Clinical Practice of Best Practice Nursing Care Standards for Older Adults with Fragility Hip Fracture: A Propensity Score Matched Analysis

Background: Hip fracture is one of the significant public concerns in terms of long-term care in aging society. We aimed to investigate the risk for the incidence of hip fracture focusing on disability among older adults. Methods: This was a population-based retrospective cohort study, focusing on adults aged 65 years or over who were included in the Korean National Health Insurance Service–National Sample from 2004 to 2013 (N = 90,802). Hazard ratios with 95% confidence interval (CIs) were calculated using the Cox proportional hazards model according to disability adjusted for age, household income, underlying chronic diseases, and comorbidity index. Results: The incidence of hip fracture was higher among older adults with brain disability (6.3%) and mental disability (7.5%) than among those with other types of disability, as observed during the follow-up period. Risk of hip fracture was higher among those who were mildly to severely disabled (hazard ratio for severe disability = 1.59; 95% CI, 1.33–1.89; mild = 1.68; 95% CI, 1.49–1.88) compared to those who were not disabled. Older men with mental disabilities experienced an incidence of hip fracture that was almost five times higher (hazard ratio, 4.98; 95% CI, 1.86–13.31) versus those that were not disabled. Conclusions: Older adults with mental disabilities and brain disability should be closely monitored and assessed for risk of hip fracture.

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Acute nursing care of the older adult with fragility hip fracture: An international perspective (Part 1)

International Journal of Orthopaedic and Trauma Nursing ◽

10.1016/j.ijotn.2012.09.001 ◽

2012 ◽

Vol 16 (4) ◽

pp. 177-194 ◽

Cited By ~ 26

Author(s):

Ann Butler Maher ◽

Anita J Meehan ◽

Karen Hertz ◽

Ami Hommel ◽

Valerie MacDonald ◽

...

Keyword(s):

Hip Fracture ◽

Older Adult ◽

Nursing Care ◽

International Perspective ◽

Fragility Hip Fracture

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Hip Fracture Confers Significantly Greater Mortality Risk in Older Adults Relative to Other Lower Extremity Fractures (Preprint)

10.2196/preprints.32683 ◽

2021 ◽

Author(s):

Andrea Dimet ◽

George Golovko ◽

Stanley Watowich

Keyword(s):

Older Adults ◽

Hip Fracture ◽

Propensity Score ◽

Lower Extremity ◽

Elderly Patients ◽

Propensity Score Matching ◽

Mortality Risk ◽

Mortality Rates ◽

One Year ◽

Fracture Types

BACKGROUND Hip fracture in older adults is tied to increased mortality risk. Deconvolution of the mortality risk specific to hip fracture from that of various other fracture types has not been performed in recent hip fracture studies, but is critical to determining current unmet needs for therapeutic intervention. OBJECTIVE This study examined whether hip fracture increases the one-year post-fracture mortality rate relative to several other fracture types and determined if dementia or type 2 diabetes (T2D) exacerbates post-fracture mortality risk. METHODS TriNetX Diamond Network data were used to identify elderly patients that suffered a single fracture event of the hip, the upper humerus, or several regions near and distal to the hip between 2010-2019. Propensity-score matching, Kaplan-Meier, and hazard ratio analyses were performed for all fracture groupings relative to hip fracture. One-year post-fracture mortality rates in elderly populations with dementia or T2D were established. RESULTS One-year mortality rates following hip fracture consistently exceeded all other lower extremity fracture groupings as well as the upper humerus. Survival probabilities were dramatically lower in the hip fracture groups even after propensity score-matching cohorts for variety of broad categories of characteristics. Dementia in younger elderly cohorts acted synergistically with hip fracture to exacerbate one-year mortality risk. T2D did not exacerbate one-year mortality risk beyond mere additive effects. CONCLUSIONS Elderly patients post-hip fracture have a significantly decreased survival probability. Greatly increased one-year mortality rates following hip fracture may arise from differences in bone quality, bone density, trauma, concomitant fractures, post-fracture treatments or diagnoses, restoration of pre-fracture mobility, or a combination thereof. The synergistic effect of dementia may suggest detrimental mechanistic or behavioral combinations between these two comorbidities Renewed efforts should focus on modulating the mechanisms behind this heightened mortality risk, with particular attention to mobility and comorbid dementia.

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International partnerships: Advancing nursing care of the older adult with fragility hip fracture

Geriatric Nursing ◽

10.1016/j.gerinurse.2013.02.011 ◽

2013 ◽

Vol 34 (2) ◽

pp. 156-157

Author(s):

Anita J. Meehan ◽

Valerie MacDonald

Keyword(s):

Hip Fracture ◽

Older Adult ◽

Nursing Care ◽

International Partnerships ◽

Fragility Hip Fracture

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Recovery in Mobility by Community-Living Older Adults following Fragility Hip Fracture

Physical & Occupational Therapy In Geriatrics ◽

10.1080/02703181.2021.2008086 ◽

2021 ◽

pp. 1-17

Author(s):

Denise M. Connelly

Keyword(s):

Older Adults ◽

Hip Fracture ◽

Community Living ◽

Fragility Hip Fracture

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Choosing the Best Evidence to Guide Clinical Practice: Application of AACN Levels of Evidence

Critical Care Nurse ◽

10.4037/ccn2014411 ◽

2014 ◽

Vol 34 (2) ◽

pp. 58-68 ◽

Cited By ~ 26

Author(s):

Mary H. Peterson ◽

Susan Barnason ◽

Bill Donnelly ◽

Kathleen Hill ◽

Helen Miley ◽

...

Keyword(s):

Clinical Practice ◽

Nursing Care ◽

Best Practice ◽

Clinical Decision Making ◽

Improve Patient Care ◽

Clinical Decision ◽

Evidence Based ◽

Clinical Expertise ◽

Levels Of Evidence ◽

Evidence Based Nursing

Evidence-based nursing care is informed by research findings, clinical expertise, and patients’ values, and its use can improve patients’ outcomes. Use of research evidence in clinical practice is an expected standard of practice for nurses and health care organizations, but numerous barriers exist that create a gap between new knowledge and implementation of that knowledge to improve patient care. To help close that gap, the American Association of Critical-Care Nurses has developed many resources for clinicians, including practice alerts and a hierarchal rating system for levels of evidence. Using the levels of evidence, nurses can determine the strength of research studies, assess the findings, and evaluate the evidence for potential implementation into best practice. Evidence-based nursing care is a lifelong approach to clinical decision making and excellence in practice.

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Clinical Practice Guidelines on Ordering Echocardiography Before Hip Fracture Repair Perform Differently from One Another

HSS Journal ® ◽

10.1007/s11420-020-09762-8 ◽

2020 ◽

Vol 16 (S2) ◽

pp. 378-382

Author(s):

Eric Swart ◽

Chris Adair ◽

Rachel B. Seymour ◽

Madhav A. Karunakar

Keyword(s):

Clinical Practice ◽

Hip Fracture ◽

Hip Fractures ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

European Society ◽

Operative Management ◽

Fracture Repair ◽

British Society ◽

Fragility Hip Fracture

Abstract Background Osteoporotic hip fractures typically occur in frail elderly patients with multiple comorbidities, and repair of the fracture within 48 h is recommended. Pre-operative evaluation sometimes involves transthoracic echocardiography (TTE) to screen for heart disease that would alter peri-operative management, yet TTE can delay surgery and is resource intensive. Evidence suggests that the use of clinical practice guidelines (CPGs) can improve care. It is unclear which guidelines are most useful in hip fracture patients. Questions/Purposes We sought to evaluate the performance of the five commonly used CPGs in determining which patients with acute fragility hip fracture require TTE and to identify common features among high-performing CPGs that could be incorporated into care pathways. Patients and Methods We performed a retrospective study of medical records taken from an institutional database of osteoporotic hip fracture patients to identify those who underwent pre-operative TTE. History and physical examination findings were recorded; listed indications for TTE were compared against those given in five commonly used CPGs: those from the American College of Cardiology/American Heart Association (ACC/AHA), the British Society of Echocardiography (BSE), the European Society of Cardiology and the European Society of Anaesthesiology(ESC/ESA), the Association of Anaesthetists of Great Britain and Ireland (AAGBI), and the Scottish Intercollegiate Guidelines Network (SIGN). We then calculated the performance (sensitivity and specificity) of the CPGs in identifying patients with TTE results that had the potential to change peri-operative management. Results We identified 100 patients who underwent pre-operative TTE. Among those, the patients met criteria for TTE 32 to 66% of the time, depending on the CPG used. In 14% of those receiving TTE, the test revealed new information with the potential to change management. The sensitivity of the CPGs ranged from 71% (ESC/ESA and AAGBI) to 100% (ACC/AHA and SIGN). The CPGs’ specificity ranged from 37% (BSE) to 74% (ESC/ESA). The more sensitive guidelines focused on a change in clinical status in patients with known disease or clinical concern regarding new-onset disease. Conclusions In patients requiring fixation of osteoporotic hip fractures, TTE can be useful for identifying pathologies that could directly change peri-operative management. Our data suggest that established CPGs can be safely used to identify which patients should undergo pre-operative TTE with low risk of missed pathology.

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