Geriatric intervention in elderly patients with hip fracture in an orthopedic ward

Merete Gregersen,Else Marie Damsgaard,Kjeld Hougaard,Marianne Metz Mørch

doi:10.5249/jivr.v4i2.96

Merete Gregersen, Else Marie Damsgaard + Show 2 more

Open Access

https://doi.org/10.5249/jivr.v4i2.96

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Abstract

:Background:Hip fracture is a common cause of long hospital stay in the elderly. Approximately one third of these patients die within the first year. As a consequence geriatric and orthopedic collaboration (orthogeriatrics) has been organized in different ways. The aim of this study is to evaluate the efficiency of a multidisciplinary geriatric in-hospital intervention on patient outcome.Methods:A total of 495 elderly hip fracture patients consecutively admitted to orthopedic surgery, were followed. Data were based on medical records. The intervention group (n=233) was compared to a historical cohort group (n=262) receiving traditional orthopedic treatment. Intervention program was based on initial physical and mental screening and evaluation, geriatric-focused care, and early discharge planning. The intervention was provided by a multidisciplinary geriatric team. After discharge, follow-up home-visits by a physiotherapist were performed, except for patients discharged to nursing homes, due to a 24-hour staff and easy access to the GP.Results:Median length of stay was reduced from 15 to 13 days. More patients began treatment with calcium/vitamin-D and bisphosphonate (p=sig). There was no difference in hemoglobin variation between the time of admission and three to six months post admission, and no difference in three-month readmissions (odds ratio (OR) = 1.09 [95%CI: 0.71;1.67]). Discharge destination was unchanged (OR=0.93 [95%CI: 0.52; 1.65]). In-hospital mortality was 8% in the intervention group vs. 6% (p=0.48), in the control group. Three-month mortality was 16% in the intervention group vs. 15% (p=0.39), in the control group. In the intervention group, residents from nursing homes had a higher three-month mortality (OR=2.37 [95% CI: 0.99; 5.67]), and the risk of new fractures within two years decreased from 9.5% to 7.7%, though not statistically significant.Conclusion:Our study indicates that co-management of hip fracture patients by orthopedic surgeons and geriatricians may be associated with a reduction in length of hospital stay without negatively affecting major patient outcomes. The concept should be further developed particularly among the frail elderly.

Highlights

I n Denmark, annually, approximately 7,000 hip fractures occur among the 65+ -years old
It is reported that the presence of geriatricians in orthopedic surgery wards can improve patients outcomes including; activities of daily living, number of medical complications, re-admissions, in-hospital mortality, discharges to nursing homes, and long-term restitution.[7,8,9,10,11]
The aim of this study is to evaluate the efficiency of multidisciplinary geriatric in-hospital intervention on patient outcomes, among a sample of elderly patients with hip fracture

Summary

Introduction

I n Denmark, annually, approximately 7,000 hip fractures occur among the 65+ -years old. 46 Injury & Violence surgery.[2] The existing literature suggests that there is a need to improve the efficiency and quality of hip fracture injury treatments and care of patients involved with such injuries. To this end, the geriatricians along with orthopedic surgeons have organized an effort toward forming so called “orthogeriatrics” collaboration in various countries.[3,4] Devas and his colleagues in Hastings, England, are among the pioneers who initiated the field of orthogeriatric care in late 1950s.5. The concept should be further developed among the frail elderly

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