Fracture Program for Elders were comanaged by orthopaedic surgeons and geriatricians. Data including age, place of origin, procedure, length of stay, 1-year mortality, Charlson score, and activities of daily living (ADLs) were retrospectively collected. A total of 758 patients 60 years of age with hip fractures between April 15, 2005, and March 1, 2009, were included. Their data were analyzed, and the Social Security Death Index and the hospital data system were searched for mortality data. Seventy-eight percent were female, with a mean age of 84.8 years. The mean Charlson score was 3. Fifty percent were admitted from an institutional setting. The overall 1-year mortality was 21.2%. Age (odds ratio [OR] ¼ 1.03, 95% confidence interval [CI] ¼ 1.00-1.05; P ¼ .02), male gender (OR ¼ 1.55, 95% CI ¼ 1.01-2.36; P ¼ .04), low Parker mobility score (OR ¼ 2.94, 95% CI ¼ 1.31-6.57; P ¼ .01), and a Charlson score of 4 or greater (OR ¼ 2.15, 95% CI ¼ 1.30-3.55; P ¼ .002) were predictive of 1-year mortality. ADL dependence was a borderline predictor, as was medium Parker mobility score. Prefracture residence and moderate comorbidity (Charlson score of 2-3) were not independently predictive of mortality at 1 year after adjusting for other characteristics. A comprehensive comanaged hip fracture program for elders not only improves the short-term outcomes but also demonstrates a low 1-year mortality rate, particularly in patients from nursing facilities.Keywords geriatric trauma, systems of care, fragility fractures, hip, fractures, mortality Hip fractures in older adults are a leading public health concern. The incidence of hip fractures has been declining over the past decade; however, the total number of fractures has grown exponentially. 1 The number of hip fractures in the United States could total 840 000 by the year 2040.2,3 Older adults are the fastest growing segment of the US population. The population aged 65 years and older is predicted to more than double by 2050, increasing from 39 million today to 89 million. 4 It has been estimated that 1 in 3 women and 1 in 12 men will sustain a hip fracture in their lifetime.5 It has been reported that 86% of hip fractures occur in individuals aged 65 years and older. Hip fractures are associated with significant morbidity, mortality, loss of independence, and financial burden. [6][7][8][9][10][11][12] In usual care, the reported 1-year mortality after sustaining a hip fracture has been estimated to be 14% to 58% (Table 1). 1,7,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The relative risk of mortality in the elderly patient population increases 4% per year. 30 The first year after a hip fracture appears to be the most critical time. A recent meta-ana...

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Section: Discussionmentioning

confidence: 99%

The 1-Year Mortality of Patients Treated in a Hip Fracture Program for Elders

Schnell

Friedman

Mendelson

et al. 2010

Geriatr Orthop Surg Rehabil

366

231

View full text Add to dashboard Cite

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“…Comparisons between 3 groups were performed using a Kruskal Wallis test for quantitative variables, followed by a Dunn test when a significant difference was found; and Fisher's exact method for qualitative variables. Survival and the risk of a new institutionalization in the 3 groups of patients were estimated by a multivariate logistic regression analysis and for survival by the Kaplan-Meier method too (differences were assessed by the log-rank test) adjusted for the factors known in the published literature [6,[12][13][14][15]19,26,33,34] (semi-parsimonious method): age (< 80,81-85, 86-90, > 90), sex (female as reference), comorbidities (CIRS-G, ≤ or > 8) [29], number of drugs per day (< or ≥ 5), prefracture ADL6 (≤ 5 or = 6) [30], the ability to walk without assistance before surgery, time-tosurgery (≤ or > 48 hours) and the occurrence of delirium during hospitalization. We tested the association of survival / new institutionalization and cognitive status before surgery in UPOG by calculating the odds ratio (OR) or Hazard ratio (HR) and their 95 percent confidence interval (CI) with these prognostic variables.…”

Section: Discussionmentioning

confidence: 99%

“…In their study, the incidence of HF among patients with and without AD was 17.4 (95% CI, 15.7-19.2) and 6.6 (95% CI, 5.8-7.6) per 1,000 person years, respectively [12]. In particular, mortality and poor functional recovery after HF seem to be more frequent in patients with dementia than in patients without dementia [12][13][14][15]. Among the patients who experienced a HF, 24 to 27% of patients with dementia and 10 to 14% of patients without dementia did not survive more than six months after the occurrence of a HF [7,12].…”

Section: Introductionmentioning

confidence: 99%

Association between Cognitive Status before Surgery and Outcomes in Elderly Patients with Hip Fracture in a Dedicated Orthogeriatric Care Pathway

Zerah

Cohen-Bittan

Raux

et al. 2017

JAD

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Background: Dementia is associated with a worse prognosis of hip fracture, but the impact of a dedicated geriatric care pathway on the prognosis of these patients has not been evaluated. Objective: According to the cognitive status before surgery, our main objective was to compare mortality rate at 6 months; secondary outcomes were to compare in-hospital complications, the risk of new institutionalization, and the ability to walk at 6 months. Methods: Between 2009 and 2015, all patients (>70 years) admitted after hip fracture surgery into a dedicated unit of perioperative geriatric care were included: patients with dementia (DP), without dementia (NDP), and with cognitive status not determined (CSND). Data are expressed as hazard ratio (HR) for multivariate cox analysis or odds ratio (OR) for multivariate logistic regression analysis and their 95% confidence interval (CI). Results: We included 650 patients (86 ± 6 years): 168 DP, 400 NDP, and 82 CSND. After adjustment for age, sex, comorbidities, polypharmacy, pre-fracture autonomy, time-to-surgery, and delirium, there were no significant differences for 6-month mortality (DP versus NDP: HR = 0.7[0.4-1.2], DP versus CSND: HR = 0.6[0.3-1.4], CSND versus NDP: HR = 0.8[0.4-1.7]); but DP and CSND were more likely to be newly institutionalized after 6 months compared to NDP (OR DP = 2.6[1.4-4.9], p = 0.003, OR CSND = 2.9[1.4-6.1], p = 0.004). 92% of population was walking after 6 months (63% with assistance): no difference was found between the three groups. Conclusion:In a dedicated geriatric care pathway, DP and CSND undergoing hip surgery have the same 6-month mortality and walking ability as NDP.

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“…In such individuals, an acute episode of disuse atrophy (e.g. a hip fracture) can lead to disability in terms of mobility, increased hospitalization, and loss of independence, which can culminate in premature mortality 11, 12. Hence, the timely recovery of muscle mass and strength is the key goal for the physical rehabilitation of patients with disuse atrophy.…”

Section: Introductionmentioning

confidence: 99%

Effect of bimagrumab on thigh muscle volume and composition in men with casting‐induced atrophy

Rooks¹,

Laurent

Præstgaard³

et al. 2017

J cachexia sarcopenia muscle

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BackgroundPatients experiencing disuse atrophy report acute loss of skeletal muscle mass which subsequently leads to loss of strength and physical capacity. In such patients, especially the elderly, complete recovery remains a challenge even with improved nutrition and resistance exercise. This study aimed to explore the clinical potential of bimagrumab, a human monoclonal antibody targeting the activin type II receptor, for the recovery of skeletal muscle volume from disuse atrophy using an experimental model of lower extremity immobilization.MethodsIn this double‐blind, placebo‐controlled trial, healthy young men (n = 24; mean age, 24.1 years) were placed in a full‐length cast of one of the lower extremities for 2 weeks to induce disuse atrophy. After cast removal, subjects were randomized to receive a single intravenous (i.v.) dose of either bimagrumab 30 mg/kg (n = 15) or placebo (n = 9) and were followed for 12 weeks. Changes in thigh muscle volume (TMV) and inter‐muscular adipose tissue (IMAT) and subcutaneous adipose tissue (SCAT) of the thigh, maximum voluntary knee extension strength, and safety were assessed throughout the 12 week study.ResultsCasting resulted in an average TMV loss of −4.8% and comparable increases in IMAT and SCAT volumes. Bimagrumab 30 mg/kg i.v. resulted in a rapid increase in TMV at 2 weeks following cast removal and a +5.1% increase above pre‐cast levels at 12 weeks. In comparison, TMV returned to pre‐cast level at 12 weeks (−0.1%) in the placebo group. The increased adiposity of the casted leg was sustained in the placebo group and decreased substantially in the bimagrumab group at Week 12 (IMAT: −6.6%, SCAT: −3.5%). Knee extension strength decreased by ~25% in the casted leg for all subjects and returned to pre‐cast levels within 6 weeks after cast removal in both treatment arms. Bimagrumab was well tolerated with no serious or severe adverse events reported during the study.ConclusionsA single dose of bimagrumab 30 mg/kg i.v. safely accelerated the recovery of TMV and reversal of accumulated IMAT following 2 weeks in a joint‐immobilizing cast.

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Factors affecting mortality of frail hip-fractured elderly patients

Cited by 60 publications

References 15 publications

The 1-Year Mortality of Patients Treated in a Hip Fracture Program for Elders

The 1-Year Mortality of Patients Treated in a Hip Fracture Program for Elders

Association between Cognitive Status before Surgery and Outcomes in Elderly Patients with Hip Fracture in a Dedicated Orthogeriatric Care Pathway

Effect of bimagrumab on thigh muscle volume and composition in men with casting‐induced atrophy

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