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Ho JPY, Wong AYF, Ong LH, Rutel A, Abdullah S, Jaffar MSA, Bong CH, Tan KT, Rao RP, Kamaruddin F. Mobility and Hip Function Among Geriatric Patients With Displaced Neck of Femur Fractures Treated With Arthroplasty. Geriatr Orthop Surg Rehabil 2023; 14:21514593231164245. [PMID: 36923160 PMCID: PMC10009023 DOI: 10.1177/21514593231164245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Background Neck of femur fractures result in impaired function for older people. Despite surgery, many patients experience a decrease in functional level and poorer health status after the injury. The objectives of this study were (1) to determine the short-term mobility and hip function of geriatric patients who underwent hip replacement surgery for a displaced neck of femur fracture in our local population and (2) to identify factors which affect the functional outcome of these patients. Methods Patients aged 60 years and above, who were admitted for neck of femur fracture from January 2017 to December 2020, and treated surgically with arthroplasty, were included. Information on patient demography, comorbidities, perioperative data, mobility, hip function and complications were retrospectively collected. Outcome measures used were independent ambulation and recovery of pre-fracture mobility at 1 year after surgery while hip function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, pain, stiffness, and physical function scores. Factors associated with these outcomes were analyzed. Results 168 patients with a mean age of 75.2 (SD 8.4) years met the inclusion criteria. 32.1% of patients regained their pre-fracture mobility and 59.6% remained independent 1 year after surgery. Logistic regression analysis identified age, gender, surgical procedure, and time to surgery as significant contributors to recovery of pre-fracture mobility. Older age and increasing requirement for postoperative ambulatory aid resulted in worse WOMAC total and physical function scores. No significant differences were observed in patient-reported hip function between those who had a total hip arthroplasty and those who had a hemiarthroplasty. Conclusion Most geriatric patients with displaced neck of femur fractures did not regain pre-fracture mobility despite surgical treatment with arthroplasty.
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Affiliation(s)
- Jade Pei Yuik Ho
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
| | - Amy Yoke Foong Wong
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
| | - Lik Han Ong
- Department of Orthopaedic Surgery, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
| | - Ankimtay Rutel
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
| | - Sabaruddin Abdullah
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
| | | | - Chun Haw Bong
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
| | - Kean Tee Tan
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
| | - Reuben Prashant Rao
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
| | - Faris Kamaruddin
- Department of Orthopaedic Surgery, Sarawak General Hospital, Ministry of Health Malaysia
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Jeon EJ, Sohng KY, Yeom HA. Development and validation of a self-care scale for older adults undergoing hip fracture surgery: the HFS-SC. BMC Nurs 2022; 21:197. [PMID: 35869535 PMCID: PMC9308275 DOI: 10.1186/s12912-022-00982-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
Background The ability to take care of oneself after hip fracture surgery is important for older adults. Various scales have been developed for evaluation of this ability, but a scale specifically focusing on hip fracture has not been developed. The aim of this study was to develop and validate a scale (Hip Fracture Surgery Self-Care Scale, HFS-SC) to evaluate self-care for older adults undergoing hip fracture surgery. Methods The scale was developed according to the guidelines by DeVellis. Initial items were derived from a literature review and individual interviews with 11 older adults who underwent hip fracture surgery. To confirm the suitability of the questions, a preliminary survey was conducted on 25 older adults. Psychometric testing was performed on 300 older adults 65 years old or over living at home after surgery for hip fracture. Psychometric properties of the scale were examined by content validity, construct validity, concurrent validity, internal consistency reliability, and test-retest reliability. Results Exploratory factor analysis and confirmatory factor analysis demonstrated that the 18-item scale comprised five factors (functional independence, symptom recognition and management, positive mental health, participation and support in social activities, and a safe environment). The results of EFA showed that the factor loadings ranging from 0.51 to 0.87. The results of CFA were χ2=375.83, χ2/df=2.14, RMSEA 0.07, SRMR 0.05, GFI 0.88, TLI 0.91, and CFI 0.92 for the 18-item scale. The reliabilities of the scale were 0.91 for Cronbach’s alpha and 0.82 for test-retest reliability. Conclusions The HFS-SC has acceptable validity and reliability and is expected to be useful for evaluating the levels of self-care for older adults undergoing hip fracture surgery and adjusting at the post-fracture period at the community or out-patient department. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-00982-3.
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Flikweert ER, Wendt KW, Diercks RL, Izaks GJ, Stewart R, Stevens M, Reininga IHF. A comprehensive multidisciplinary care pathway for hip fractures better outcome than usual care? Injury 2021; 52:1819-1825. [PMID: 33947587 DOI: 10.1016/j.injury.2021.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hip fracture surgery is among the most performed surgical procedures in elderly patients. Mortality rates are high, however, and patients often fail to live independently following a hip fracture. To improve outcome, multidisciplinary care pathways have been initiated, but longer-term results are lacking. Aim of this study was to compare functional outcome and living situation six months after hip fracture treatment with and without a care pathway. PATIENTS AND METHODS A multicentre prospective controlled trial was conducted with three hospitals: in one hospital patients were treated with a care pathway, in the other hospitals patients received usual care. All patients aged ≥ 60 years with a hip fracture were asked to participate. Besides basic characteristics, health-related quality of life (EQ-5D) and performance scores of activities of daily living (Katz Index and Lawton IADL) were assessed. Differences in scores were analysed using linear regression. Propensity score adjustment was used to correct for differences between the care pathway and the usual care group. Missing data were imputed. RESULTS No differences in rate of return to prefracture ADL level were found between patients in the care pathway group and the usual care group. The percentage of participants in the same situation as before the fracture was the same in both treatment groups (81%). There were no significant differences in quality of life, activities of daily living or mortality (15% vs 10%, p = 0.17), but hospital stay in the care pathway group was significantly shorter (median 7 vs 10 days). DISCUSSION Treatment of elderly patients with a hip fracture is commonly organised in care pathways. Although short-term advantages are reported, positive effects on longer-term functional results could not be proven in our study. This study confirmed a shorter hospital stay in the care pathway group, which potentially may lead to a reduction in costs. CONCLUSIONS Functional outcome and living situation six months after a hip fracture is the same for patients treated with or without a care pathway.
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Affiliation(s)
- Elvira R Flikweert
- Department of Surgery-Traumatology University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands.
| | - Klaus W Wendt
- Department of Surgery-Traumatology University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands
| | - Ronald L Diercks
- Department of Orthopedic Surgery University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands
| | - Gerbrand J Izaks
- University Center for Geriatric Medicine University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands
| | - Roy Stewart
- Department of Health Sciences, Community and Occupational Medicine University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands
| | - Inge H F Reininga
- Department of Surgery-Traumatology University of Groningen, University Medical Center Groningen, P.O. Box 300019700 RB Groningen, The Netherlands
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Gioffrè-Florio M, Murabito LM, Visalli C, Pergolizzi FP, Famà F. Trauma in elderly patients: a study of prevalence, comorbidities and gender differences. G Chir 2019; 39:35-40. [PMID: 29549679 DOI: 10.11138/gchir/2018.39.1.035] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Trauma, in geriatric patients, increases with age, and is a leading cause of disability and institutionalization, resulting in morbidity and mortality. The aim of our study was to analyse the prevalence of trauma, the related risk factors, mortality and sex differences in the prevalence in a geriatric population. PATIENTS AND METHOD We observed 4,554 patients (≥65 years) with home injuries or car accidents. Patients were evaluated with ISS (Injury Severity Score) and major trauma with ATLS (Advanced Trauma Life Support). The instrumental investigation was in the first instance, targeted X-Ray or whole-body CT. RESULTS In over four years of study we treated 4,554 geriatric: 2,809 females and 1,745 Males. When the type of trauma was analysed the most common was head injury, followed by fractures of lower and upper limbs. In our experience hospitalization mainly involved patients over 80. In all patients mortality during assessment was 0.06%. DISCUSSION The geriatric patient is often defined as a "frail elderly", for the presence of a greater "injury sensitivity". This is due to the simultaneous presence of comorbidity, progressive loss of full autonomy and exposure to a high risk of traumatic events. Optimal management of the trauma patient can considerable reduce mortality and morbidity. CONCLUSIONS Falls and injuries in geriatric age are more frequent in women than in men. Among typical elder comorbidities, osteoporosis certainly causes a female preponderance in the prevalence of fractures. Our discharge data demonstrate that disability, which requires transfer to health care institutions, has a greater effect on women than men.
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de Vries R, Reininga IHF, de Graaf MW, Heineman E, El Moumni M, Wendt KW. Older polytrauma: Mortality and complications. Injury 2019; 50:1440-1447. [PMID: 31285055 DOI: 10.1016/j.injury.2019.06.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 06/11/2019] [Accepted: 06/24/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Older adults enduring a polytrauma have an increased mortality risk. Apart from age, the role of other predisposing factors on mortality are mainly described for the total polytrauma population. This study aimed to describe the mortality pattern of older polytrauma patients, its associated risk factors, and the role and etiology of in-hospital complications. METHODS An eight-year retrospective cohort was constructed from 380 polytrauma patients aged ≥65 in a Dutch level 1 trauma center and linked to the national trauma database (DTR). Demographics, injury characteristics, comorbidity, clinical characteristics, in-hospital mortality, mortality etiology and complications scored according to the Clavien-Dindo classification were analyzed. Primary outcome was the identification of risk factors associated with in-hospital mortality, followed by identification of in-hospital complications and their nature. RESULTS Overall in-hospital mortality was 36.3%, rising significantly with age. For patients aged ≥85 in-hospital mortality was 60.8%. Polytrauma patients aged ≥75 showed a peak of late-onset deaths one week following trauma. Age, a Glasgow coma score ≤8, coagulopathy, acidosis, injury severity score and the presence of a large subdural hematoma were significant risk factors influencing in-hospital mortality. Respiratory failure was the most prevalent severe and fatal complication. The proportion of fatal complications grew significantly with age (p < 0.01). CONCLUSIONS Age is strongly associated with in-hospital mortality in polytraumatized elderly. Coagulopathy, acidosis, a low Glasgow coma score, presence of a large subdural hematoma and injury severity score were independently of age associated with an increased mortality. Patients older than 75 years showed a unique trimodal distribution of mortality with a late onset one week following the initial trauma. Elderly were more susceptible for fatal complications. Respiratory failure was the most prevalent severe and fatal complication. Aggressive monitoring and treatment of the pulmonary status is therefore of utmost importance.
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Affiliation(s)
- Rob de Vries
- Department of Trauma Surgery, University Medical Centre Groningen (UMCG), Groningen, the Netherlands.
| | - Inge H F Reininga
- Department of Trauma Surgery, University Medical Centre Groningen (UMCG), Groningen, the Netherlands; Emergency Care Network Northern Netherlands, AZNN, Nothern Netherlands Trauma Registry, Groningen, the Netherlands.
| | - Max W de Graaf
- Department of Trauma Surgery, University Medical Centre Groningen (UMCG), Groningen, the Netherlands.
| | - Erik Heineman
- Department of Surgery, University Medical Centre Groningen (UMCG), Groningen, the Netherlands.
| | - Mostafa El Moumni
- Department of Trauma Surgery, University Medical Centre Groningen (UMCG), Groningen, the Netherlands.
| | - Klaus W Wendt
- Department of Trauma Surgery, University Medical Centre Groningen (UMCG), Groningen, the Netherlands.
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Panella M, Seys D, Sermeus W, Bruyneel L, Lodewijckx C, Deneckere S, Sermon A, Nijs S, Boto P, Vanhaecht K. Minimal impact of a care pathway for geriatric hip fracture patients. Injury 2018; 49:1581-1586. [PMID: 29884319 DOI: 10.1016/j.injury.2018.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/23/2018] [Accepted: 06/02/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adherence to guidelines for patients with proximal femur fracture is suboptimal. OBJECTIVE To evaluate the effect of a care pathway for the in-hospital management of older geriatric hip fracture patients on adherence to guidelines and patient outcomes. DESIGN The European Quality of Care Pathways study is a cluster randomized controlled trial. SETTING 26 hospitals in Belgium, Italy and Portugal. SUBJECTS Older adults with a proximal femur fracture (n = 514 patients) were included. METHODS Hospitals treating older adults (>65) with a proximal femur fracture were randomly assigned to an intervention group, i.e. implementation of a care pathway, or control group, i.e. usual care. Thirteen patient outcomes and 24 process indicators regarding in-hospital management, as well as three not-recommended care activities were measured. Adjusted and unadjusted regression analyses were conducted using intention-to-treat procedures. RESULTS In the intervention group 301 patients in 15 hospitals were included, and in the control group 213 patients in 11 hospitals. Sixty-five percent of the patients were older than 80 years. The implementation of this care pathway had no significant impact on the thirteen patient outcomes. The preoperative management improved significantly. Eighteen of 24 process indicators improved, but only two improved significantly. Only for a few teams a geriatrician was an integral member of the treatment team. DISCUSSION Implementation of a care pathway improved compliance to evidence, but no significant effect on patient outcomes was found. The impact of the collaboration between surgeons and geriatricians on adherence to guidelines and patient outcomes should be studied. TRIAL REGISTRATION ClinicalTrials.gov: NCT00962910.
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Affiliation(s)
- Massimiliano Panella
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Department of Translational Medicine, University of Eastern Piedmont "A. Avogadro", Italy
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium
| | - Walter Sermeus
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Belgium
| | - Cathy Lodewijckx
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium
| | - Svin Deneckere
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Medical Department, Delta Hospitals Roeselare, Belgium
| | - An Sermon
- Department of Development and Regeneration, KU Leuven - University of Leuven, Belgium; Department of Traumatology, University Hospitals Leuven, Belgium
| | - Stefaan Nijs
- Department of Development and Regeneration, KU Leuven - University of Leuven, Belgium; Department of Traumatology, University Hospitals Leuven, Belgium
| | - Paulo Boto
- Department of Health Services Policy and Management, Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP), Universidade Nova de Lisboa (UNL), Portugal
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Belgium.
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Ibrahim NI, Ahmad MS, Zulfarina MS, Zaris SNASM, Mohamed IN, Mohamed N, Mokhtar SA, Shuid AN. Activities of Daily Living and Determinant Factors among Older Adult Subjects with Lower Body Fracture after Discharge from Hospital: A Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15051002. [PMID: 29772744 PMCID: PMC5982041 DOI: 10.3390/ijerph15051002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/09/2018] [Accepted: 05/14/2018] [Indexed: 01/06/2023]
Abstract
Fracture is a type of musculoskeletal injury that contributes to an inability to perform daily activities. The objective of this study was to evaluate activities of daily living (ADL) of older adult patients with lower body fracture and to determine factors influencing ADL. Patient's ADL was assessed at pre-fracture, ward admission and post-discharge phases using the Katz ADL questionnaire. There were 129 subjects at pre-fracture and ward phases and 89 subjects at discharge phase. There were four independent variables; age, gender, type of fracture and ability to walk before fracture. Logistic regression models showed that 'age' and 'ability to walk before fracture' were the determinant factors of dependent for 'bathing', 'dressing' and 'toileting'. The 'ability to walk before fracture' was the determinant factor of dependent for 'transferring'. 'Age' and 'gender' were the determinant factors of dependent for 'continence', while 'age' was the determinant factor of dependent for 'feeding'. The ADL score changes were significant across the phases with a reduction in ADL score in the ward admission phase and partial increment during the post-discharge phase. There were improvements in the health outcomes of subjects aged more than 50 years old after 3 months of being discharged from the hospital. In conclusion, age, being female, having a hip fracture and using a walking aid before fracture were the determinants identified in this study.
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Affiliation(s)
- Nurul Izzah Ibrahim
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Mohd Sharkawi Ahmad
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Mohamed S Zulfarina
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Sharifah Nurul Aqilah Sayed Mohd Zaris
- Department of Orthopedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Isa Naina Mohamed
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Norazlina Mohamed
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Sabarul Afian Mokhtar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
| | - Ahmad Nazrun Shuid
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia.
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de Vries R, Reininga IHF, Pieske O, Lefering R, El Moumni M, Wendt K. Injury mechanisms, patterns and outcomes of older polytrauma patients-An analysis of the Dutch Trauma Registry. PLoS One 2018; 13:e0190587. [PMID: 29304054 PMCID: PMC5755835 DOI: 10.1371/journal.pone.0190587] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/18/2017] [Indexed: 11/18/2022] Open
Abstract
Background Polytrauma patients nowadays tend to be older due to the growth of the elderly population and its improved mobility. The aim of this study was to compare demographics, injury patterns, injury mechanisms and outcomes between younger and older polytrauma patients. Methods Data from polytrauma (ISS≥16) patients between 2009 and 2014 were extracted from the Dutch trauma registry (DTR). Younger (Group A: ages 18–59) and older (Group B: ages ≥60) polytrauma patients were compared. Differences in injury severity, trauma mechanism (only data for the year 2014), vital signs, injury patterns, ICU characteristics and hospital mortality were analyzed. Results Data of 25,304 polytrauma patients were analyzed. The older patients represented 47.8% of the polytrauma population. Trauma mechanism in the older patients was more likely to be a bicycle accident (A: 17%; B: 21%) or a low-energy fall (A: 13%; B: 43%). Younger polytrauma patients were more likely to have the worst scores on the Glasgow coma scale (EMV = 3, A: 20%, B: 13%). However, serious head injuries were seen more often in the older patients (A: 53%; B: 69%). The hospital mortality was doubled for the older polytrauma patients (19.8% vs. 9.6%). Conclusion Elderly are involved more often in polytrauma. Although injury severity did not differ between groups, the older polytrauma patients were at a higher risk of dying than their younger counterparts despite sustaining less high-energy accidents.
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Affiliation(s)
- Rob de Vries
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
- * E-mail:
| | - Inge H. F. Reininga
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
- Emergency Care Network Northern Netherlands (AZNN), Northern Netherlands Trauma Registry, Groningen, The Netherlands
| | - Oliver Pieske
- Department of Surgery, Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicin (IFOM), Universität Witten/Herdecke, Witten, Germany
| | - Mostafa El Moumni
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Klaus Wendt
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
- Emergency Care Network Northern Netherlands (AZNN), Northern Netherlands Trauma Registry, Groningen, The Netherlands
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Orive M, Anton-Ladislao A, García-Gutiérrez S, Las Hayas C, González N, Zabala J, Quintana JM. Prospective study of predictive factors of changes in pain and hip function after hip fracture among the elderly. Osteoporos Int 2016; 27:527-36. [PMID: 26243365 DOI: 10.1007/s00198-015-3267-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 07/24/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED Our study identified pre-fracture variables, such as home status or function, that are directly or indirectly associated with frailty status before fracture. The prevention in the deterioration of those variables would improve the prognosis of those hip fractured, being this an important issue for the societies with increasingly aging population. INTRODUCTION This study was designed to identify predictors of pain and declines in function among elderly patients following a fall-related hip fracture. METHODS Patients aged 65 or older with a fall-related hip fracture retrospectively completed pre-fracture status questionnaires (T0; n = 740) and were then prospectively followed for 6 months (T1; n = 546). Of these, 474 were randomly selected to complete an additional 18 months of follow-up (T2; n = 356). Primary outcome measures were changes in the pain and function dimensions of the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire's short form (WOMAC-SF). Potential predictors included sociodemographic variables, in-hospital and clinical pre- and post-fracture data, and activities of daily living at baseline and follow-up. Multivariate logistic regression was used for analysis. RESULTS Predictors of worsening pain at T1 and/or T2 included living in a home care situation or nursing home before the fracture (OR at T1, 1.515; OR at T2, 2.749), and low pre-fracture pain (OR at T1, 1.028; OR at T2, 1.027). Predictors of deterioration in function at T1 and/or T2 included age ≥85 years (OR at T1, 2.714; OR at T2, 4.762), lower income (OR at T1, 1.755), high pre-fracture hip function (OR at T1, 1.029; OR at T2, 1.028), referral to rehabilitation upon discharge (OR at T1, 2.378; OR at T2, 2.881), and longer delay between fall and surgery (OR at T1, 1.133; OR at T2, 1.124). CONCLUSIONS Frailty before hip fracture is a predictor of greater post-fracture pain and deterioration in function. Given that exercise programs help prevent frailty, promoting exercise in elderly may improve the prognosis of hip fracture.
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Affiliation(s)
- M Orive
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga, s/n, 48960, Usansolo, Bizkaia, Spain.
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, 48010, Bizkaia, Spain.
| | - A Anton-Ladislao
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga, s/n, 48960, Usansolo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, 48010, Bizkaia, Spain
| | - S García-Gutiérrez
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga, s/n, 48960, Usansolo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, 48010, Bizkaia, Spain
| | - C Las Hayas
- Psychology Department of Personality, Assessment and Treatment, University of Deusto, Bilbao, 48007, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, 48010, Bizkaia, Spain
| | - N González
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga, s/n, 48960, Usansolo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, 48010, Bizkaia, Spain
| | - J Zabala
- Traumatology Service, Galdakao-Usansolo Hospital, Galdakao, 48960, Bizkaia, Spain
| | - J M Quintana
- Research Unit, Galdakao-Usansolo Hospital, Barrio Labeaga, s/n, 48960, Usansolo, Bizkaia, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, 48010, Bizkaia, Spain
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Factors related to functional prognosis in elderly patients after accidental hip fractures: a prospective cohort study. BMC Geriatr 2014; 14:124. [PMID: 25425462 PMCID: PMC4280690 DOI: 10.1186/1471-2318-14-124] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/13/2014] [Indexed: 11/10/2022] Open
Abstract
Background A restriction in functional capacity occurs in all hip fractures and a variety of factors have been shown to influence patient functional outcome. This study sought to provide new and comprehensive insights into the role of factors influencing functional recovery six months after an accidental hip fracture. Methods A prospective cohort study was conducted of patients aged 65 years or more who attended the Emergency Room (ER) for a hip fracture due to a fall. The following were studied as independent factors: socio-demographic data (age, sex, instruction level, living condition, received help), comorbidities, characteristics of the fracture, treatment performed, destination at discharge, health-related quality of life (12-Item Short Form Health Survey) and hip function (Short Western Ontario and McMaster Universities Osteoarthritis Index). As main outcome functional status was measured (Barthel Index and Lawton Instrumental Activities of Daily Living Scale). Data were collected during the first week after fracture occurrence and after 6 months of follow-up. Patients were considered to have deteriorated if there was worsening in their functional status as measured by Barthel Index and Lawton IADL scores. Factors associated with the outcome were studied via logistic regression analysis. Results Six months after the fall, deterioration in function was notable, with mean reductions of 23.7 (25.2) and 1.6 (2.2) in the Barthel Index and Lawton IADL Scale scores respectively. Patients whose status deteriorated were older, had a higher degree of comorbidity and were less educated than those who remained stable or improved. The multivariate model assessing the simultaneous impact of various factors on the functional prognosis showed that older patients, living with a relative or receiving some kind of social support and those with limited hip function before the fall had the highest odds of having losses in function. Conclusion In our setting, the functional prognosis of patients is determined by clinical and social factors, already present before the occurrence of the fracture. This could make it necessary to perform comprehensive assessments for patients with hip fractures in order to identify those with a poor functional prognosis to tackle their specific needs and improve their recovery.
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