Patients aged ninety years and older are exposed to increased risk of one-year mortality after hip fractures

Leal, Jaime; García, Luisa; Peña, Omar R.; Gomez-Gelvez, Amparo

doi:10.1007/s00590-021-02918-0

Cited by 7 publications

(9 citation statements)

References 32 publications

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“…Hip fracture is a major geriatric injury in old age, and the ultra-old are the fastest-growing group in the aging population, raising additional clinical concerns in terms of functional reserve and recovery after such surgical stress ( 3 ). Current evidence is largely insufficient to identify chronological age as a major determinant of mortality and unfavorable outcomes in these patients ( 3 ).…”

Section: Discussionmentioning

confidence: 99%

Ultra-old patients and long-term survival after hip fracture: a real-world assessment

Tiso,

Pizzonia,

Giannotti

et al. 2023

Front. Med.

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It’s still undetermined whether ultra-old persons, aged >90 years, are able to tolerate hip fracture surgical stress while maintaining their functional reserve, and even fewer studies have investigated the role of frailty on the risk of mortality, disability, or morbidity in the ultra-old. This is a prospective study performed at the Orthogeriatrics Ward of the IRCCS Policlinico San Martino (Genoa, Italy) that consecutively enrolled 205 older adult patients with hip fractures due to low-energy trauma. Namely, 85 patients were categorized as ultra-old, and 120 patients (64–89 years) were the younger control group. Demographic data, perioperative data, and rehabilitation data were collected. Here we estimated the overall survival and related predictive variables in hospitalized ultra-old hip fracture patients based on a methodologically robust frailty stratification (Rockwood 40-item tool). The median OS for the ultra-old was 18.7 months, which also showed a doubled 1-year mortality risk. Our findings assessed that frailty in the presence of malnutrition, delayed verticalization, and post-operative respiratory complications was associated with a two-fold increase in the risk of long-term mortality, irrespective of advanced chronological age in the ultra-old. Although the higher mortality rate in these patients may be related to a priori lower life expectancy, chronological age alone is an insufficient prognostic determinant for unfavorable outcomes. Our multicomponent prognostic score can be used in combination to stratify frailty in the ultra-old for timely screening and to deliver goals of care discussions prior to surgery, potentially targeting new orthogeriatric pathways for the improvement of appropriateness and treatment intensity.

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Section: Discussionmentioning

confidence: 99%

Ultra-old patients and long-term survival after hip fracture: a real-world assessment

Tiso,

Pizzonia,

Giannotti

et al. 2023

Front. Med.

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“…The impact of decreasing Indeed, this appears imperative, because even if hip fracture rates among some elderly subgroups appear be declining [74], or similar to those of the year preceding the COVID pandemic [57,77], and those who have the disease may not necessarily exhibit excess mortality rates [44], a high percentage of elderly cases who currently experience hip fracture injuries plus a COVID-19 infection, do appear to have a potentially worse hip fracture outcome than those who do not, regardless of location, and age [78]. Since hip fractures and related mortality rates are anticipated to increase in their own right due to fragility and poor bone health in the very near future [75], and while possible new waves of the corona virus and its variants are anticipated, along with current possible post hospital discharge infections [82], and persistent disruptions in operative and home care elder services [69, 78] it appears action is needed now more than ever to avert any further degree of preventable excess disability and personal devastation among the aging population and is strongly advocated.…”

Section: Referencesmentioning

confidence: 99%

Covid-19, and Hip Fracture Mortality Rates in the Elderly at One Year: Impact and Implications

Marks¹

2021

Open J Geriatr

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Both the presence of the corona virus , plus the widespread prevalence of hip fractures, are immense current major health concerns in most aging nations. This review examines whether there is any tangible impact on survival rates among older adults admitted to hospital in the past year (January 1, 2020-March 1, 2021 in the midst of the persistent COVID-19 pandemic. It specifically explores if more dedicated and focused preventive efforts are warranted in this regard, if indeed, a third wave of this infectious disease is on the horizon, and vaccines may not prove 100 percent effective, as is predicted by some. To address these questions, this present review examines pertinent literature sources published in the peer reviewed English language between January 1 2020 and March 1, 2021 concerning hip fractures relative to COVID-19 regardless of report type. The aim was to identify if specific interventions to offset the risk of incurring both COVID-19, as well as hip fractures are warranted at this time of widespread lock downs and service closures or delays. In particular, support for an enhanced focus on preventing both COVID-19 infections as well as hip fracture injuries was examined. Based on available data located in PUBMED and other electronic data bases, we conclude older adults who sustain a hip fracture, especially the modest percentage testing positive for COVID-19 are potentially at a higher risk for premature mortality than comparable cases with no infection. To avert any preventable excess suffering along with the immense social costs experienced by the both the affected individual, as well as society, heightened efforts to minimize COVID-19 infection risk, along with standard falls prevention approaches appear imperative especially among isolated older adults suffering from osteoporosis, poor nutrition, pain, cognitive challenges, and muscle weakness.

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“…In one study, the group of nonagenarians with hip fracture was with more women patients, higher prevalence of heart disease, lower prevalence of COPD and diabetes than younger patients with hip fracture 7 . A recent study reported that patients older than 90 years with hip fractures had higher mortality rates per year than younger patients 8 . Baseline functional status was poorer among the nonagenarians.…”

Section: Introductionmentioning

confidence: 97%

Risk factors and prognosis of postoperative delirium in nonagenarians with hip fracture

Zhao

Sun²,

Zhang³

et al. 2023

Sci Rep

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Hip fractures in nonagenarians is one of the great challenges for patients of this age, the family and the larger society. The purpose of this study was to investigate the risk factors and prognosis of postoperative delirium in nonagenarians with hip fracture. 199 Eligible patients were enrolled. Confusion Assessment Method (CAM) were used to identify the delirium. Logistic regressions were used to investigate the effect of 18 pre-existing conditions on postoperative delirium. Prognosis of postoperative delirium in nonagenarians with hip fracture were also be evaluated. The results indicated the following: (1) the prevalence of postoperative delirium among nonagenarians with hip fracture was 28.1% (56 of 199); (2) coexisting disease ≥ 4 (OR = 5.355, 95% CI = 1.394–9.074, P = 0.007), longer admission to operating time (OR = 1.514, 95% CI = 1.247–1.837, P = 0.000), and general anesthesia (OR = 2.086, 95% CI = 1.804–7.968, P = 0.032) were independent risk factors for postoperative delirium in nonagenarians with hip fracture; (3) nonagenarians with postoperative delirium had a predominantly high burden of perioperative complications, long length of stay, and postoperative mortality at 30 days follow-up and 1 year follow-up than the patients without postoperative delirium. The results could enable clinicians to improve outcome after operation in nonagenarians with hip fracture.

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Patients aged ninety years and older are exposed to increased risk of one-year mortality after hip fractures

Cited by 7 publications

References 32 publications

Ultra-old patients and long-term survival after hip fracture: a real-world assessment

Ultra-old patients and long-term survival after hip fracture: a real-world assessment

Covid-19, and Hip Fracture Mortality Rates in the Elderly at One Year: Impact and Implications

Risk factors and prognosis of postoperative delirium in nonagenarians with hip fracture

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