Post-hip Fracture Surgery Research Articles

Physical Activity Levels of Community-Dwelling Older Adults During Daily Life Activities: A Descriptive Study

Background/Objectives: Measuring the physical functioning of older hip fracture patients using wearables is desirable, with physical activity monitoring offering a promising approach. However, it is first important to assess physical activity in healthy older adults. This study quantifies physical functioning with physical activity parameters and assesses those parameters in community-dwelling older adults. The results are compared with the results from one case participant 2 months post-hip fracture surgery. Methods: Twenty-four community-dwelling older adults (aged ≥ 80) participated. The acts of moving around the house, toileting, getting in/out of bed, and preparing meals was quantified by total time, time spent sitting, standing, and walking, number of transfers, and intensity of physical activity. MOX and APDM sensors measured the intensity of physical activity, with the tasks performed in a living lab while video-recorded. The case participant’s total time and intensity of physical activity were measured for walking to a door and getting in/out of bed. Results: Preparing meals showed the longest total time and time spent standing/walking, while moving around the house and getting in/out of bed had the highest intensity of physical activity. Only getting in/out of bed required sitting. The physical activity parameters varied among participants, with very active participants completing tasks faster. The case participant had longer total times and lower intensities of physical activity two months post-surgery compared to before the fracture. Conclusions: This study provides initial insights into the physical activity levels of community-dwelling older adults. It represents the beginning of more efficient and continuous monitoring of physical functioning.

Facilitating the transition from hospital to home after hip fracture surgery: a qualitative study from the HIP HELPER trial

BackgroundPeople post-hip fracture have reported experiences of fragmented care and poor discharge planning, therefore improvements in patient flow are required. This study reports the challenges people face during the discharge process and offers potential solutions for improving the transition from hospital to home from the perspectives of patients, carers, and health professionals.MethodsThis was a qualitative study embedded within a multi-centre, feasibility randomised controlled trial (HIP HELPER). We undertook semi-structured interviews with 10 patient-carer dyads (10 people with hip fracture; 10 unpaid carers) and eight health professionals (four physiotherapists, two occupational therapists, one nurse and one physiotherapy researcher) between November 2021 and March 2022. Data were analysed using the principles of Framework Analysis.ResultsParticipants identified challenges in the transition from hospital to home post-hip fracture surgery: ineffective communication, disjointed systems, untimely services and ‘it’s more than just the hip’. Possible solutions and insights to facilitate this transition included the need for reassurance, collaborative planning, and individualisation.ConclusionThe transition from hospital to home following hip fracture surgery can be a challenging experience for patients, and for friends and family who support them as carers, making them feel vulnerable, frustrated and uncertain. Enabling a coordinated, collaborative approach to discharge planning and early recovery provision is considered a positive approach to improving NHS care.Trial registrationISRCTN13270387. Registered 29th October 2020.

Preoperative inflammatory biomarkers reveal renal involvement in postsurgical mortality in hip fracture patients: an exploratory study.

Hip fractures in frail patients result in excess mortality not accounted for by age or comorbidities. The mechanisms behind the high risk of mortality remain undetermined but are hypothesized to be related to the inflammatory status of frail patients. In a prospective observational exploratory cohort study of hospitalized frail hip fracture patients, 92 inflammatory markers were tested in pre-operative serum samples and markers were tested against 6-month survival post-hip fracture surgery and incidence of acute kidney injury (AKI). After correcting for multiple testing, adjustments for comorbidities and demographics were performed on the statistically significant markers. Of the 92 markers tested, circulating levels of fibroblast growth factor 23 (FGF-23) and interleukin-15 receptor alpha (IL15RA), both involved in renal disease, were significantly correlated with 6-month mortality (27.5% overall) after correcting for multiple testing. The incidence of postoperative AKI (25.4%) was strongly associated with 6-month mortality, odds ratio = 10.57; 95% CI [2.76-40.51], and with both markers plus estimated glomerular filtration rate (eGFR)- cystatin C (CYSC) but not eGFR-CRE. The effect of these markers on mortality was significantly mediated by their effect on postoperative AKI. High postoperative mortality in frail hip fracture patients is highly correlated with preoperative biomarkers of renal function in this pilot study. The effect of preoperative circulating levels of FGF-23, IL15RA, and eGFR-CYSC on 6-month mortality is in part mediated by their effect on postoperative AKI. Creatinine-derived preoperative renal function measures were very poorly correlated with postoperative outcomes in this group.

A Prospective, Observational Study of the Effect of a High-Calorie, High-Protein Oral Nutritional Supplement with HMB in an Old and Malnourished or at-Risk-of-Malnutrition Population with Hip Fractures: A FracNut Study.

Hip fractures are prevalent among older people, often leading to reduced mobility, muscle loss, and bone density decline. Malnutrition exacerbates the prognosis post surgery. This study aimed to evaluate the impact of a 12-week regimen of a high-calorie, high-protein oral supplement with β-hydroxy-β-methylbutyrate (HC-HP-HMB-ONS) on nutritional status, daily activities, and compliance in malnourished or at-risk older patients with hip fractures receiving standard care. A total of 270 subjects ≥75 years of age, residing at home or in nursing homes, malnourished or at risk of malnutrition, and post hip fracture surgery, received HC-HP-HMB-ONS for 12 weeks. Various scales and questionnaires assessed outcomes. During the 12 weeks of follow-up, 82.8% consumed ≥75% of HC-HP-HMB-ONS. By week 12, 62.4% gained or maintained weight (+0.3 kg), 29.2% achieved normal nutritional status (mean MNA score +2.8), and 46.8% improved nutritional status. Biochemical parameters improved significantly. Subjects reported good tolerability (mean score 8.5/10), with 87.1% of healthcare providers concurring. The administration of HC-HP-HMB-ONS markedly enhanced nutritional status and biochemical parameters in older hip-fracture patients, with high compliance and tolerability. Both patients and healthcare professionals expressed satisfaction with HC-HP-HMB-ONS.

Therapeutic advantage of teriparatide in very elderly patients with proximal femoral fractures: a functional and BMD analysis

BackgroundTeriparatide, a recombinant parathyroid hormone, is pivotal in osteoporosis treatment, particularly in post-surgical recovery for hip fractures. This study investigates its efficacy in functional recovery post-hip fracture surgery in elderly patients, a demographic particularly susceptible to osteoporotic fractures.MethodsIn this retrospective cohort study, 150 elderly patients with proximal femoral fractures undergoing open reduction and internal fixation were enrolled. They were categorized into two groups: receiving 20 µg of daily teriparatide injections for 18 months and receiving standard antiresorptive medications during a 24-month follow-up. Detailed records of patient demographics, Fracture Risk Assessment Tool scores, and comorbidities were kept. Key outcomes, including bone mineral density (BMD) and functional scores (Barthel Index and Visual Analog Scale for hip pain), were evaluated at 3 and 24 months post-surgery.ResultsOut of the original cohort, 126 patients (20 men and 106 women with an average age of 85.5 ± 9.3 years) completed the study. The teriparatide group exhibited significant enhancements in both functional scores and BMD when compared to the control group. Notably, functional improvements were less pronounced in male patients compared to female patients. Additionally, the incidence of new fractures was markedly lower in the teriparatide group.ConclusionAdministering teriparatide daily for 18 months post-surgery for proximal femoral fractures significantly benefits very elderly patients by improving functionality and bone density, with observed differences in recovery between genders. These results reinforce the efficacy of teriparatide as a potent option for treating osteoporosis-related fractures in the elderly and highlight the importance of considering gender-specific treatment and rehabilitation strategies.

Association Between Long‑Term Exposure to Air Pollution and the Rate of Mortality After Hip Fracture Surgery in Patients Older Than 60 Years: Nationwide Cohort Study in Taiwan.

To enhance postoperative patient survival, particularly in older adults, understanding the predictors of mortality following hip fracture becomes paramount. Air pollution, a prominent global environmental issue, has been linked to heightened morbidity and mortality across a spectrum of diseases. Nevertheless, the precise impact of air pollution on hip fracture outcomes remains elusive. This retrospective study aims to comprehensively investigate the profound influence of a decade-long exposure to 12 diverse air pollutants on the risk of post-hip fracture mortality among older Taiwanese patients (older than 60 years). We hypothesized that enduring long-term exposure to air pollution would significantly elevate the 1-year mortality rate following hip fracture surgery. From Taiwan's National Health Insurance Research Database, we obtained the data of patients who underwent hip fracture surgery between July 1, 2003, and December 31, 2013. Using patients' insurance registration data, we estimated their cumulative exposure levels to sulfur dioxide (SO2), carbon dioxide (CO2), carbon monoxide (CO), ozone (O3), particulate matter having a size of <10 μm (PM10), particulate matter having a size of <2.5 μm (PM2.5), nitrogen oxides (NOX), nitrogen monoxide (NO), nitrogen dioxide (NO2), total hydrocarbons (THC), nonmethane hydrocarbons (NMHC), and methane (CH4). We quantified the dose-response relationship between these air pollutants and the risk of mortality by calculating hazard ratios associated with a 1 SD increase in exposure levels over a decade. Long-term exposure to SO2, CO, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 demonstrated significant associations with heightened all-cause mortality risk within 1 year post hip fracture surgery among older adults. For older adults, each 1 SD increment in the average exposure levels of SO2, CO, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 corresponded to a substantial escalation in mortality risk, with increments of 14%, 49%, 18%, 12%, 41%, 33%, 38%, 20%, 9%, and 26%, respectively. We further noted a 35% reduction in the hazard ratio for O3 exposure suggesting a potential protective effect, along with a trend of potentially protective effects of CO2. This comprehensive nationwide retrospective study, grounded in a population-based approach, demonstrated that long-term exposure to specific air pollutants significantly increased the risk of all-cause mortality within 1 year after hip fracture surgery in older Taiwanese adults. A reduction in the levels of SO2, CO, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 may reduce the risk of mortality after hip fracture surgery. This study provides robust evidence and highlights the substantial impact of air pollution on the outcomes of hip fractures.

Independent Walking Disability After Fragility Hip Fractures: A Prognostic Factors Analysis.

Up to one-third of patients with fragility hip fractures are totally dependent in the year following the injury which leads to later morbidity and mortality. Understanding the related factors that affect patients' ambulation helps health care providers prepare for the treatment plans to improve their functional outcomes. This study aimed to evaluate the factors associated with independent walking disability in the early postoperative period after fragility hip fractures. This retrospective cohort study involved 394 patients with fragility hip fractures with either intertrochanteric, subtrochanteric, or femoral neck fractures from January 2018 to June 2023. The related factors including preoperative demographics, perioperative, and postoperative factors, were collected and analyzed. The endpoint was the independent walking disability of patients at 6 weeks after surgery. 110 patients (27.9%) were disabled, whereas 284 patients (72.1%) could walk independently at postoperative 6 weeks. The multivariable risk ratio regression analysis showed that patients with age ≥80 years (RR 1.65; 95% CI 1.21-2.25; P = 0.001), pre-fracture walking with the gait aid (RR 2.03; 95% CI 1.53-2.69; P < 0.001), having ≥2 underlying comorbidities (RR 1.63; 95% CI 1.19-2.23; P = 0.002), preoperative hypoalbuminemia (RR 1.74; 95% CI 1.32-2.29; P < 0.001), and presence of the postoperative medical complication (RR 2.04; 95% CI 1.37-3.02; P < 0.001) were significantly associated with independent walking disability at the early postoperative period of 6 weeks. Post-hip fracture surgery patients with the presence of postoperative medical complication have the highest risk of independent walking disability. Health care providers should concentrate on high-risk patients, correct the modifiable factors, and minimize any postoperative complications to improve functional recovery and decrease morbidity related to non-ambulation after fragility hip fractures.

Early hip fracture surgery and rehabilitation. How to improve functional quality outcomes. A retrospective study.

Hip fractures are one of the major disability causes associated with a high morbidity and mortality rate. Early surgery and stable fixation could be associated with better pain control, possibly lower mortality rates, and early recovery of autonomy.

SOCIAL ISOLATION IN OLDER ADULTS POST HIP SURGERY IS CORRELATED WITH MOBILITY AND PHYSIOLOGICAL INDICATORS

Abstract Hip fracture affect approximately 30,000 people in Canada and more than 300,000 people in U.S., annually. Older adults post hip-fracture surgery experience social isolation along with reduced physical mobility, changes in sleeping patterns, reduced indoor and outdoor activities, and other physiological changes once they are discharged form inpatient rehabilitation. Our team has developed MAISON (Multimodal AI-based Sensor platform for Older iNdividuals), a cloud-based multimodal sensor system that supports the collection of physiological, ambient and contextual data from various smart devices. Currently, MAISON consists of a smart watch, a smart phone, a motion sensor and a sleep mattress. Using MAISON, we have collected 24 weeks of raw acceleration data, heartrate, step count, frequency of indoor motion, GPS and sleep metrics from three older adults post-hip surgery living in the community. Statistical and domain-specific features were extracted from the collected data with a time window of one day, including average heartrate, maximum acceleration, total sleep time, total steps taken, and average number of exits. Additionally, clinical data is collected from the participants on a biweekly basis consisting of three questionnaires (i.e., Social Isolation Scale (SIS)) and two physical tests. The correlation between features from sensor data and clinical data was performed using Spearman coefficient, which showed a strong positive correlation (&amp;gt;0.5) between the SIS and number of exits, variance of acceleration, total sleep time, and heartrate variance. Various correlation values were found between features from all the sensors and SIS, indicating the usefulness of multimodal sensors for this application.

Patient-clinician digital health interventions for the hip fracture population: a scoping review

IntroductionOlder adults with hip fracture often require extensive post-surgery care across multiple sectors, making follow-up care even more important to ensure an ideal recovery. With the increased adoption of technology, patient-clinician digital health interventions can potentially improve post-surgery outcomes of hip fracture patients by helping them and their caregivers better understand the various aspects of their care, post-hip fracture surgery. The purpose of this study was to examine the available literature on the impact of hip fracture-specific, patient-clinician digital health interventions on patient outcomes and health care delivery processes. We also aimed to identify the barriers and enablers to the uptake and implementation of these technologies and to provide strategies for improved use of these digital health interventions.MethodsWe conducted a scoping review following the six stages of Arksey and O’Malley’s framework and following the PRISMA-ScR reporting format. Searches were conducted in five databases. In addition to hand searching for relevant studies from the references of all included studies, we also conducted a grey literature search to identify relevant primary studies. Screening of titles and abstracts as well as full texts were performed independently by two reviewers. Two reviewers also performed the data extraction of the included studies.ResultsAfter screening 3,638 records, 20 articles met the criteria and 1 article was identified through hand searching. Various patient-clinician digital health interventions were described including telehealth /telerehabilitation programs (n = 6), care transition /follow-up interventions (n = 5), online resources (n = 2), and wearable devices /sensor monitoring (n = 1). Outcomes were varied and included functional status, gait/mobility, quality of life, psychological factors, satisfaction, survival/complications, caregiver outcomes, compliance, technology-user interactions, and feedback on the use of the digital health interventions. For clinicians, a key barrier to the use of the digital health interventions was the acceptability of the technology. However, the usefulness of the digital health intervention by clinicians was seen as both a barrier and an enabler. For patients and caregivers, all the themes were seen as both a barrier and an enabler depending on the study. These themes included: 1) availability and access, 2) usability, 3) knowledge and skills, 4) acceptability, and 5) usefulness of the digital health intervention.ConclusionMany behavioural factors affect the use of patient-clinician digital health interventions. However, a specific attention should be focused on the acceptability of the technology by the clinicians to encourage uptake of the digital health interventions. The results of this scoping review can help to better understand the factors that may be targeted to increase the use of these technologies by clinicians, patients, and caregivers.

Prevalence of Urinary Tract Infection and Health Outcomes in Older Adults Undergoing Hip Surgery: A Prospective Study

Urinary tract infections are complications found mostly in older adults undergoing hip surgery. However, little is known about the impact of urinary tract infections on health at after post-hip fracture surgery, particularly in Thailand. This prospective study investigated the prevalence of urinary tract infections and their impact on length of stay, functional ability, re-admission, surgical site infections, and in-hospital mortality. The participants were 120 older adults undergoing hip surgery at four tertiary care hospitals in Bangkok, Thailand. Instruments for collection the data were the Demographic Data Questionnaire, Health Outcome Data Record Form—length of hospital stays, surgical site infections, re-admission, and in-hospital mortality, and the Hip Disability and Osteoarthritis Outcome Score. Data were analyzed using descriptive statistics and Firth’s logistic regression. Results demonstrated that the prevalence of urinary tract infections was 28.32%. Significantly, older adults who developed urinary tract infections had a 2.88-fold increased the risk of impaired functional ability four weeks after surgery and a 3.21-fold increased the risk of re-admission to the hospital compared to those without urinary tract infections. Findings suggest that nurses should continually evaluate urinary tract infections and related factors from admission to post-discharge, as urinary tract infections profoundly affect health outcomes. Strict compliance with guidelines or strengthening post-acute care services to prevent urinary tract infections and its consequences is recommended to promote and restore health, especially functional ability in older adults undergoing hip surgery.

Postsurgery paths and outcomes for hip fracture patients (POST-OP HIP PATHS): a population-based retrospective cohort study protocol

IntroductionHip fracture patients receive varying levels of support posthip fracture surgery and often experience significant disability and increased risk of mortality. Best practice guidelines recommend that all hip fracture patients...

Barriers and Enablers to the Use of Web-Based Applications for Older Adults and Their Caregivers Post-Hip Fracture Surgery: A Descriptive Qualitative Study.

The purpose of this study was to describe the barriers and enablers to the use of web-based applications designed to help manage the personalized needs of older adults and their caregivers post-hip fracture surgery while transitioning from hospital to geriatric rehabilitation to home. This was a descriptive qualitative study consisting of semi-structured interviews informed by the Theoretical Domains Framework. The study took place between March 2021 and April 2022 on an orthopaedic unit in a large academic health sciences centre and in a geriatric rehabilitation service in Ontario, Canada. The transcripts were analyzed using a systematic 6-step approach. Interviews were conducted with older adults (n = 10) and with caregivers (n = 8) post-hip fracture surgery. A total of 21 barriers and 24 enablers were identified. The top two barriers were a need for basic computer skills (n = 11, 61.1%) and a preference for direct verbal communication (n = 10, 55.6%). The top two enablers were having no concerns with using web-based applications (n = 12, 66.7%) and having ease of access to information (n = 10, 55.6%). We described the key barriers and enablers to the use of web-based applications from the perspectives of older adults and their caregivers. These factors will inform further developments of web-based applications aimed at improving the care transition from hospital to geriatric rehabilitation to home post-hip fracture surgery.

Comparing Intramedullary Nails Versus Dynamic Hip Screws in the Treatment of Intertrochanteric Hip Fractures on Post-operative Rehabilitation Outcomes:A Systematic Review Protocol.

Background: Intertrochanteric hip fractures are treated by fixation with either an intramedullary (IM) Nail or Dynamic Hip Screw (DHS). It is unknown whether one surgery type has better post-operative rehabilitative outcomes for the hip fracture population. This systematic review aims to compare post-operative rehabilitation outcomes of intertrochanteric hip fractures treated via IM Nails versus DHS. Methods: We will conduct a systematic review following the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) format. A search strategy will be developed, and the following databases will be searched: MEDLINE, EMBASE, Cochrane Library, and Web of Science. Two reviewers will perform a two-step screening process and data extraction of included studies. Any disagreement will be resolved with a discussion or a third reviewer. Risk of bias and the quality of the studies will also be assessed. A narrative synthesis will be used for the data analysis. Conclusion: This systematic review will provide evidence for orthopaedic surgeons and rehabilitation clinicians to further improve patient rehabilitation outcomes post-hip fracture surgery.

Development and validation of a predictive model for early functional recovery in the post-hip fracture surgery population.

Development and validation of a predictive model for early functional recovery in the post-hip fracture surgery population.

Healthcare professionals' perspectives on rehabilitating persons with cognitive impairment.

Background and ObjectivesDespite emerging evidence that persons with cognitive impairment (CI) (including dementia and/or delirium) can be rehabilitated post-hip fracture surgery, there still remains a paucity of research on best practice rehabilitation strategies that help healthcare providers effectively rehabilitate persons with CI. Therefore, this qualitative study explores healthcare professionals’ (HCPs) perspectives who have been successfully providing rehabilitation for people with CI.Research Design and MethodsSixteen HCPs with a specialty in rehabilitating persons with CI from one inpatient rehabilitation facility with various professional backgrounds were purposively sampled using a maximum diversity sampling strategy. Three focus group discussions were conducted to explore their experiences of providing rehabilitation to persons with CI. A hybrid inductive–deductive approach was used to analyze the data.FindingsHCPs acknowledged that older adults with CI deserved the opportunity for inpatient rehabilitation and that good outcomes were achievable; however, their knowledge, skills, and attitudes required reframing. The analysis identified three essential components to rehabilitation: (1) staff education and support, (2) tailored rehabilitation approaches, and (3) care partner involvement and support.Discussion and ImplicationsRehabilitation of persons with CI post-hip fracture surgery is achievable, and HCPs can learn to modify their practices to achieve positive patient outcomes. The attitudes of the healthcare team members had to be shifted to embrace the belief that persons with CI can be rehabilitated. However, it takes a steep learning curve, creativity, ingenuity, and tailored approaches to rehabilitate persons with CI successfully. This involves knowing the individual, maintaining routines, and learning the best ways to engage and motivate the person. As well, care partners’ knowledge and understanding of the individual improved the chances of a successful rehabilitation stay and discharge. Essential to the success of rehabilitation of persons with CI includes a supportive management team to help create the processes to enable their staff to succeed.

Development of a Risk Score to Predict Postoperative Delirium in Patients With Hip Fracture

Post-hip fracture surgery delirium (PHFD) is a significant clinical problem in older patients, but an adequate, simple risk prediction model for use in the preoperative period has not been developed. The 2016 American College of Surgeons National Surgical Quality Improvement Program Hip Fracture Procedure Targeted Participant Use Data File was used to obtain a cohort of patients ≥60 years of age who underwent hip fracture surgery (n = 8871; randomly assigned to derivation [70%] or validation [30%] cohorts). A parsimonious prediction model for PHFD was developed in the derivation cohort using stepwise multivariable logistic regression with further removal of variables by evaluating changes in the area under the receiver operator characteristic curve (AUC). A risk score was developed from the final multivariable model. Of 6210 patients in the derivation cohort, PHFD occurred in 1816 (29.2%). Of 32 candidate variables, 9 were included in the final model: (1) preoperative delirium (adjusted odds ratio [aOR], 8.32 [95% confidence interval {CI}, 6.78-10.21], 8 risk score points); (2) preoperative dementia (aOR, 2.38 [95% CI, 2.05-2.76], 3 points); (3) age (reference, 60-69 years of age) (age 70-79: aOR, 1.60 [95% CI, 1.20-2.12], 2 points; age 80-89: aOR, 2.09 [95% CI, 1.59-2.74], 2 points; and age ≥90: aOR, 2.43 [95% CI, 1.82-3.23], 3 points); (4) medical comanagement (aOR, 1.43 [95% CI, 1.13-1.81], 1 point); (5) American Society of Anesthesiologists (ASA) physical status III-V (aOR, 1.40 [95% CI, 1.14-1.73], 1 point); (6) functional dependence (aOR, 1.37 [95% CI, 1.17-1.61], 1 point); (7) smoking (aOR, 1.36 [95% CI, 1.07-1.72], 1 point); (8) systemic inflammatory response syndrome/sepsis/septic shock (aOR, 1.34 [95% CI, 1.09-1.65], 1 point); and (9) preoperative use of mobility aid (aOR, 1.32 [95% CI, 1.14-1.52], 1 point), resulting in a risk score ranging from 0 to 20 points. The AUCs of the logistic regression and risk score models were 0.77 (95% CI, 0.76-0.78) and 0.77 (95% CI, 0.76-0.78), respectively, with similar results in the validation cohort. A risk score based on 9 preoperative risk factors can predict PHFD in older adult patients with fairly good accuracy.

INFLUENCE OF HEALTH AND SOCIAL SUPPORTS ON OUTCOMES POST-REHABILITATION FOR HIP FRACTURE SURGERY: SYSTEMATIC REVIEW

Background: Older adults who sustain hip fractures encounter physical and functional decline after discharge from inpatient rehabilitation. Currently, a synthesis of literature is lacking on health and social supports that may impact outcomes in the community-dwelling older adults, post-discharge from rehabilitation. Methodology: We conducted a systematic review to a) evaluate how health and social supports influence outcomes for older adults and their caregivers following inpatient rehabilitation post-hip fracture surgery, and b) identify the factors that affect their impact on outcomes. We searched Medline, CINAHL, Embase, Emcare, Psychinfo, and Ageline for publications between 2000 and 2018. We followed Cochrane Handbook methods to screen titles and abstracts, appraise quality, collect data and synthesize results. Results: A total of 3364 articles were retrieved, and 34 studies were included for final synthesis, including 24 randomized control trials and 10 observational studies. Most studies excluded persons with moderate or severe cognitive impairment. Interventions can be broadly categorized as either comprehensive care delivered by interdisciplinary teams focusing on exercise, nutrition and fracture prevention; or exercise sessions delivered by health professionals, trained instructors or volunteers. Interventions involving interdisciplinary teams demonstrated moderate improvement of mobility and functional ability in the first 3 months. However, the longitudinal effects of interventions were not realized for all. Conclusion: This review provides evidence of the effectiveness of health and social supports provided to older adults post-hip fracture. We are uncertain of the applicability to people with cognitive decline due to exclusion from most studies. Implications for practice and research will be discussed.

Swallowing disorders in an older fractured hip population.

Dysphagia is prevalent in the older population and might lead to complications, such as pneumonia, malnutrition and dehydration. This study examines an older population post hip-fracture surgery to examine the factors correlated with dysphagia, severity of dysphagia and the incidence of dysphagia in a regional setting. This prospective cohort study replicates Love etal's (2013, Age Ageing, 42:782) and compares the studies' results. Participants were assessed for dysphagia within 72hours post hip-fracture surgery. Descriptive statistics were used to calculate the incidence and severity of dysphagia, and collate pre-operative and post-operative characteristics. Univariate and multivariate logistic regression analyses were used to describe relationships between dysphagia and explanatory variables, and to predict the presence of post-operative oropharyngeal dysphagia. General orthopaedic ward at a North Queensland regional hospital. One-hundred-three participants: 78 women and 25 men, aged 65-94 years. The presence and severity of dysphagia were identified based on the clinical judgement of speech pathologists with at least 2years' experience in managing patients with acute dysphagia. Fifty-four per cent of the participants were diagnosed with dysphagia of varying severity. Female sex, post-operative confusion and living in a residential aged-care facility prior to admission, significantly predicted dysphagia post-surgery. Post-operative confusion and living in a residential aged-care facility prior to admission, were also significantly correlated with severity of dysphagia post-operatively. Dysphagia was present in a higher proportion of this cohort than that reported by Love etal. This highlights the necessity of timely assessment and management of dysphagia in an older population post-surgery for a fractured hip.

Early Mobilization Post-Hip Fracture Surgery.

Introduction:Early mobilization after hip fracture surgery is a widely practiced component of postoperative care. However, there is little evidence to suggest that early mobilization post–hip fracture surgery is beneficial in reducing postoperative complications. This study aims to investigate the effect of early mobilization following hip fracture surgery on postoperative complications.Materials and Methods:This study retrospectively included 240 patients (female = 165, male = 75, mean age: 82.2 years) admitted to a level 1 trauma center in Adelaide, Australia, for hip fracture surgery. The effect of early mobilization on postoperative complications was assessed along with premorbid status. Subgroup analysis of patients stratified by premorbid health was subsequently analyzed to reduce confounding.Results:The odds of developing a complication were 1.9 times higher if the patient remained bedbound compared to mobilizing. Early mobilization was favorable to delayed mobilization. On average, complication-free patients mobilized earlier (mean [M] = 29 hours) compared to patients who experienced complications (M = 38 hours). In particular, rates of delirium was significantly reduced in patients who mobilized compared to remaining bedbound. However, premorbid status varied greatly. Early mobilizers had significantly better premorbid health than patients who remained bedbound. Overall subgroup analysis of patients with similar premorbid health showed mobilization was not associated with a reduction in complications. With an exception of patients with poor premorbid health, who experienced a reduction in complications following early mobilization.Discussion:In general, early mobilization was associated with the same complication rates as delayed mobilization and remaining bedbound. Patients with poor premorbid health benefited most from early mobilization with reduced complication rates.Conclusion:Postoperative delirium and premorbid health were better indicators of postoperative outcomes than time to mobilization.