Abstract
Older patients presenting with hip fractures are some of the frailest and sickest patients in hospital. In addition to complex medical problems and comorbidities, they have to overcome the additional physiological challenges posed by the hip fracture itself, and subsequent surgery. Hip fracture associated morbidity and mortality at one year remains high. Published guidelines stress the need for a multidisciplinary approach and the importance of the care environment for good outcomes. A combined management approach identifies and addresses not only the surgical but also the complex analgesic, medical, cognitive, nutritional, social and rehabilitation needs of our patients, thereby improving outcome for our patients.
Highlights
The lifetime risk of sustaining a hip fracture in the United Kingdom from age 50 is around 11% for women and 3% for men.[1]
Older patients presenting with hip fractures comprise some of the frailest and sickest patients, with complex medical problems and comorbidities, who have to overcome the additional physiological challenges posed by trauma and surgery.[4]
In our unit we developed a pro-forma for the admission of hip fracture patients, greatly improving our documentation of many of the components of falls assessments
Summary
The lifetime risk of sustaining a hip fracture in the United Kingdom from age 50 is around 11% for women and 3% for men.[1]. A combined management approach (Box 1) identifies and addresses the surgical and the complex analgesic, medical, cognitive, nutritional, social and rehabilitation needs of these patients, with concomitantly improved outcomes.[8] A recent Cochrane review found that older patients, who are part of enhanced multidisciplinary care and rehabilitation models, had lower complications rates, reduced length of hospital stay and institutional placement, as well as better function and achievement of pre-injury walking ability.[15]. The introduction in recent years of specialist nurses to look after older hip fracture patients has proved to be very helpful, promoting sustainable high standards of care They support the geriatricians (vide infra) and provide a mechanism for holistic and regular review of these frail older patients, as well as providing a vital link to family and carers
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