Older hip fracture patients: three groups with different needs

Abstract

BackgroundNorway, and particularly Oslo, has the highest reported incidence of hip fractures in the world. It is increasingly common to care for older hip fracture patients in orthogeriatric units where orthopaedic care is combined with interdisciplinary geriatric care. The characteristics and needs of older hip fracture patients are poorly described. The aim of this paper is to describe the characteristics of these patients in order to better understand their need for care and rehabilitation.MethodsThis is an observational study based on a quality register for all patients 65+ years in an orthogeriatric unit who are operated for a hip fracture. The unit covers 250,000 inhabitants in Oslo. Patient data were collected in the aim of quality control. The quality database includes demographic, medical, and functional data collected from routine assessment by the interdisciplinary team.ResultsFrom January 2007 to September 2009, 1010 patients, included 241 (24%) from long-term care institutions, were enrolled in the database. Mean age was 85.1 years (SD 7.1), 76% were female, and 83% had experienced an indoor fall. Chronic diseases were registered in 88%, and 38% of the community-dwelling patients had pre-fracture cognitive impairment defined as IQCODE-SF > 3.6. Complications were observed in 51% of the patients, of which the most common were a need for blood transfusion, delirium, and urinary tract infections. Post-operative orthopaedic infections were rare (3.1%). Patients from long-term care were older, (87 vs. 84 years, p < 0.001), more had American Society of Anaesthesiologists (ASA) score >/= 3 (67% vs. 48%, p < 0.001) and a higher number of chronic medical conditions (mean 2.2 vs. 1.6, p < 0.001). Among community-dwelling patients, those who had fallen indoors were older, more often female, had ASA score >/= 3, chronic medical conditions, impairment in pre-fracture ADL and cognitive function, and more complications during hospital stay.ConclusionsOlder hip fracture patients in this orthogeriatric unit may be divided into three groups; patients who are relatively fit and have experienced outdoors falls (17%), frail community-dwelling patients who have fallen indoors (59%), and patients from long-term care institutions (24%). Different caring pathways are needed for these groups.

Repercusión de las heridas crónicas en las unidades de rehabilitación funcional

“…Ranhoff y cols. observaron que de un total de 1010 pacientes mayores de 65 años admitidos en una unidad de ortogeriatría donde se realizó la reparación de la FC, el 24% fueron ingresados en instituciones de media/larga estancia para continuación de cuidados 9 . Sin embargo, la prevención del deterioro funcional que aparece durante la hospitalización en ancianos es factible una vez estabilizada la patología aguda, y si el deterioro se ha establecido en grado moderado-grave su tratamiento es posible en unidades hospitalarias específicas para la recuperación funcional como las URF de media/larga estancia 31 .…”

“…Las fracturas de cadera (FC) o de la extremidad proximal del fémur, el síndrome del inmovilismo o los politraumatismos son los diagnósti-cos más frecuentes en los pacientes que ingresan en estas unidades para realizar rehabilitación funcional. Existe escasa bibliografía en la que se relacione la recuperación funcional en pacientes con los diagnósticos médicos anteriormente referidos y la presencia de HC, aunque se ha demostrado que una de las complicaciones tras fractura más frecuentes en pacientes que necesitan cuidados a largo plazo con FC es la de sufrir una UPP, y que puede contribuir al aumento de la mortalidad entre un 50-70% [7][8][9][10] . Un alto porcentaje de estas UPP se producen por la inmovilización tras reparación de la FC y la mitad de estas son de origen intrahospitalario 11 .…”

Rehabilitation after Traumatic Brain Injuries - The Challenge of the Elderly

“…The falls occur most frequently at home [7], and there may be a time delay of medical care and diagnosis. In a national multicenter study in Norway delayed referral to the trauma centers were documented in the elderly [8], and the mortality was twice as high in the group above 65 years [9].…”

Depression, Dementia and Delirium in Older Adults Presenting with Hip Fractures to Orthopaedic Services at a General Hospital

“…High rates of psychiatric morbidity have been reported amongst subjects with hip fracture as compared to community rates [1][2][3][4]. Low activity of daily living (ADL) scores and mental state affect the ability of patients with fractures to return back to community [3,5,6].…”

“…Low activity of daily living (ADL) scores and mental state affect the ability of patients with fractures to return back to community [3,5,6]. Depression is also associated with a slower recovery post hip fracture [7] and higher mortality rates [8].…”