Impact of delayed intervention on clinical outcomes following traumatic hip fracture in the elderly: A national analysis

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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Effects of Vitamin A Supplementation on Immune Responses and Correlation with Clinical Outcomes

Clinical Microbiology Reviews ◽

10.1128/cmr.18.3.446-464.2005 ◽

2005 ◽

Vol 18 (3) ◽

pp. 446-464 ◽

Cited By ~ 212

Author(s):

Eduardo Villamor ◽

Wafaie W. Fawzi

Keyword(s):

Vitamin A ◽

Clinical Outcomes ◽

Age Groups ◽

Lymphocyte Activation ◽

The Elderly ◽

Conclusive Evidence ◽

Vitamin A Supplementation ◽

Mortality And Morbidity ◽

Severe Diarrhea ◽

Positive Effects

SUMMARY Vitamin A supplementation to preschool children is known to decrease the risks of mortality and morbidity from some forms of diarrhea, measles, human immunodeficiency virus (HIV) infection, and malaria. These effects are likely to be the result of the actions of vitamin A on immunity. Some of the immunomodulatory mechanisms of vitamin A have been described in clinical trials and can be correlated with clinical outcomes of supplementation. The effects on morbidity from measles are related to enhanced antibody production and lymphocyte proliferation. Benefits for severe diarrhea could be attributable to the functions of vitamin A in sustaining the integrity of mucosal epithelia in the gut, whereas positive effects among HIV-infected children could also be related to increased T-cell lymphopoiesis. There is no conclusive evidence for a direct effect of vitamin A supplementation on cytokine production or lymphocyte activation. Under certain circumstances, vitamin A supplementation to infants has the potential to improve the antibody response to some vaccines, including tetanus and diphtheria toxoids and measles. There is limited research on the effects of vitamin A supplementation to adults and the elderly on their immune function; currently available data provide no consistent evidence for beneficial effects. Additional studies with these age groups are needed.

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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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RISK FACTORS OF ADVERSE CLINICAL OUTCOMES IN THE ELDERLY AND SENILE PATIENTS WITH STROKE-ASSOCIATED PNEUMONIA

Успехи геронтологии ◽

10.34922/ae.2021.34.4.012 ◽

2021 ◽

pp. 586-591

Author(s):

В.А. Белобородов ◽

И.А. Степанов ◽

А.В. Щербатых ◽

И.И. Томашов ◽

З.С. Саакян ◽

...

Keyword(s):

Risk Factors ◽

Clinical Outcomes ◽

Nosocomial Pneumonia ◽

Binary Logistic Regression ◽

The Elderly ◽

Older Age ◽

Binary Logistic Regression Model ◽

Protein Levels ◽

Reactive Protein ◽

Degree Of Disability

В отечественной и зарубежной специализированной литературе отсутствуют исследования, посвященные изучению факторов риска развития неблагоприятного исхода у пациентов старшей возрастной группы с инсультассоциированной нозокомиальной пневмонией. Цель исследования - изучение факторов риска развития неблагоприятного клинического исхода у пациентов пожилого и старческого возраста с нозокомиальной пневмонией на фоне ОНМК. В исследование были включены 247 пациентов пожилого и старческого возраста (139 мужчин, 108 женщин, средний возраст - 74,1±6,3 года), госпитализированных с признаками ОНМК по ишемическому или геморрагическому типу. Согласно модели бинарной логистической регрессии, статистически значимо ассоциированы с развитием неблагоприятного исхода у изучаемой группы респондентов следующие параметры: возраст свыше 75 лет (p=0,011), степень инвалидизации по шкале mRS 3 (р=0,009), а также уровень С-РБ >100 мг/л (р=0,023) и мочевины >7 ммоль/л (р=0,044). Для снижения частоты встречаемости неблагоприятного клинического исхода у пациентов старшей возрастной группы с инсульт-ассоциированной нозокомиальной пневмонией необходимо верифицировать перечисленные выше клинико-лабораторные параметры на ранних этапах госпитализации. In the domestic and foreign specialized literature, there are no studies devoted to the study of risk factors of mortality in the older age patients with stroke-associated nosocomial pneumonia. The purpose of the study was to study the risk factors of adverse clinical outcomes in elderly and senile patients with stroke-associated nosocomial pneumonia. The study included 247 elderly and senile patients (139 men, 108 women, mean age - 74,1±6,3 years) who were hospitalized with signs of ischemic or hemorrhagic stroke. According to the binary logistic regression model, the following parameters are statistically significantly associated with adverse clinical outcomes in the studied group of respondents: age over 75 years (p=0.011), degree of disability according to mRS ≥3 (p=0,009), and C-reactive protein levels over 100 mg/l (p=0,023) and urea more than 7 mmol/l (p=0,044). In order to reduce the incidence of adverse clinical outcomes in patients of the older age group with stroke-associated nosocomial pneumonia, it is necessary to verify the above clinical and laboratory parameters at the early stages of hospitalization.

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