Proximal Humerus Fractures In The Older Adult: A Retrospective Review Of Proximal Humerus Fractures In The Emergency Department

Abstract

Abstract Background This study aimed to describe the epidemiology and outcomes of older adults diagnosed with proximal humeral fractures (PHFs) in an Irish adult emergency department (ED). Methods A retrospective chart review was conducted on all patients (>65) who had a diagnosis of a PHF, in 2022 within an ED of a large suburban academic teaching hospital in Dublin. Assessment by the Frailty at the Front Door (FFD) team (older adults >75) for those with a PHF was also analysed. Results A total of 53 older adults (>65) were identified within the study period with a PHF while 43 patients (<65) were identified. In the >65 group, seventy-nine percent (N=42) were female. The mean age was 75.6 years of age (Range 65-95). Only 21% (N=11) had operative management. Two-thirds of PHFs in the >65 group required admission to hospital (N=24) (P<0.001). The mean length of stay (LOS) was 12.9 days compared to only 4.5 days in those under the age of 65 (P= 0.14). There were 26 older adults (>75) diagnosed with a PHF. The FFD team assessed 49% (N=11) of older adults (>75) with a PHF. Only 31% (N=8) presented to ED within FFD team operational hours. The average Clinical Frailty Sale was 5 (N=11). The FFD team completed 22 inpatient MDT referrals, four HSCP community referrals, one Public Health Nurse Referral and one application for increase in home care package. Conclusion PHFs tended to occur in older female patients. The majority of PHFs in older adults do not have operative treatment and were associated with higher LOS. FFD teams can play a pivotal role in the assessment and treatment of older adults with a PHF. This may represent opportunities to develop integrated care pathways to maximize an individuals’ independence, to support people at home with PHFs.