National System and Comments on the Holistic Elements of Care of the Elderly with Overview of Hip Fracture Research and Service

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

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Hip fractures among the elderly in Kyoto, Japan: a 10-year study

Archives of Osteoporosis ◽

10.1007/s11657-021-00888-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Maki Asada ◽

Motoyuki Horii ◽

Kazuya Ikoma ◽

Tsuyoshi Goto ◽

Naoki Okubo ◽

...

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Incidence Rate ◽

Acute Care ◽

Hip Fractures ◽

Age Groups ◽

The Elderly ◽

Femoral Neck Fractures ◽

Age Group ◽

Trochanteric Fractures

Abstract Summary In Kyoto Prefecture, Japan, the number of hip fractures increased during 2013–2017 compared to 2008–2012. However, the estimated overall incidence rate increased only in femoral neck fractures in men aged ≥75 and women aged ≥85. Purpose The incidence rate of hip fractures in Japan has plateaued or decreased. We investigated the annual hip fracture occurrences in Kyoto Prefecture, Japan, from 2008 to 2017. Methods Patients aged 65 years and above who sustained hip fractures between 2008 and 2017 and were treated at one of the participating 11 hospitals were included. The total number of beds in these institutions was 3701, accounting for 21.5% of the 17,242 acute-care beds in Kyoto Prefecture. The change in incidence rate was estimated utilizing the population according to the national census conducted in 2010 and 2015. Results The total number of hip fractures was 10,060, with 47.5% femoral neck fractures and 52.5% trochanteric fractures. A decrease in number was seen only in trochanteric fractures in the group of 75- to 84-year-old women. The population-adjusted numbers of femoral neck fractures showed a significant increase in all age groups in men, whereas in women, there was an increase in femoral neck fractures in the ≥85 group and trochanteric fractures in the age group 65–74, and a decrease in trochanteric fractures in the age group 75–84. The estimated change in incidence rate showed an increase in femoral neck fractures in men aged ≥75 and women aged ≥85. Conclusion In Kyoto Prefecture, the number of hip fractures increased in the second half of the study period (2013–2017) compared to the first half (2008–2012). However, the incidence rate had not increased, except in femoral neck fractures in men aged ≥75 and women aged ≥85.

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PP045-SUN INTEGRATED NUTRITIONAL INTERVENTION IN THE ELDERLY AFTER HIP FRACTURE. A PROCESS EVALUATION

Clinical Nutrition Supplements ◽

10.1016/s1744-1161(12)70097-2 ◽

2012 ◽

Vol 7 (1) ◽

pp. 43 ◽

Cited By ~ 2

Author(s):

J.J. Breedveld-Peters ◽

P.L. Reijven ◽

C.E. Wyers ◽

S. van Helden ◽

J.J.C. Arts ◽

...

Keyword(s):

Hip Fracture ◽

Process Evaluation ◽

The Elderly ◽

Nutritional Intervention

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Hip fracture incidence in the elderly in Portugal. An epidemiological study from 2005 to 2013

Revue de Chirurgie Orthopédique et Traumatologique ◽

10.1016/j.rcot.2016.08.077 ◽

2016 ◽

Vol 102 (7) ◽

pp. S106

Author(s):

João Duarte Silva ◽

Daniela Linhares ◽

Mariana Ferreira ◽

Nuno Neves ◽

Manuel Ribeiro Silva ◽

...

Keyword(s):

Hip Fracture ◽

Epidemiological Study ◽

The Elderly ◽

Fracture Incidence ◽

Hip Fracture Incidence

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Four or Twelve Months' Follow-Up in the Evaluation of Functional Outcome after Hip Fracture Surgery?

Scandinavian Journal of Surgery ◽

10.1177/145749690509400115 ◽

2005 ◽

Vol 94 (1) ◽

pp. 59-66 ◽

Cited By ~ 23

Author(s):

T. Heikkinen ◽

P. Jalovaara

Keyword(s):

Hip Fracture ◽

Repeated Measures ◽

The Elderly ◽

Important Variable ◽

Walking Ability ◽

Hip Fracture Surgery ◽

Age Related ◽

Walking Aids ◽

One Year

Background and Aims: As a rule, follow-up for at least one year is recommended for fracture studies. This is considered the shortest reliable interval. Still, in the case of hip fractures of the elderly, shorter follow-up might be more practical, since the life expectancy of these patients is often short. The aim of this study was to see if a short four months follow-up period would be acceptable in hip fracture surveys. Material and Methods: Information on 196 consecutive non-pathological hip fracture patients aged 50 years or over (mean 79 years) was collected using a standardised hip fracture audit concentrating on functional measurements at admission and at four and twelve months' follow-ups. Results: 167 patients were alive at four months and 152 and at one year. The patients who died between four and twelve months had poorer functional capacity in the four-month evaluation than those who survived one year. The analysis of repeated measures, including only the patients alive at the last follow-up, showed that residential status, use of walking aids and 6 out of 10 and ADL variables (bathing, toileting, shopping, household activities, doing laundry, banking) did not change significantly. Walking ability and the rest 4 ADL variables (dressing, eating, food preparation, use of transportation) improved and pain decreased. Conclusions: Due to high mortality and age-related deterioration of functioning, no steady state i.e. “final result” is ever reached after hip fracture in the elderly. Four-month follow-up is justified as the shortest possible period, because the socioeconomically most important variable, i.e. place of living, and most of the ADL functions do not change significantly after that.

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Re-Admissions Following Hip Fracture Surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/003588409x432374 ◽

2009 ◽

Vol 91 (7) ◽

pp. 591-595 ◽

Cited By ~ 46

Author(s):

James Hahnel ◽

Hannah Burdekin ◽

Sanjeev Anand

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

The Elderly ◽

Index Admission ◽

Study Cohort ◽

Rehabilitation Care ◽

Hip Fracture Surgery ◽

Fatal Adverse Events ◽

The Uk ◽

Fracture Surgery

INTRODUCTION Hip fractures in the elderly are a growing problem with a predicted incidence of 117,000 cases per year by 2016. Re-admission following a healthcare episode is an important outcome measure, which reflects non-fatal adverse events and indicates the natural history of disease. The purpose of this observational, multicentre audit was to examine rates and reasons for re-admission following hip fracture, to identify areas in the index admission and rehabilitation care that could be improved to prevent re-admission. PATIENTS AND METHODS A total of 535 patients (> 65 years old) in two district general hospitals in the UK who underwent hip fracture surgery were recruited into the study. RESULTS Of the study cohort, 72 patients (13.5%) died during their index admission and 88 (19.0%) of 463 patients were re-admitted once within 3 months. Causes of re-admission were attributed to medical (54.8%), failure to rehabilitate (23.8%), orthopaedic (19.0%) and surgical (2.4%) reasons. Infection was the most common (31.0%) reason for re-admission and arguably the most treatable. During the 3-month postoperative period, the mortality rate was 21.3%, increasing in those re-admitted to 35.1% representing the frailty of this group of patients. CONCLUSIONS High rates of re-admission are seen following discharge in elderly patients with hip fractures. Re-admitted patients have high mortality rates. Understanding causes of re-admission may help to reduce this burden.

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Covid-19, and Hip Fracture Mortality Rates in the Elderly at One Year: Impact and Implications

Open Journal of Geriatrics ◽

10.22259/2639-359x.0401001 ◽

2021 ◽

Vol 4 (1) ◽

pp. 1-13

Author(s):

Ray Marks

Keyword(s):

Hip Fracture ◽

The Elderly ◽

Mortality Rates ◽

One Year ◽

Hip Fracture Mortality

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Minidose Bupivacaine–Fentanyl Spinal Anesthesia for Surgical Repair of Hip Fracture in the Aged

Anesthesiology ◽

10.1097/00000542-200001000-00007 ◽

2000 ◽

Vol 92 (1) ◽

pp. 6-6 ◽

Cited By ~ 107

Author(s):

Bruce Ben-David ◽

Roman Frankel ◽

Tatianna Arzumonov ◽

Yuri Marchevsky ◽

Gershon Volpin

Keyword(s):

Blood Pressure ◽

Hip Fracture ◽

Spinal Anesthesia ◽

Surgical Repair ◽

Systolic Pressure ◽

The Elderly ◽

Vasopressor Support ◽

Group A ◽

Blood Pressures ◽

Group B

Background Spinal anesthesia for surgical repair of hip fracture in the elderly is associated with a high incidence of hypotension. The synergism between intrathecal opioids and local anesthetics may make it possible to achieve reliable spinal anesthesia with minimal hypotension using a minidose of local anesthetic. Methods Twenty patients aged > or = 70 yr undergoing surgical repair of hip fracture were randomized into two groups of 10 patients each. Group A received a spinal anesthetic of bupivacaine 4 mg plus fentanyl 20 microg, and group B received 10 mg bupivacaine. Hypotension was defined as a systolic pressure of < 90 mmHg or a 25% decrease in mean arterial pressure from baseline. Hypotension was treated with intravenous ephedrine boluses 5-10 mg up to a maximum 50 mg, and thereafter by phenylephrine boluses of 100-200 microg. Results All patients had satisfactory anesthesia. One of 10 patients in group A required ephedrine, a single dose of 5 mg. Nine of 10 patients in group B required vasopressor support of blood pressure. Group B patients required an average of 35 mg ephedrine, and two patients required phenylephrine. The lowest recorded systolic, diastolic, and mean blood pressures as fractions of the baseline pressures were, respectively, 81%, 84%, and 85% versus 64%, 69%, and 64% for group A versus group B. Conclusions A "minidose" of 4 mg bupivacaine in combination with 20 microg fentanyl provides spinal anesthesia for surgical repair of hip fracture in the elderly. The minidose combination caused dramatically less hypotension than 10 mg bupivacaine and nearly eliminated the need for vasopressor support of blood pressure.

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