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[Disabilities and handicaps due to hip fractures in the elderly]
C Becker1, S Fleischer, A Hack
1Bethesda Geriatrische Klinik, Akademisches Krankenhaus der Universitätsklinik Ulm, Geriatrisches Zentrum Ulm/Alb-Donau, Zollernring 26-28, D-89073 Ulm. clemens.becker@medizin.uni-ulm.de
Objective:
to examine mortality, mobility, pain, institutionalization rates six month after hip fractures.
Design:
observational study, non-selected consecutive patients, time-set protocol.
Setting:
urban area (population n = 116,5000), five hospitals.
Participants:
hip fracture patients (n = 214), age 65 + years (mean 82.4 years).
Measurements:
age, gender, prefracture status, operative procedures, complications, comorbidity, cognition (MMSE), depression (GDS), fear of falling, ADL (Barthel) and mobility and pain status (SAHFE protocol).
Results:
the incidence for this age group was 636.9/100,000, 31.8% were institutionalized elderly. 84% of the patients were female. Pre-existing comorbidity showed a high prevalence of neurodegenerative (cognitive deficits 53. 6%, Parkinson's disease/syndrome 11.2%) and cerebrovascular diseases (16.8%). Six month postfracture, the mortality was 17.6%. From those surviving 76.2% did walk indoors, 58.5% did also walk outdoors. Independent to dress were 54.6%. Severe pain was reported by 10.2%, whereas 36.9% described no pain. The institutionalization rate at six month was 19.0%.
Conclusions:
the study showed considerable mortality, a significant loss in function and social disintegration. Considerable differences were observed for subgroups of patients. Future treatment should focus on risk stratification and include postdischarge training programs. Moreover, preventive strategies should be implemented for high risk groups, such as ambulating patients with a history of stroke. Parkinson's disease and syndrome, dementia and nursing home residents.