Abstract:Previous studies found that the risk of a femoral fracture in residents newly admitted to nursing homes was highest during the first months after admission and declined thereafter. Many nursing home admissions are preceded by a hospitalization. Therefore, the present study aimed to analyze if a similar risk pattern of fall-related fractures could also be observed in community-dwelling people at home after discharge from the hospital. Routine data of more than 690,000 German people aged 65 years and older with … Show more
“…This is in line with the study performed by Rapp et al who reported that this may have minor benefit for patients during the first weeks after discharge from hospital. This is in line with the study performed by Rapp et al who reported that exercise alone may have minor benefits for patients during the first weeks after discharge from hospital, and emphasise the importance of good discharge planning in order to optimize the support given to patients in their home environment to prevent future falls [ 50 ].…”
BackgroundStudies have shown that patients with hip fracture treated in a Comprehensive Geriatric Care (CGC) unit report better results in comparison to orthopaedic care. Furthermore, involving patients in their healthcare by encouraging patient participation can result in better quality of care and improved outcomes. To our knowledge no study has been performed comparing rehabilitation programmes within a CGC unit during the acute phase after hip fracture with focus on improving patients’ perceived participation and subsequent effect on patients’ function.MethodsA prospective, controlled, intervention performed in a CGC unit and compared with standard care. A total of 126 patients with hip fracture were recruited who were prior to fracture; community dwelling, mobile indoors and independent in personal care. Intervention Group (IG): 63 patients, mean age 82.0 years and Control Group (CG): 63 patients mean age 80.5 years. Intervention: coordinated rehabilitation programme with early onset of patient participation and intensified occupational therapy and physiotherapy after hip fracture surgery. The primary outcome measure was self-reported patient participation at discharge. Secondary outcome measures were: TLS-BasicADL; Bergs Balance Scale (BBS); Falls Efficacy Scale FES(S); Short Physical Performance Battery (SPPB) and Timed Up and Go (TUG) at discharge and 1 month and ADL staircase for instrumental ADL at 1 month.ResultsAt discharge a statistically significant greater number of patients in the IG reported higher levels of participation (p < 0.05) and independence in lower body hygiene (p < 0.05) and dressing (p < 0.001). There were however no statistically significant differences at discharge and 1 month between groups in functional balance and confidence, performance measures or risk for falls.ConclusionThis model of OT and PT coordinated inpatient rehabilitation had a positive effect on patients’ perceived participation in their rehabilitation and ADL at discharge but did not appear to affect level of recovery or risk for future falls at 1 month. A large proportion of patients remained at risk for future falls at 1 month in both groups highlighting the need for continued rehabilitation after discharge.Trial registrationClinicalTrials.gov Identifier: NCT03301584 (Retrospectively registered: 4th October 2017).Electronic supplementary materialThe online version of this article (10.1186/s12877-017-0640-z) contains supplementary material, which is available to authorized users.
“…This is in line with the study performed by Rapp et al who reported that this may have minor benefit for patients during the first weeks after discharge from hospital. This is in line with the study performed by Rapp et al who reported that exercise alone may have minor benefits for patients during the first weeks after discharge from hospital, and emphasise the importance of good discharge planning in order to optimize the support given to patients in their home environment to prevent future falls [ 50 ].…”
BackgroundStudies have shown that patients with hip fracture treated in a Comprehensive Geriatric Care (CGC) unit report better results in comparison to orthopaedic care. Furthermore, involving patients in their healthcare by encouraging patient participation can result in better quality of care and improved outcomes. To our knowledge no study has been performed comparing rehabilitation programmes within a CGC unit during the acute phase after hip fracture with focus on improving patients’ perceived participation and subsequent effect on patients’ function.MethodsA prospective, controlled, intervention performed in a CGC unit and compared with standard care. A total of 126 patients with hip fracture were recruited who were prior to fracture; community dwelling, mobile indoors and independent in personal care. Intervention Group (IG): 63 patients, mean age 82.0 years and Control Group (CG): 63 patients mean age 80.5 years. Intervention: coordinated rehabilitation programme with early onset of patient participation and intensified occupational therapy and physiotherapy after hip fracture surgery. The primary outcome measure was self-reported patient participation at discharge. Secondary outcome measures were: TLS-BasicADL; Bergs Balance Scale (BBS); Falls Efficacy Scale FES(S); Short Physical Performance Battery (SPPB) and Timed Up and Go (TUG) at discharge and 1 month and ADL staircase for instrumental ADL at 1 month.ResultsAt discharge a statistically significant greater number of patients in the IG reported higher levels of participation (p < 0.05) and independence in lower body hygiene (p < 0.05) and dressing (p < 0.001). There were however no statistically significant differences at discharge and 1 month between groups in functional balance and confidence, performance measures or risk for falls.ConclusionThis model of OT and PT coordinated inpatient rehabilitation had a positive effect on patients’ perceived participation in their rehabilitation and ADL at discharge but did not appear to affect level of recovery or risk for future falls at 1 month. A large proportion of patients remained at risk for future falls at 1 month in both groups highlighting the need for continued rehabilitation after discharge.Trial registrationClinicalTrials.gov Identifier: NCT03301584 (Retrospectively registered: 4th October 2017).Electronic supplementary materialThe online version of this article (10.1186/s12877-017-0640-z) contains supplementary material, which is available to authorized users.
“…Potential causes of the observed pattern may be the new environment which is a challenge to many of the new and often cognitively impaired residents. Another German study found that patients hospitalized due to any reason had an increased risk for hip fractures during the first weeks after discharge from hospital to their homes [27]. A morbidity-related weakness with a deterioration of gait and balance, and a persisting (sub-acute) delirium may be further reasons for a transient increased risk of falls and fractures.Fig.…”
Background
Hip fractures are regarded as a worldwide epidemic and a major public health concern. Changing risk factors, local differences and temporal trends contribute to the particular epidemiology of hip fractures. This overview gives a comprehensive insight into the epidemiology of hip fractures and reviews where German data have contributed to the literature.
Methods
The review of the epidemiology of hip fractures in Germany is based on a systematic literature search in PubMed. Information about the global epidemiology of hip fractures was provided by a selective literature review focusing on specific aspects of the epidemiology of hip fractures.
Results
Hip fracture rates vary more than 100-fold between different countries. In most high-income countries, a rise in age-standardized hip fracture rates was observed until the 1980s and 1990s and a decrease thereafter. Such a decrease has not been observed for Germany so far. Many factors, diseases and drugs have been found to be associated with hip fractures and there is some evidence that fracture risk in later life is already programmed during fetal life and early childhood. Of the hip fracture burden 50% occur in people with disability and in need of care. In nursing homes approximately 4 fractures can be expected in 100 women per year. In people with intellectual or developmental disabilities comparable risks of hip fracture occur 10–40 years earlier than in the general population. Incidence of disability, institutionalization and death are frequent consequences of hip fractures.
Conclusion
The epidemiology of hip fractures is characterized by a high burden of disease, local differences, temporal trends, well-defined high-risk populations and many established risk factors.
Electronic supplementary material
The online version of this article (10.1007/s00391-018-1382-z) contains supplementary material, which is available to authorized users.
“…These aspects may have been responsible for an increased risk of falling. Another study in old community-dwelling people found that the first weeks after discharge from hospital were associated with an increased risk for femoral fractures [ 3 ]. A morbidity-related weakness with a deterioration of gait and balance, and a still (sub-acute) delirium may be further reasons for a transient increased risk of falling which could explain the observed time-dependent pattern.…”
BackgroundThere is evidence about time-dependent fracture rates in different settings and situations. Lacking are data about underlying time-dependent fall risk patterns. The objective of the study was to analyse fall rates as a function of time after admission to sub-acute hospital units and to evaluate the time-dependent impact of clinical factors at baseline on fall risk.MethodsThis retrospective cohort study used data of 5,255 patients admitted to sub-acute units in a geriatric rehabilitation clinic in Germany between 2010 and 2014. Falls, personal characteristics and functional status at admission were extracted from the hospital information system. The rehabilitation stay was divided in 3-day time-intervals. The fall rate was calculated for each time-interval in all patients combined and in subgroups of patients. To analyse the influence of covariates on fall risk over time multivariate negative binomial regression models were applied for each of 5 time-intervals.ResultsThe overall fall rate was 10.2 falls/1,000 person-days with highest fall risks during the first week and decreasing risks within the following weeks. A particularly pronounced risk pattern with high fall risks during the first days and decreasing risks thereafter was observed in men, disoriented people, and people with a low functional status or impaired cognition. In disoriented patients, for example, the fall rate decreased from 24.6 falls/1,000 person-days in day 2–4 to about 13 falls/1,000 person-days 2 weeks later. The incidence rate ratio of baseline characteristics changed also over time.ConclusionsFall risk differs considerably over time during sub-acute hospitalisation. The strongest association between time and fall risk was observed in functionally limited patients with high risks during the first days after admission and declining risks thereafter. This should be considered in the planning and application of fall prevention measures.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0346-7) contains supplementary material, which is available to authorized users.
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