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Qi YM, Li HT, Chang SM, Hu SJ, Du SC, Liu CD, Chu YQ, Rui YF. Sarcopenia is a risk factor for postoperative delirium in geriatric hip fracture patients: a retrospective study. Front Med (Lausanne) 2025; 11:1526240. [PMID: 39835112 PMCID: PMC11743499 DOI: 10.3389/fmed.2024.1526240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Accepted: 12/16/2024] [Indexed: 01/22/2025] Open
Abstract
BACKGROUND Various factors contribute to postoperative delirium (POD) in elderly patients undergoing hip fracture surgeries. Sarcopenia was defined as the progressive loss of skeletal muscle mass and strength associated with aging. The aim of this study was to explore the prevalence of POD and sarcopenia in geriatric patients undergoing hip fracture surgeries and to investigate the correlation between preoperative sarcopenia and POD. METHODS After applying specific inclusion and exclusion criteria, the information of 234 patients were retrospectively collected. POD was screened for with 4A's Test and diagnosed with DSM-5 criteria. The incidences of POD and sarcopenia were calculated. The demographic and perioperative features as well as comorbidities of delirious and non-delirious patients were analyzed and the risk factors analysis for POD in elderly hip fracture patients were conducted through univariate analysis and multivariate regression analysis. RESULTS 48.7% patients were diagnosed of POD, 78.95% of which were females. The average age of delirious and non-delirious patients were 84.75 years and 80.63 years, respectively. The incidence of sarcopenia was 41.02% for all the included patients with 60.53% for delirious patients and 20.55% for non-delirious patients. Results of univariate analysis showed that sarcopenia (OR:5.281, 95%CI 2.988-9.337, p = 0.000), age increase per year (OR:1.128, 95CI 1.070-1.190, p = 0.000), operation duration increase (OR:1.017, 95%CI 1.004-1.030, p = 0.011), intertrochanteric fracture (OR:2.571, 95%CI 1.517-4.358, p = 0.000), dementia (OR: 6.029, 95%CI 2.532-14.359, p = 0.000), ASA > 2 (OR: 6.955, 95%CI 3.461-13.976, p = 0.000), coronary heart disease (OR: 2.201, 95%CI 1.257-3.854, p = 0.006), renal insufficiency (OR: 2.215, 95%CI 1.187-4.133, p = 0.012) and COPD (OR: 2.554, 95%CI 1.414-4.615, p = 0.002) were risk factors for POD. Results of multivariate analysis identified sarcopenia (OR: 2.457, 95% CI 1.226-4.923, p = 0.011), ASA > 2 (OR: 3.968, 95% CI 1.805-8.722, p = 0.001), dementia (OR: 3.912, 95% CI 1.390-11.014, p = 0.010) and coronary heart disease (OR: 2.176, 95% CI 1.044-4.538, p = 0.038) as independent risk factors for POD in geriatric hip fracture patients. CONCLUSION The incidences of POD and sarcopenia in geriatric hip fracture patients are high. Sarcopenia is an independent risk factor for POD in geriatric hip fracture patients.
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Affiliation(s)
- Yi-Ming Qi
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hao-Tao Li
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shi-Min Chang
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Sun-Jun Hu
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shou-Chao Du
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chen-Dong Liu
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yong-Qian Chu
- Department of Orthopaedic Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yun-Feng Rui
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
- Orthopaedic Trauma Institute (OTI), School of Medicine, Southeast University, Nanjing, China
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Lee SW, Elsakr C, Joung KM, Ayutyanont N. Outcomes after inpatient rehabilitation for older adults with hip fractures: A cross-sectional study. Clin Rehabil 2025; 39:35-46. [PMID: 39584387 DOI: 10.1177/02692155241300647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2024]
Abstract
OBJECTIVE To investigate the clinical characteristics of older adults undergoing inpatient rehabilitation after hip fractures and to find factors associated with discharge location. DESIGN Cross-sectional analysis. SETTING Inpatient rehabilitation units in the United States. PARTICIPANTS ≥65 years old patients with hip fractures. INTERVENTION Inpatient rehabilitation with ≥1 hour of physical and occupational therapy per weekday. MAIN MEASURES Home versus nonhome discharges. RESULTS 79% of 7439 (n = 5,908) patients were discharged to home after a median stay of 14 days, while 13% (n = 990) were discharged to skilled nursing facilities. 6% (n = 423) were transferred to acute care during rehabilitation stay. Functional mobility levels for bed-to-chair transfer and sit-to-stand at admission were significantly lower in patients discharged to facilities than in patients discharged to home. Older age (OR 0.97 per 1 year, CI 0.96-0.98); comorbidities of dementia (OR 0.68, CI 0.56-0.83) and cerebrovascular disease (OR 0.53, CI 0.36-0.78); and the use of opioid analgesics (OR 0.71, CI 0.56-0.91), antipsychotics (OR 0.73, CI 0.58-0.92), and anticonvulsants (OR 0.81, CI 0.67-0.96), and lower initial functional levels in bed-to-chair transfers (OR 0.08, CI 0.05-0.12) for dependent level; OR 0.16, CI 0.10-0.25 for level requiring maximal assistance; OR 0.38, CI 0.24-0.60 for level requiring partial, moderate assistance), were associated with a decreased likelihood of discharge to home after inpatient rehabilitation. CONCLUSION Older adults with dementia, cerebrovascular disorders, and lower bed-to-chair transfer mobility levels at admission after hip fractures may benefit from additional targeted rehabilitation to improve the chances of a successful community discharge.
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Affiliation(s)
- Se Won Lee
- Sunrise Health GME Consortium, MountainView Hospital, Las Vegas, NV, USA
| | - Carol Elsakr
- Sunrise Health GME Consortium, MountainView Hospital, Las Vegas, NV, USA
| | - Keong M Joung
- Department of Physical Medicine and Rehabilitation, VA Southern Nevada Healthcare System, Las Vegas, NV, USA
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Kalan Farmanfarma K, Yarmohammadi S, Fakharian E, Gobbens RJ, Mahdian M, Batooli Z, Lotfi MS, Abedzadeh-Kalahroudi M, Vatan RF, Khosravi GR, Fazel MR, Sehat M. Prognostic Factors of Hip Fracture in Elderly: A Systematic Review. Int J Prev Med 2024; 15:42. [PMID: 39381356 PMCID: PMC11460988 DOI: 10.4103/ijpvm.ijpvm_169_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 02/20/2024] [Indexed: 10/10/2024] Open
Abstract
The hip fracture causes significant disabilities in many elderly people. Many studies around the world have identified various risk factors for the hip fracture. The aim of this study was to systematically investigate the risk factors of hip fractures. This study is a systematic review of risk factors for hip fractures. All published papers in English and Persian languages on patients in Iran and other countries between 2002 - 2022 were examined. The search strategy used keywords matching the mesh, including : predictors, hip fracture, and disability. Articles were selected from international databases (PubMed, Proquest ,Web of Sience, Scopus, Google scholar and Persian(Sid,Magiran), and the Newcastle Ottawa Scale was used to assess the risk of bias. The study has identified several factors that were significantly correlated with the risk of hip fracture, including age, cigarette and alcohol consumption, visual and hearing problems, low BMI levels, history of falling, weakness, and diseases such as stroke, cardiovascular disease, high blood pressure, arthritis, diabetes, dementia, Alzheimer's, Parkinson's, liver and kidney diseases, bone density, osteoporosis, vertebral fracture, and hyperthyroidism. However, the study did not find any significant correlations between the consumption of calcium and vitamin D, history of fractures, cognitive disorders, schizophrenia, and household income, and the risk of hip fracture. The results of this study reveal the determining role of some risk factors in hip fracture in older persons. Therefore, it is recommended that health policy makers provide the possibility of early intervention for some changeable factors.
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Affiliation(s)
| | | | - Esmaeil Fakharian
- Trauma Research Center, Department of Neurosurgery, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Robbert J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Mehrdad Mahdian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Batooli
- Social Determinants of Health (SDH)Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad-Sajjad Lotfi
- Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Reza Fadaei Vatan
- Iranian Research Center on Ageing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | | | - Mojtaba Sehat
- MD, PhD in Epidemiology, Trauma Research Center, Department of Community Medicine, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
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Kamimura T, Kobayashi Y, Tamaki S, Koinuma M. Impact of Prefracture Cognitive Impairment and Postoperative Delirium on Recovery after Hip Fracture Surgery. J Am Med Dir Assoc 2024; 25:104961. [PMID: 38428834 DOI: 10.1016/j.jamda.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES This study aimed to examine the impact of prefracture cognitive impairment (CI) severity and postoperative delirium on recovery after hip fracture surgery in older patients. DESIGN Prospective study with a 1-year follow-up. SETTING AND PARTICIPANTS We included 355 patients aged ≥80 years from 2 acute hospitals in Japan. METHODS Barthel Index (BI) ambulation scores were assessed prefracture and at 1, 3, 6, and 12 months postoperatively. The score at each time point minus the prefracture score was used as the ambulation recovery variable. The 21-item Dementia Assessment Sheet for the Community-based Care System (DASC-21) and Confusion Assessment Method were used to assess CI severity and delirium, respectively. The impacts of CI severity and delirium on recovery at 1 month and by 12 months postoperatively were examined. Linear multiple regression and linear mixed effects models were used. RESULTS BI ambulation scores remained the same or improved from prefracture levels in 26.8%, 34.4%, 33.0%, and 30.4% of patients at 1, 3, 6, and 12 months, respectively. Ten patients (2.8%) had fall-related hip fractures, 20 (5.6%) were rehospitalized, and 43 (12.1%) died during this period. Although DASC-21 CI severity significantly affected the recovery both at 1 month and by 12 months postoperatively [standardized β (Stdβ) = -0.39, P < .0001, and Stdβ = -0.37, P < .0001, respectively], delirium did not. Other variables affecting recovery by 12 months postoperatively included prefracture BI ambulation scores, Mini Mental State Examination scores, age, fracture type, place of residence, and time. CONCLUSIONS AND IMPLICATIONS Postoperative ambulation recovery, excluding the effect of death and other poor outcomes, is influenced by prefracture CI severity, and the presence of delirium itself may not be the moderating variable. These results emphasize the importance of treatment planning based on prefracture CI severity and indicate that assessments such as the DASC-21 may be useful in implementing such a plan.
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Affiliation(s)
- Tomoko Kamimura
- Department of Medical Sciences, Shinshu University, Matsumoto, Nagano, Japan.
| | - Yuya Kobayashi
- Department of Rehabilitation, Aizawa Hospital, Matsumoto, Nagano, Japan
| | - Satoshi Tamaki
- Department of Rehabilitation, Kamiiida-Daiichi General Hospital, Nagoya, Aichi, Japan
| | - Masayoshi Koinuma
- Faculty of Pharmaceutical Sciences, Teikyo Heisei University, Tokyo, Japan
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de Groot AJ, Wattel EM, van Balen R, Hertogh CM, van der Wouden JC. Association of Vulnerability Screening on Hospital Admission with Discharge to Rehabilitation-Oriented Care after Acute Hospital Stay. Ann Geriatr Med Res 2023; 27:301-309. [PMID: 37691483 PMCID: PMC10772331 DOI: 10.4235/agmr.23.0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/18/2023] [Accepted: 09/03/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND We assessed the vulnerability of patients aged ≥70 years during hospital admission based on the Short Dutch Safety Management Screening (DSMS). Screening of four geriatric domains aims to prevent adverse outcomes and may support targeted discharge planning for post-acute care. We explored whether the DSMS criteria for acutely admitted patients were associated with rehabilitation-oriented care needs. METHODS This retrospective cohort study included community-dwelling patients aged ≥70 years acutely admitted to a tertiary hospital. We recorded patient demographics, morbidity, functional status, malnutrition, fall risk, and delirium and used descriptive analysis to calculate the risks by comparing the discharge destination groups. RESULTS Among 491 hospital discharges, 349 patients (71.1%) returned home, 60 (12.2%) were referred for geriatric rehabilitation, and 82 (16.7%) to other inpatient post-acute care. Non-home referrals increased with age from 21% (70-80 years) to 61% (>90 years). A surgical diagnosis (odds ratio [OR]=4.92; 95% confidence interval [CI], 2.03-11.95), functional decline represented by Katz-activities of daily living positive screening (OR=3.79; 95% CI, 1.76-8.14), and positive fall risk (OR=2.87; 95% CI, 1.31-6.30) were associated with non-home discharge. The Charlson Comorbidity Index did not differ significantly between the groups. CONCLUSION Admission diagnosis and vulnerability screening outcomes were associated with discharge to rehabilitation-oriented care in patients >70 years of age. The usual care data from DSMS vulnerability screening can raise awareness of discharge complexity and provide opportunities to support timely and personalized transitional care.
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Affiliation(s)
- Aafke J. de Groot
- Department of Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Elizabeth M. Wattel
- Department of Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Cees M.P.M. Hertogh
- Department of Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Johannes C. van der Wouden
- Department of Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
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Gandossi CM, Zambon A, Ferrara MC, Tassistro E, Castoldi G, Colombo F, Mussi C, Martini E, Sergi G, Coin A, Zatti G, Trevisan C, Volpato S, Ungar A, Bellelli G. Frailty and post-operative delirium influence on functional status in patients with hip fracture: the GIOG 2.0 study. Aging Clin Exp Res 2023; 35:2499-2506. [PMID: 37542601 PMCID: PMC10628048 DOI: 10.1007/s40520-023-02522-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND This study analyzes the effect of frailty and Post-Operative Delirium (POD) on the functional status at hospital discharge and at 4-month follow-up in patients with hip fracture (HF). METHODS Multicenter prospective observational study of older patients with HF admitted to 12 Italian Orthogeriatric centers (July 2019-August 2022). POD was assessed using the 4AT. A 26-item Frailty Index (FI) was created using data collected on admission. The outcome measures were Cumulated Ambulation Score (CAS) ≤ 2 at discharge and a telephone-administered CAS ≤ 2 after 4 months. Poisson regression models were used to assess the effect of frailty and POD on outcomes. RESULTS 984 patients (median age 84 years, IQR = 79-89) were recruited: 480 (48.7%) were frail at admission, 311 (31.6%) developed POD, and 158 (15.6%) had both frailty and POD. In a robust Poisson regression, frailty alone (Relative Risk, RR = 1.56, 95% Confidence Intervals, CI 1.19-2.04, p = 0.001) and its combination with POD (RR = 2.57, 95% CI 2.02-3.26, p < 0.001) were associated with poor functional status at discharge. At 4-month follow-up, the combination of frailty with POD (RR 3.65, 95% CI 1.85-7.2, p < 0.001) increased the risk of poor outcome more than frailty alone (RR 2.38, 95% CI 1.21-4.66, p < 0.001). CONCLUSIONS POD development exacerbates the negative effect that frailty exerts on functional outcomes in HF patients.
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Affiliation(s)
| | - Antonella Zambon
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy
- Biostatistics Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Elena Tassistro
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Centre), School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Giuseppe Castoldi
- Orthopedic Unit, Carate Brianza Hospital, ASST Brianza, Vimercate, MB, Italy
| | - Francesca Colombo
- Orthopedic Unit, Carate Brianza Hospital, ASST Brianza, Vimercate, MB, Italy
| | - Chiara Mussi
- Orthogeriatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Emilio Martini
- Orthogeriatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Sergi
- Department of Medicine, Geriatrics Unit, University of Padua, Padua, Italy
| | - Alessandra Coin
- Department of Medicine, Geriatrics Unit, University of Padua, Padua, Italy
| | - Giovanni Zatti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Orthopedic Unit, IRCCS S. Gerardo Hospital, Monza, Italy
| | - Caterina Trevisan
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Orthogeriatric Unit, Arcispedale S. Anna, University Hospital of Ferrara, Ferrara, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
- Orthogeriatric Unit, Arcispedale S. Anna, University Hospital of Ferrara, Ferrara, Italy
| | - Andrea Ungar
- Geriatrics and Intensive Care Unit, University of Florence and AOU Careggi, Florence, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.
- Orthogeriatric Unit, IRCCS San Gerardo Hospital, Monza, Italy.
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Wang NJ, Zhang YM, Zhang BF. The Association Between Red Cell Distribution Width (RDW) and All-Cause Mortality in Elderly Patients with Hip Fractures: A Retrospective Cohort Study. Int J Gen Med 2023; 16:3555-3566. [PMID: 37609519 PMCID: PMC10441634 DOI: 10.2147/ijgm.s417079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
Background Red cell distribution width (RDW) may be related to the prognosis of hip fractures. The purpose of this study was to evaluate the association between (RDW) and all-cause mortality in elderly hip fractures. Materials and Methods Elderly patients aged ≥65 years who had a hip fracture were screened between January 1, 2015, and September 30, 2019. The age, gender of patients and other demographics, as well as history of allergy, injury mechanism, underlying illnesses at the time of admission, fracture classification, time from admission to operation, RDW, operation time, blood loss, infusion, transfusion, treatment strategy, and length in hospital stay and follow-up and other clinical characteristics were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between RDW and mortality in these patients. Analyses were performed using EmpowerStats and the R software. Results A total of 2587 patients were included in this retrospective cohort study. The mean follow-up period was 38.92 months. A total of 873 (33.75%) patients died due to all-cause mortality. The RDW was linearly associated with mortality in elderly patients with hip fractures. Linear multivariate Cox regression models showed that RDW was associated with mortality (hazard ratio [HR]=1.03, 95% confidence interval [CI]:1.02-1.05, P < 0.0001) after adjusting for confounding factors. The mortality risk increased by 3% when RDW increased by 1 fL. Conclusion RDW is associated with mortality in elderly patients with hip fractures, and RDW could be considered a predictor of mortality risk. Registration ChiCTR2200057323.
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Affiliation(s)
- Neng-Jun Wang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Yu-Min Zhang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Bin-Fei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, People’s Republic of China
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Everink IHJ, Grund S, Benzinger P, de Vries A, Gordon AL, van Wijngaarden JP, Bauer JM, Schols JMGA. Nutritional Care Practices in Geriatric Rehabilitation Facilities across Europe: A Cross-Sectional Study. J Clin Med 2023; 12:jcm12082918. [PMID: 37109255 PMCID: PMC10142565 DOI: 10.3390/jcm12082918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Many patients in geriatric rehabilitation (GR) are physically frail at the time of admission and suffer from malnutrition and sarcopenia, which may worsen rehabilitation outcomes. This study aims to obtain insight into the current nutritional care practices in GR facilities across Europe. METHODS In this cross-sectional study, a questionnaire focused on nutritional care practices in GR was distributed across experts in EUGMS member countries. Data were analyzed by using descriptive statistics. RESULTS In total, 109 respondents working in 25 European countries participated, and the results showed that not all GR patients were screened and treated for malnutrition, and not all participants used (inter)national guidelines when performing nutritional care. The results also showed variations across European geographical areas related to screening and treatment of malnutrition, sarcopenia, and frailty. Even though the participants underlined the importance of dedicating time to nutritional care, they experienced barriers in its implementation, which were mostly due to a lack of resources. CONCLUSION As malnutrition, sarcopenia, and frailty are often present in patients admitted to GR, in addition to being interrelated, it is recommended to develop an integrated approach to screening and treatment of all three clinical problems.
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Affiliation(s)
- Irma H J Everink
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Stefan Grund
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, 69126 Heidelberg, Germany
| | - Petra Benzinger
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, 69126 Heidelberg, Germany
- Institute for Health and Generations, University of Applied Sciences Kempten, 87435 Kempten, Germany
| | - Anne de Vries
- Danone Trading Medical B.V., 2132 LS Hoofddorp, The Netherlands
| | - Adam L Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham DE22 3NE, UK
| | | | - Jürgen M Bauer
- Center for Geriatric Medicine, Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, 69126 Heidelberg, Germany
| | - Jos M G A Schols
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD Maastricht, The Netherlands
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Chan HCN, Fei X, Leung ELY, Langston K, Marshall S, van der Meij BS. Post-discharge consequences of protein-energy malnutrition, sarcopenia, and frailty in older adults admitted to rehabilitation: A systematic review. Clin Nutr ESPEN 2023; 54:382-397. [PMID: 36963884 DOI: 10.1016/j.clnesp.2023.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 12/29/2022] [Accepted: 01/19/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND & AIMS Malnutrition, sarcopenia, and frailty are three prevalent wasting conditions among older rehabilitation patients that lead to multiple health-related negative outcomes. This systematic review and meta-analysis aimed to determine the post-discharge consequences of malnutrition, sarcopenia, and frailty in older adults admitted to inpatient rehabilitation. METHODS MEDLINE, Embase, Web of Science, and CINAHL databases were searched on 20 April, 2021 for longitudinal studies in older adults (≥65 years) admitted for inpatient rehabilitation. This systematic review included and synthesised studies that 1) measured malnutrition, sarcopenia, and/or frailty using a validated assessment tool or guideline; and 2) reported the association with post-discharge mortality, physical function, quality of life, or discharge location. The Academy of Nutrition & Dietetics Quality Criteria Checklist and GRADE criteria were used to assess risk of bias and evidence certainty. Where possible, data were pooled using Revman. RESULTS Twenty-six observational studies (n = 9709 participants in total) with similarly aged populations were included. Eight, seven, and eleven studies assessed malnutrition, sarcopenia, and frailty, respectively. Follow-up periods ranged from immediate to 7 years post-rehabilitation. Malnutrition was associated with discharge to a higher level of care (GRADE: very low), and worse quality of life (GRADE: very low) and physical function (GRADE: very low). Sarcopenia was associated with worse physical function (GRADE: very low) and lower rate of home discharge (OR: 0.14; 95%CI: 0.09-0.20; I2:30%; GRADE: low). Frailty was associated with increased mortality (GRADE: very low), hospital readmission (GRADE: very low), and decreased home discharge (GRADE: very low). CONCLUSION Wasting conditions in older adults during rehabilitation admission may be associated with poorer quality of life, lower rates of home discharge, and higher rates of health service use, physical dysfunction, and mortality following discharge. Further research is needed to investigate the comparative and combined impacts, as well as the overlap of malnutrition, sarcopenia, and frailty during and after rehabilitation to guide priority screening and intervention.
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Affiliation(s)
- Hei Chun Nicholas Chan
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Xinzhu Fei
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Eden Long Yin Leung
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Keanne Langston
- Department of Nutrition and Dietetics, Robina Hospital, Gold Coast, Queensland, Australia
| | - Skye Marshall
- Research Institute for Future Health, Gold Coast, Queensland, Australia
| | - Barbara Suzanne van der Meij
- Dietetics and Foodservices, Mater Health, Brisbane, Queensland, Australia; Mater Research Institute - University of Queensland, Brisbane, Queensland, Australia; Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands; Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands.
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10
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Muscat F, Camilleri L, Attard C, Lungaro Mifsud S. Assessment Tools for the Admission of Older Adults to Inpatient Rehabilitation: A Scoping Review. J Clin Med 2023; 12:919. [PMID: 36769567 PMCID: PMC9918169 DOI: 10.3390/jcm12030919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
(1) Objective: To identify the assessment tools and outcome measures used to assess older adults for inpatient rehabilitation. (2) Design: Scoping review. (3) Data sources: ProQuest, PEDro, PubMed, CINAHL Plus with full text (EBSCO), Cochrane Library and reference lists from included studies. (4) Review method: The inclusion of studies covering patients aged >60, focusing on rehabilitation assessments delivered in hospitals in community settings. Studies reporting on rehabilitation specifically designed for older adults-testing for at least one domain that affects rehabilitation or assessments for admission to inpatient rehabilitation-were also included. Results were described both quantitatively and narratively. (5) Results: 1404 articles were identified through selected databases and registers, and these articles underwent a filtering process intended to identify and remove any duplicates. This process reduced the number to 1186 articles. These, in turn, were screened for inclusion criteria, as a result of which 37 articles were included in the final review. The majority of assessments for geriatric rehabilitation were carried out by a multidisciplinary team. Multiple studies considered more than one domain during assessment, with a high percentage evaluating a specific outcome measure used in geriatric rehabilitation. The most common domains assessed were function, cognition and medical status-with communication, vision and pain being the least common. A total of 172 outcome measures were identified in this review, with MMSE, BI, FIM and CCI being the most frequent. (6) Conclusions: This review highlights the lack of standardised approaches in existing assessment processes. Generally, older-adult-rehabilitation assessments struggle to capture rehabilitation potential in a holistic manner. Hence, a predictive model of rehabilitation for assessing patients at the initial stages would be useful in planning a patient-specific programme aimed at maximising functional independence and, thus, quality of life.
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Affiliation(s)
- Francesca Muscat
- Department of Physiotherapy, Faculty of Health Sciences, University of Malta, MSD 2090 Msida, Malta
| | - Liberato Camilleri
- Statistics and Operations Research, Faculty of Science, University of Malta, MSD 2080 Msida, Malta
| | - Conrad Attard
- Computer Information Systems, Faculty of ICT, University of Malta, MSD 2080 Msida, Malta
| | - Stephen Lungaro Mifsud
- Department of Physiotherapy, Faculty of Health Sciences, University of Malta, MSD 2090 Msida, Malta
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11
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Chen Y, Liang S, Wu H, Deng S, Wang F, Lunzhu C, Li J. Postoperative delirium in geriatric patients with hip fractures. Front Aging Neurosci 2022; 14:1068278. [PMID: 36620772 PMCID: PMC9813601 DOI: 10.3389/fnagi.2022.1068278] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Postoperative delirium (POD) is a frequent complication in geriatric patients with hip fractures, which is linked to poorer functional recovery, longer hospital stays, and higher short-and long-term mortality. Patients with increased age, preoperative cognitive impairment, comorbidities, perioperative polypharmacy, and delayed surgery are more prone to develop POD after hip fracture surgery. In this narrative review, we outlined the latest findings on postoperative delirium in geriatric patients with hip fractures, focusing on its pathophysiology, diagnosis, prevention, and treatment. Perioperative risk prediction, avoidance of certain medications, and orthogeriatric comprehensive care are all examples of effective interventions. Choices of anesthesia technique may not be associated with a significant difference in the incidence of postoperative delirium in geriatric patients with hip fractures. There are few pharmaceutical measures available for POD treatment. Dexmedetomidine and multimodal analgesia may be effective for managing postoperative delirium, and adverse complications should be considered when using antipsychotics. In conclusion, perioperative risk intervention based on orthogeriatric comprehensive care is the most effective strategy for preventing postoperative delirium in geriatric patients with hip fractures.
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Affiliation(s)
- Yang Chen
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shuai Liang
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Huiwen Wu
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shihao Deng
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Fangyuan Wang
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Ciren Lunzhu
- Department of Orthopedics, Shannan City People’s Hospital, Shannan, China
| | - Jun Li
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China,*Correspondence: Jun Li,
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12
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Yan B, Sun W, Wang W, Wu J, Wang G, Dou Q. Prognostic significance of frailty in older patients with hip fracture: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2022; 46:2939-2952. [PMID: 36227383 DOI: 10.1007/s00264-022-05605-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Hip fracture (HF) has become a major healthcare concern associated with higher mortality in older patients. Frailty is one of the most important problems in aging population but its prognostic value in HF remains susceptible. This systematic review and meta-analysis aimed to evaluate the association between frailty and adverse outcomes in older patients with HF. METHODS We systematically searched electrical databases including PubMed and Embase to find eligible literature with end-search restriction of February 20, 2021. The main endpoints were all-cause mortality, peri-operative complications, abnormal discharge, and length of stay (LOS). Pooled effect size was calculated by random-effects or fixed-effect model according to study heterogeneity. Three subgroup analyses based on follow-up times, study design, and frailty criteria were conducted. RESULTS We screened 22 studies out of 1599 identified studies in our analysis. Compared with normal patients, frail ones had a higher risk of mortality both before (OR = 3.48, 95% CI: 2.50-4.85, I2 = 87.2%, P < 0.001) and after (OR = 1.87, 95% CI: 1.44-2.44, I2 = 85.5%, P < 0.001) adjustment. The incidence of peri-operative complications, abnormal discharge, and prolonged LOS also significantly increased in frail subjects. There was no publication bias observed and the pooled results were stable based on sensitivity analysis. CONCLUSION Overall, more attention needs to be paid to the prognostic effects caused by frailty in seniors with HF. Better understanding of the association between frailty and adverse outcomes in HF could help doctors perform co-management across orthopaedic and geriatric departments.
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Affiliation(s)
- Bingzi Yan
- West China School of Medicine, Sichuan University, Renmin South Road, No. 17, Wuhou District, Chengdu, 610041, China
| | - Wanting Sun
- West China School of Medicine, Sichuan University, Renmin South Road, No. 17, Wuhou District, Chengdu, 610041, China
| | - Wen Wang
- Chinese Evidence-Based Medicine Center and CREAT Group, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Centre, Chengdu, Sichuan, China
| | - Jinhui Wu
- National Clinical Research Center of Geriatrics, Geriatric Medicine Center, West China Hospital, Sichuan University, No. 37, Guoxue Rd, Wuhou District, Chengdu, 610041, China
| | - Guanglin Wang
- Department of Orthopedics, West China School of Medicine, West China Hospital, Sichuan University, No. 37, Wuhou Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Qingyu Dou
- National Clinical Research Center of Geriatrics, Geriatric Medicine Center, West China Hospital, Sichuan University, No. 37, Guoxue Rd, Wuhou District, Chengdu, 610041, China.
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13
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Araiza-Nava B, Méndez-Sánchez L, Clark P, Peralta-Pedrero ML, Javaid MK, Calo M, Martínez-Hernández BM, Guzmán-Jiménez F. Short- and long-term prognostic factors associated with functional recovery in elderly patients with hip fracture: A systematic review. Osteoporos Int 2022; 33:1429-1444. [PMID: 35247062 DOI: 10.1007/s00198-022-06346-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/10/2022] [Indexed: 01/17/2023]
Abstract
UNLABELLED This systematic review aimed to identify short- and long-term associated factors to functional recovery of elderly hip fracture patients after discharge. We identified 43 studies reporting 74 associated factors to functional recovery; most of them were biological, sociodemographic, or inherent factors to patients' baseline characteristics, including their pre-facture functional capacity. PURPOSE This systematic review aimed to identify short- and long-term associated factors to functional recovery of elderly hip fracture patients after hospital discharge. We assessed the use of the hip fracture core-set and key-performance indicators for secondary fracture reduction. METHODS A search was performed in seven electronic databases. Observational studies reporting predictors after usual care of elderly patients with hip fracture diagnoses receiving surgical or conservative treatment were included. Primary outcomes considered were part of the domains corresponding to functional capacity. RESULTS Of 3873 references identified, and after the screening and selection process, 43 studies were included. Sixty-one functional measures were identified for ten functional outcomes, including BADLs, IADLs, ambulation, and mobility. Biological characteristics such as age, sex, comorbidities, cognitive status, nutritional state, and biochemical parameters are significantly associated. Determinants such as contact and size of social network and those related to institutional care quality are relevant for functional recovery at six and 12 months. Age, pre-fracture function, cognitive status, and complications continue to be associated five years after discharge. We found 74 associated factors to functional recovery of elderly hip fracture patients. Ten of the studies reported rehabilitation programs as suggested in KPI 9; none used the complete hip fracture core-set. CONCLUSION Most of the associated factors for functional recovery of elderly hip fracture were biological, sociodemographic, or inherent factors to patients' baseline characteristics, including their pre-facture functional capacity. For the core-set and KPI's, we found an insufficient use and report. This study reports 61 different instruments to measure functional capacity. REGISTRATION NUMBER PROSPERO (CRD42020149563).
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Affiliation(s)
- Berenice Araiza-Nava
- Clinical Epidemiology Research Unit, Hospital Infantil de Mexico "Federico Gomez", Mexico city, Mexico. Faculty of Medicine of National Autonomous University of Mexico (Universidad Nacional Autónoma de México), Mexico City, Mexico
| | - Lucia Méndez-Sánchez
- Clinical Epidemiology Research Unit, Hospital Infantil de Mexico "Federico Gomez", Mexico city, Mexico. Faculty of Medicine of National Autonomous University of Mexico (Universidad Nacional Autónoma de México), Mexico City, Mexico.
| | - Patricia Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de Mexico "Federico Gomez", Mexico city, Mexico. Faculty of Medicine of National Autonomous University of Mexico (Universidad Nacional Autónoma de México), Mexico City, Mexico
| | | | - Muhammad Kassim Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mónica Calo
- Regional Manager of IOF Latin America, Buenos Aires, Argentina
| | - Brenda María Martínez-Hernández
- Faculty of Medicine of National Autonomous University of Mexico (Universidad Nacional Autónoma de México), Mexico City, Mexico
| | - Fabiola Guzmán-Jiménez
- Medical Unit of High Specialty Traumatology and Orthopaedics Hospital "Lomas Verdes", Mexican Institute of Social Security (UMAE Hospital de Traumatología Y Ortopedia "Lomas Verdes", Instituto Mexicano del Seguro Social), Naucalpan de Juárez, Mexico. Faculty of Medicine of National Autonomous University of Mexico (Universidad Nacional Autónoma de México), Mexico City, Mexico
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14
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Dementia is a surrogate for frailty in hip fracture mortality prediction. Eur J Trauma Emerg Surg 2022; 48:4157-4167. [PMID: 35355091 PMCID: PMC9532301 DOI: 10.1007/s00068-022-01960-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/13/2022] [Indexed: 12/12/2022]
Abstract
Purpose Among hip fracture patients both dementia and frailty are particularly prevalent. The aim of the current study was to determine if dementia functions as a surrogate for frailty, or if it confers additional information as a comorbidity when predicting postoperative mortality after a hip fracture. Methods All adult patients who suffered a traumatic hip fracture in Sweden between January 1, 2008 and December 31, 2017 were considered for inclusion. Pathological fractures, non-operatively treated fractures, reoperations, and patients missing data were excluded. Logistic regression (LR) models were fitted, one including and one excluding measurements of frailty, with postoperative mortality as the response variable. The primary outcome of interest was 30-day postoperative mortality. The relative importance for all variables was determined using the permutation importance. New LR models were constructed using the top ten most important variables. The area under the receiver-operating characteristic curve (AUC) was used to compare the predictive ability of these models. Results 121,305 patients were included in the study. Initially, dementia was among the top ten most important variables for predicting 30-day mortality. When measurements of frailty were included, dementia was replaced in relative importance by the ability to walk alone outdoors and institutionalization. There was no significant difference in the predictive ability of the models fitted using the top ten most important variables when comparing those that included [AUC for 30-day mortality (95% CI): 0.82 (0.81–0.82)] and excluded [AUC for 30-day mortality (95% CI): 0.81 (0.80–0.81)] measurements of frailty. Conclusion Dementia functions as a surrogate for frailty when predicting mortality up to one year after hip fracture surgery. The presence of dementia in a patient without frailty does not appreciably contribute to the prediction of postoperative mortality. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-022-01960-9.
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15
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Becker N, Hafner T, Pishnamaz M, Hildebrand F, Kobbe P. Patient-specific risk factors for adverse outcomes following geriatric proximal femur fractures. Eur J Trauma Emerg Surg 2022; 48:753-761. [PMID: 35325262 PMCID: PMC9001566 DOI: 10.1007/s00068-022-01953-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Proximal femur fractures (PFFs) occur frequently among geriatric patients due to diverse risk factors, such as a lower bone mineral density and the increased risk of falls. METHODS In this review, we focus on recent literature of patient-specific risk factors and their impact on common complications and outcome parameters in patients with PFF. RESULTS Patient- and treatment related factors have a significant impact on outcome and are associated with an increased risk of mortality, impairments in functional rehabilitation and complicative courses. CONCLUSION Geriatric patients at high risk for complications are nursing home inhabitants suffering from severe osteoporosis, dementia and sarcopenia. The early and ongoing assessment for these individual risk factors is crucial. Strategies including interdisciplinary approaches, addressing comorbidities and facilitating an optimal risk factor evaluation result in a beneficial outcome. The ongoing ambulant assessment and therapy of complicating factors (e.g., malnutrition, sarcopenia, frailty or osteoporosis) have to be improved.
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Affiliation(s)
- Nils Becker
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Tobias Hafner
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Miguel Pishnamaz
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Philipp Kobbe
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
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16
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Chiang MH, Huang YY, Kuo YJ, Huang SW, Jang YC, Chu FL, Chen YP. Prognostic Factors for Mortality, Activity of Daily Living, and Quality of Life in Taiwanese Older Patients within 1 Year Following Hip Fracture Surgery. J Pers Med 2022; 12:jpm12010102. [PMID: 35055417 PMCID: PMC8778381 DOI: 10.3390/jpm12010102] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/19/2021] [Accepted: 01/11/2022] [Indexed: 01/05/2023] Open
Abstract
Background. Hip fractures among older adults are a major public health concern worldwide. This study investigated the potential clinical factors that predict postoperative 1-year activities of daily living (ADL), quality of life (QoL), and mortality in Taiwanese older adults following hip fracture. Methods. This is a prospective cohort study enrolling older adults (≥60 years) who had undergone hip fracture surgery in a single medical center. The comprehensive clinical history of each patient was examined. QoL, ADL, and mortality events were recorded consecutively at 3, 6, and 12 months after operation. The multiple logistic regression model and the generalized estimating equation (GEE) were adopted to identify contributing factors for mortality and postoperative ADL and QoL prognosis, respectively. Results. Among 377 participants with hip fracture, 48 died within 1 year of the index operation. ADL and QoL considerably decreased at 3 months following hip surgery. Old age, high Charlson Comorbidity Index, and American Society of Anesthesiologists grading were crucial predictors for mortality at the 1-year follow-up. The generalized estimating equation analysis indicated that the length of postoperative follow-up time, serum albumin level, patient cognitive status, and handgrip strength were considerably associated with QoL and ADL recovery prognosis in the Taiwanese older adults following hip fracture. Conclusions. Hip fractures have long-lasting effects on the older adults. Our data imply several prognosis predicting parameters that may assist clinicians in accounting for an individual’s personalized risks in order to improve functional outcomes and reduce mortality.
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Affiliation(s)
- Ming-Hsiu Chiang
- Department of General Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
| | - Yu-Yun Huang
- Department of Nursing & Graduate Institute of Nursing, Chang Gung University of Science and Technology, Kweishan, Taoyuan 333, Taiwan;
| | - Yi-Jie Kuo
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-J.K.); (S.-W.H.)
- Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Shu-Wei Huang
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-J.K.); (S.-W.H.)
| | - Yeu-Chai Jang
- Department of Obstetrics and Gynecology, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
| | - Fu-Ling Chu
- Department of Nursing & Graduate Institute of Nursing, Chang Gung University of Science and Technology, Kweishan, Taoyuan 333, Taiwan;
- Correspondence: (F.-L.C.); (Y.-P.C.); Tel.: +886-03-2118999 (F.-L.C.); Fax: +886-03-2118866 (F.-L.C.)
| | - Yu-Pin Chen
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan; (Y.-J.K.); (S.-W.H.)
- Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: (F.-L.C.); (Y.-P.C.); Tel.: +886-03-2118999 (F.-L.C.); Fax: +886-03-2118866 (F.-L.C.)
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17
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Gandossi CM, Zambon A, Oliveri G, Codognola M, Szabo H, Cazzulani I, Ferrara MC, Mottadelli C, Galeazzi M, Amoroso I, Zarcone C, Principato G, Corsi M, Mazzola P, Zatti G, Foti G, Bellelli G. Frailty, post-operative delirium and functional status at discharge in patients with hip fracture. Int J Geriatr Psychiatry 2021; 36:1524-1530. [PMID: 33908103 PMCID: PMC8518900 DOI: 10.1002/gps.5561] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/17/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To explore the effect of frailty, alone and in combination with post-operative delirium (POD), on the risk of poor function at discharge in patients with hip fracture (HF). METHODS This is a prospective cohort study of patients with HF admitted to an Orthogeriatric Unit (OGU) between October 1, 2011 and March 15, 2019. POD was assessed using the 4AT and the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5-edition criteria. A 22-items Frailty Index (FI) was created using the data collected on admission. The outcome measure was the Cumulated Ambulation Score (CAS) score at discharge. A log-binomial regression model was used to assess the effect of frailty and POD on CAS. RESULTS A total of 988 patients (median age = 84.9 years, Interquartile range = 80.6-89.2) were included: 360 patients (36.4%) were frail and 411 (42%) developed POD. Poor functional status at discharge (CAS score ≤2) was more common in frail than non-frail patients (68.3% vs. 53.8%, p < 0.001) In a regression adjusted for confounders, frailty alone (Relative Risk, RR = 1.33, 95% Confidence Intervals, CI = 1.14-1.55) and POD alone (RR 1.38, 95% CI = 1.2-1.59) were associated with poor functional status at discharge; when combined, frailty and POD had an interaction, yielding a mild increase in the risk of poor outcome (RR 1.47, 95% CI = 1.28-1.69). CONCLUSIONS In older patients undergoing HF surgery, frailty, POD and their combination, are associated with poor functional status at discharge.
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Affiliation(s)
| | - Antonella Zambon
- Department of Statistics and Quantitative MethodsUnit of BiostatisticsEpidemiology and Public HealthUniversity of Milano‐ BicoccaMilanItaly
| | | | | | - Hajnalka Szabo
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly
| | - Ilaria Cazzulani
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly
| | | | | | | | - Isabella Amoroso
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly
| | - Cristina Zarcone
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly
| | | | - Maurizio Corsi
- Acute Geriatric and Orthogeriatric UnitSan Gerardo HospitalMonzaItaly
| | - Paolo Mazzola
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly,Acute Geriatric and Orthogeriatric UnitSan Gerardo HospitalMonzaItaly
| | - Giovanni Zatti
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly,Orthopedic DepartmentSan Gerardo HospitalMonzaItaly
| | - Giuseppe Foti
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly,Department of Anesthesia and Intensive CareSan Gerardo HospitalMonzaItaly
| | - Giuseppe Bellelli
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly,Acute Geriatric and Orthogeriatric UnitSan Gerardo HospitalMonzaItaly
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18
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Ma J, Li C, Zhang W, Zhou L, Shu S, Wang S, Wang D, Chai X. Preoperative anxiety predicted the incidence of postoperative delirium in patients undergoing total hip arthroplasty: a prospective cohort study. BMC Anesthesiol 2021; 21:48. [PMID: 33579195 PMCID: PMC7879687 DOI: 10.1186/s12871-021-01271-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/08/2021] [Indexed: 12/16/2022] Open
Abstract
Background Delirium was characterized with a series of symptoms of a sudden onset of disturbances in attention, a loss in memory loss and defects in other cognitive abilities that were also appeared in the syndrome of anxiety. Even though there are overlapped clinical symptoms existed in anxiety and delirium, the relationship between anxiety and delirium was still unclear. The propose of this study was to investigated the effect of preoperative anxiety on postoperative delirium. Methods Three hundred and seventy-two adults undergoing total hip arthroplasty were enrolled from October 2019 to May 2020 in the study. The preoperative anxiety was measured with the Hospital Anxiety and Depression Scale-Anxiety (HADS-A). The participants were allocated into anxiety group (HADS-A≧7) and non-anxiety group (HADS-A < 7). The primary outcome was the incidence of the postoperative delirium assessed with the Confusion Assessment Method (CAM). The secondary outcomes were the duration and the severity of delirium evaluated with the Memorial Delirium assessment Scale (MDAS). The risks of delirium were also evaluated with logistic regression analysis. Results There were 325 patients enrolled in the end, 95 of whom met the criteria for anxiety. The incidence of delirium was 17.8% in all participants. The patients with anxiety had a higher incidence of delirium than the non-anxiety patients (25.3% vs. 14.8%, odds ratio (OR) = 0.51, 95% confidence interval (CI) = 0.92–0.29, p = 0.025). However, no significant differences were found in the duration and the severity of the delirium between the above two groups. The age, alcohol abuse, history of stroke, scores of the HADS-A, and education level were considered to be predictors of delirium. Conclusions The preoperative anxiety predicted the incidence of the postoperative delirium in total hip arthroplasty patients. The related intervention may be a good point for delirium prophylaxis. Trial registration It was registered at Chinese Clinical Trial Registry (www.chictr.org.cn) with the name of “the effect of preoperative anxiety on the postoperative cognitive function” (ChiCTR1900026054) at September 19, 2019.
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Affiliation(s)
- Jun Ma
- Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.,Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Chuanyao Li
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Wei Zhang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Ling Zhou
- Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.,Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Shuhua Shu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Sheng Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Di Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Xiaoqing Chai
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China.
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19
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Inoue T, Maeda K, Nagano A, Shimizu A, Ueshima J, Murotani K, Sato K, Tsubaki A. Undernutrition, Sarcopenia, and Frailty in Fragility Hip Fracture: Advanced Strategies for Improving Clinical Outcomes. Nutrients 2020; 12:E3743. [PMID: 33291800 PMCID: PMC7762043 DOI: 10.3390/nu12123743] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022] Open
Abstract
Geriatric patients with hip fractures often experience overlap in problems related to nutrition, including undernutrition, sarcopenia, and frailty. Such problems are powerful predictors of adverse responses, although few healthcare professionals are aware of them and therefore do not implement effective interventions. This review aimed to summarize the impact of undernutrition, sarcopenia, and frailty on clinical outcomes in elderly individuals with hip fractures and identify successful strategies that integrate nutrition and rehabilitation. We searched PubMed (MEDLINE) and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant literature published over the last 10 years and found that advanced interventions targeting the aforementioned conditions helped to significantly improve postoperative outcomes among these patients. Going forward, protocols from advanced interventions for detecting, diagnosing, and treating nutrition problems in geriatric patients with hip fractures should become standard practice in healthcare settings.
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Affiliation(s)
- Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Shimami-cho 950-3198, Japan; (T.I.); (A.T.)
| | - Keisuke Maeda
- Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute 480-1195, Japan
| | - Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya 663-8211, Japan;
| | - Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8127, Japan;
| | - Junko Ueshima
- Department of Clinical Nutrition and Food Service, NTT Medical Center Tokyo, Tokyo 141-8625, Japan;
| | - Kenta Murotani
- Biostatistics Center, Kurume University, Kurume 830-0011, Japan;
| | - Keisuke Sato
- Okinawa Chuzan Hospital Clinical Research Center, Chuzan Hospital, Matsumoto 904-2151, Japan;
| | - Atsuhiro Tsubaki
- Department of Physical Therapy, Niigata University of Health and Welfare, Shimami-cho 950-3198, Japan; (T.I.); (A.T.)
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