scholarly journals Early mobility after fragility hip fracture: a mixed methods embedded case study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lynn Haslam-Larmer ◽  
Catherine Donnelly ◽  
Mohammad Auais ◽  
Kevin Woo ◽  
Vincent DePaul
Keyword(s):  
Hip Fracture ◽  
Healthcare Provider ◽  
Functional Decline ◽  
Healthcare Providers ◽  
Early Mobility ◽  
Fragility Hip Fracture ◽  
Increased Risk ◽  
Poor Outcomes ◽  
Embedded Case Study

Abstract Background Following a hip fracture up to 60% of patients are unable to regain their pre-fracture level of mobility. For hospitalized older adults, the deconditioning effect of bedrest and functional decline has been identified as the most preventable cause of ambulation loss. Recent studies demonstrate that this older adult population spends greater than 80% of their time in bed during hospitalization, despite being ambulatory before their fracture. We do not fully understand why there continues to be such high rates of sedentary times, given that evidence demonstrates functional decline is preventable and early mobility recommendations have been available for over a decade. Methods A descriptive mixed method embedded case study was selected to understand the phenomenon of early mobility after fragility hip fracture surgery. In this study, the main case was one post-operative unit with a history of recommendation implementation, and the embedded units were patients recovering from hip fracture repair. Data from multiple sources provided an understanding of mobility activity initiation and patient participation. Results Activity monitor data from eighteen participants demonstrated a mean sedentary time of 23.18 h. Median upright time was 24 min, and median number of steps taken was 30. Qualitative interviews from healthcare providers and patients identified two main categories of themes; themes external to the person and themes unique to the person. We identified four factors that can influence mobility; a patient’s pre-fracture functional status, cognitive status, medical unpredictability, and preconceived notions held by healthcare providers and patients. Conclusions There are multi-level factors that require consideration with implementation of best practice interventions, namely, systemic, healthcare provider related, and patient related. An increased risk of poor outcomes occurs with compounding multiple factors, such as a patient with low pre-fracture functional mobility, cognitive impairment, and a mismatch of expectations. The study reports several variables to be important considerations for facilitating early mobility. Communicating mobility expectations and addressing physical and psychological readiness are essential. Our findings can be used to develop meaningful healthcare provider and patient-centred interventions to address the risks of poor outcomes.

scholarly journals Early Mobility After Fragility Hip Fracture: A Mixed Methods Embedded Case Study

2020 ◽  
Author(s):  
Lynn Haslam-Larmer ◽  
Catherine Donnelly ◽  
Mohammad Auais ◽  
Kevin Woo ◽  
Vincent DePaul
Keyword(s):  
Hip Fracture ◽  
Healthcare Provider ◽  
Functional Decline ◽  
System Level ◽  
Physical Factors ◽  
Early Mobility ◽  
Fragility Hip Fracture ◽  
Time In Bed ◽  
Embedded Case Study

Abstract BackgroundFollowing a hip fracture up to 60% of patients are unable to regain their pre-fracture level of mobility. For hospitalized older adults, the deconditioning effect of bedrest and functional decline has been identified as the most preventable cause of loss of ambulation. Participating in early mobility activities can decrease the overall length of hospital stay and aid in re-establishing a patients’ functional status. Recent studies demonstrate that this older adult population spends greater than 80% of their time in bed during hospitalization, despite being ambulatory prior to their fracture. We do not fully understand why there continues to be such high rates of sedentary times, given that evidence demonstrates functional decline is preventable and early mobility recommendations have been available for over a decade.MethodsA descriptive mixed method embedded case study was selected to understand the phenomenon of early mobility after fragility hip fracture surgery. In this study, the main case was one post-operative unit with a history of recommendation implementation, and the embedded units were patients recovering from hip fracture repair. Data from multiple sources provided an understanding of mobility activity initiation and patient participation.ResultsActivity monitor data from eighteen participants demonstrated a mean sedentary time of 23.18h. Median upright time was 24 min, and median number of steps taken was 30. Qualitative interviews from healthcare providers and patients identified two main categories of themes; factors that are external to the person (system, healthcare provider team, environment) and factors that are unique to the person (psychological and physical factors). Discussion There are multi-level factors that require consideration with implementation of best practice interventions, namely, systemic, healthcare provider related, and patient related. Recommendations are being sustained at the system level, and the unit has embraced a strong interdisciplinary approach. At the micro level, patients identify several factors influencing their participation, which ultimately demonstrates successful uptake of recommendations.ConclusionsThe study reports several variables to be important considerations for facilitating early mobility. Communicating mobility expectations and addressing physical and psychological readiness are essential. Our findings can be used to develop meaningful patient centred interventions to address these barriers.

scholarly journals Peripheral IL-6 Levels but not Sarcopenia Are Predictive of 1-Year Mortality After Hip Fracture in Older Patients

2020 ◽  
Vol 75 (10) ◽  
pp. e130-e137
Author(s):  
Paloma Bermejo-Bescós ◽  
Sagrario Martín-Aragón ◽  
Alfonso José Cruz-Jentoft ◽  
Ana Merello de Miguel ◽  
María-Nieves Vaquero-Pinto ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Muscle Mass ◽  
Older Patients ◽  
Primary Outcome Measure ◽  
First Year ◽  
Increased Risk ◽  
European Working ◽  
Cutoff Points ◽  
Poor Outcomes ◽  
Definition Of

Abstract Background Sarcopenic patients may have an increased risk of poor outcomes after a hip fracture. The objective of this study was to determine whether sarcopenia and a set of biomarkers were potential predictors of 1-year-mortality in older patients after a hip fracture. Methods About 150 patients at least 80 years old were hospitalized for the surgical treatment of a hip fracture. The primary outcome measure was the death in the first year after the hip fracture. Sarcopenia was defined at baseline by having both low muscle mass (bioimpedance analysis) and handgrip and using the updated European Working Group on Sarcopenia in Older People (EWGSOP2) definition of probable sarcopenia. Janssen’s (J) and Masanés (M) cutoff points were used to define low muscle mass. Results Mortality 1 year after the hip fracture was 11.5%. In univariate analyses, baseline sarcopenia was not associated with mortality, using neither of the muscle mass cutoff points: 5.9% in sarcopenic (J) versus 12.4% in non-sarcopenic participants (p = .694) and 16% in sarcopenic (M) versus 9.6% in non-sarcopenic participants (p = .285). Probable sarcopenia (EWGSOP2) was not associated with mortality. Peripheral levels of IL-6 at baseline were significantly higher in the group of participants who died in the year after the hip fracture (17.14 ± 16.74 vs 11.42 ± 7.99 pg/mL, p = .026). TNF-α peripheral levels had a nonsignificant trend to be higher in participants who died. No other biomarker was associated with mortality. Conclusions Sarcopenia at baseline was not a predictor of 1-year mortality in older patients after a hip fracture. IL-6 was associated with a higher risk of mortality in these patients, regardless of sarcopenia status.

scholarly journals Delay in hip fracture surgery and its outcomes. A reflection

2020 ◽  
Author(s):  
Ángela Merchán-Galvis ◽  
David Andrés Muñoz ◽  
Felipe Solano ◽  
Julián Camilo Velásquez
Keyword(s):  
Quality Of Life ◽  
Hip Fracture ◽  
Functional Decline ◽  
Healthcare Providers ◽  
Third Party ◽  
Public Healthcare ◽  
Hip Fracture Surgery ◽  
Life Impact ◽  
Risk Of Falls

Hip fracture is one of the major public healthcare problems in elderly patients around the world, mainly because of the risk of falls and osteoporosis which are typical during this stage of life, and may be the cause for up to 36% of deaths among those affected. Its management in principle is surgical and the best results are achieved with patients undergoing surgery during the first 24 to 72 after the fracture. Any delays in surgery are mostly associated with decompensated personal pathological factors, delays in perioperative assessment, or in presurgical complementary tests; sometimes, the delays are the result of administrative formalities of the healthcare providers. These determining factors may affect both morbidity and mortality, and contribute to functional decline, disability, and reduced quality of life of these patients. A third party intervention is then necessary to improve the preventable factors that delay the osteosynthesis in these types of fractures, in addition to ensuring education, infrastructure, inputs, skilled human resources, and prompt referral of patients from the first level of care. Investigating this scenario and assessing the quality of life impact on these patients should be a priority.

scholarly journals Prognostic factors related to ambulation deterioration after 1-year of geriatric hip fracture in a Chinese population

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ronald Man Yeung Wong ◽  
Jianghui Qin ◽  
Wai Wang Chau ◽  
Ning Tang ◽  
Chi Yin Tso ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Hip Fracture ◽  
Length Of Stay ◽  
Old Age ◽  
Early Discharge ◽  
Fragility Hip Fracture ◽  
Post Surgery ◽  
Increased Risk ◽  
Male Patients ◽  
Old Age Homes

AbstractThe objective of this study was to investigate the prognostic factors predicting the ambulation recovery of fragility hip fracture patients. 2286 fragility hip fracture patients were collected from the Fragility Fracture Registry in Hong Kong. Predictive factors of ambulation deterioration including age, gender, pre-operation American Society of Anesthesiologists grade, pre-fracture mobility, delay to surgery, length of stay, fracture type, type of surgery, discharge destination and complications were identified. Patients with outdoor unassisted and outdoor with aids ambulatory function before fracture had 3- and 1.5-times increased risk of mobility deterioration, respectively (Odds Ratio (OR) = 2.556 and 1.480, 95% Confidence Interval (CI) 2.101–3.111 and 1.246–1.757, both p < 0.001). Patients living in old age homes had almost 1.4 times increased risk of deterioration when compared to those that lived in their homes (OR = 1.363, 95% CI 1.147–1.619, p < 0.001). The risk also increased for every 10 years of age (OR = 1.831, 95% CI 1.607–2.086, p < 0.001). Patients in the higher risk ASA group shows a decreased risk of ambulation deterioration compared to those in lower risk ASA group (OR = 0.831, 95% CI 0.698–0.988, p = 0.038). Patients who suffered from complications after surgery did not increased risk of mobility decline at 1-year post-surgery. Delayed surgery over 48 h, delayed discharge (> 14 days), early discharge (less than 6 days), and length of stay also did not increased risk of mobility decline. Male patients performed worse in terms of their mobility function after surgery compared to female patients (OR = 1.195, 95% CI 1.070–1.335, p = 0.002). This study identified that better premorbid good function, discharge to old age homes especially newly institutionalized patients, increased age, lower ASA score, and male patients, correlate with mobility deterioration at 1-year post-surgery. With the aging population and development of FLS, prompt identification of at-risk patients should be performed for prevention of deterioration.

scholarly journals Effects of COVID-19 infection during pregnancy

2021 ◽  
Vol 9 (39) ◽  
pp. 28-34
Author(s):  
Sabiha Armin ◽  
Kenneth Nugent
Keyword(s):  
Pregnant Women ◽  
Vertical Transmission ◽  
Respiratory Infections ◽  
Healthcare Providers ◽  
Neonatal Infection ◽  
Fetal Tissue ◽  
Extensive Literature ◽  
Perinatal Complications ◽  
Increased Risk ◽  
Poor Outcomes

Women develop important changes in their cardiovascular and respiratory systems during pregnancy. They also have important changes in their immune system which are necessary to tolerate foreign fetal tissue. These expected alterations can increase the likelihood of poor outcomes with certain respiratory infections, especially viral infection. There is extensive literature describing COVID-19 in pregnant women, and there is evidence that this virus can infect the placenta, raising implications for maternal-fetal transmission. Women who contract COVID-19 during pregnancy are at increased risk of preterm labor and other perinatal complications when compared to non-pregnant women. Trials on the safety and efficacy of the COVID-19 vaccines during pregnancy are in progress; several reproductive societies have recommended that women who are planning to get pregnant or are pregnant should get vaccination since there are few reports of adverse events in pregnant women who have received vaccines. Healthcare providers will need to address concerns of infertility, the possibility of vertical transmission, and neonatal infection with women regarding timely vaccination against this disease and other necessary precautions. Keywords: coronavirus, COVID-19, pregnancy, placental pathology, vertical transmission

scholarly journals In-hospital mortality rate after osteoporotic hip fracture in Bucharest

2019 ◽  
Vol 2 (1) ◽  
pp. 48-51
Author(s):  
Ramona Dobre ◽  
Dan Niculescu ◽  
Gheorghe Popescu ◽  
Adrian Barbilian ◽  
Cătălin Cîrstoiu ◽  
...  
Keyword(s):  
Risk Factor ◽  
Hip Fracture ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Average Length ◽  
Fragility Fractures ◽  
Fragility Hip Fracture ◽  
Osteoporotic Hip Fracture ◽  
Increased Risk ◽  
Male Sex

AbstractIntroduction: Hip fracture is the most severe consequence of osteoporosis and an important cause of excess mortality in the elderly.Objective: We aimed to evaluate the in-hospital mortality rate after osteoporotic hip fracture in patients treated surgically or functionally in specialized centers in Bucharest.Materials and methods: We calculated the in-hospital mortality rate in 745 patients (540 women [72.48%], with a mean age of 79.1 ± 11 years), surgically or functionally treated for fragility hip fracture over a 12 months period.Results: Average length of hospitalization was 18.12 days. In hospital mortality rate was 5.36% (n=40, women 60%). An important risk factor associated with mortality was age, p=0.001. The male sex was also a risk factor with a mortality rate of 7,8% (n=16), compared to 4.44% in women, p<0.005, with OR of 1.57. Out of the 40 patients, 57.5% had a femoral neck fracture, 35% intertrochanteric, and 5.5% atypical fracture in absence of bisphosphonates. 7.5% had previous fragility fractures. 85% of the patients had a history of one or more cardiac pathologies (34.28% with atrial fibrillation), 57.5% underwent surgical intervention (n=23) with an average day of intervention of 8.82 after admission. None of the patients had an osteoporosis treatment before the event and on average 3.73 medications with an increased risk of falling and fracture.Conclusion: In-hospital mortality rate after hip fracture remains high; probably this being related to the high comorbidity associated with male sex and increased age as risk factors.

scholarly journals A health care record review of early mobility activities after fragility hip fracture: Utilizing the French systematic method to inform future interventions

2020 ◽  
Author(s):  
Lynn Haslam-Larmer ◽  
Kevin Woo ◽  
Mohammad Auais ◽  
Catherine Donnelly ◽  
Vincent DePaul
Keyword(s):  
Health Care ◽  
Cognitive Impairment ◽  
Hip Fracture ◽  
Health Care Providers ◽  
Care Providers ◽  
Early Mobility ◽  
Fragility Hip Fracture ◽  
Hip Fracture Surgery ◽  
Fracture Function ◽  
Practice Gaps

Abstract Background A fragility hip fracture is a serious injury in older adults. Following a fragility fracture, a large percentage of patients are unable to regain their pre-fracture level of mobility. There are several international guidelines recommending early mobility after surgery. We do not know the utilization of these early mobility recommendations by health care providers within our institution. An evidence to practice gap occurs when there is a failure to implement best practices. Utilization of a systematic method allows for a strategic approach to assessment of an evidence to practice gap. A recent publication of quality standards in Ontario provides an opportunity for a local needs assessment of potential evidence to practice gaps. The aim of this project was to identify evidence to practice gaps in health care provider implementation of recommendations for early mobility after fragility hip fracture surgery.Methods A retrospective chart review was performed to document the rates of early mobility activities during the first five days after hip fracture surgery at a large tertiary centre in Toronto, Ontario. Patients with cognitive impairment were included.Results Early mobility activities in this older adult population are initiated in the first five days after surgery to varying degrees. Between 11% - 50% of patients are not participating in early mobility activities, thereby not meeting recommendations. Those with low pre-fracture function and cognitive impairment have lower rates of participation when compared to those with a high pre-fracture function and no cognitive impairment.Conclusions The chart review has identified a paucity of contextual information which may influence health care providers’ behaviours related to early mobility. The chart audit is limited in its ability to assess the systems issues, which may have an influence on the health care provider behaviour. Considering the lack of information in these areas, we have identified that further work is required to explore factors which may be having an impact on the health care provider’s ability to engage the patients in early mobility activities.

scholarly journals A health care record review of early mobility activities after fragility hip fracture: Utilizing the French systematic method to inform future interventions

2020 ◽  
Author(s):  
Lynn Haslam-Larmer ◽  
Kevin Woo ◽  
Mohammad Auais ◽  
Catherine Donnelly ◽  
Vincent DePaul
Keyword(s):  
Health Care ◽  
Cognitive Impairment ◽  
Hip Fracture ◽  
Health Care Providers ◽  
Care Providers ◽  
Early Mobility ◽  
Fragility Hip Fracture ◽  
Hip Fracture Surgery ◽  
Fracture Function ◽  
Practice Gap

Abstract Background A fragility hip fracture is a serious injury in older adults. Following a fragility fracture, a large percentage of patients are unable to regain their pre-fracture level of mobility. There are several international guidelines recommending early mobility after surgery. We do not know the utilization of these early mobility recommendations by health care providers within our institution. An evidence to practice gap occurs when there is a failure to implement best practices. Utilization of a systematic method allows for a strategic approach to assessment of an evidence to practice gap. A recent publication of quality standards in Ontario provides an opportunity for a local needs assessment of potential evidence to practice gaps. Objective To identify if there is an evidence to practice gap in health care provider implementation of recommendations for early mobility after fragility hip fracture surgery. Methods A retrospective chart review was performed to document the rates of early mobility activities during the first five days after hip fracture surgery at a large tertiary centre in Toronto, Ontario. Patients with cognitive impairment were included. Results Early mobility activities in this older adult population are initiated in the first five days after surgery to varying degrees. Between 11% - 50% of patients are not participating in early mobility activities, thereby not meeting recommendations. Those with low pre-fracture function and cognitive impairment have lower rates of participation when compared to those with a high pre-fracture function and no cognitive impairment. Conclusions The chart review has identified a paucity of contextual information which may influence health care providers’ behaviours related to early mobility. The chart audit is limited in its ability to assess the systems issues, which may have an influence on the health care provider behaviour. Considering the lack of information in these areas, we have identified that further work is required to explore factors which may be having an impact on the health care provider’s ability to engage the patients in early mobility activities.

scholarly journals Case Study Application of an Ethical Decision-Making Process for a Fragility Hip Fracture Patient

2019 ◽  
Vol 22 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Lynn Haslam ◽  
Vincent DePaul
Keyword(s):  
Decision Making ◽  
Hip Fracture ◽  
Health Care Providers ◽  
Ethical Decision ◽  
Surgical Repair ◽  
Ethical Decision Making ◽  
Care Providers ◽  
Term Care ◽  
Fragility Hip Fracture

In Canada, up to 32,000 older adults experience a fragility hip fracture. In Ontario, the Ministry of Health and Long Term Care has implemented strategies to reduce surgical wait times and improve outcomes in target areas. These best practice standards advocate for immediate surgical repair, within 48 hours of admission, in order to achieve optimal recovery outcomes. The majority of patients are good candidates for surgical repair; however, for some patients, given the risks of anesthetic and trauma of the operative procedure, surgery may not be the best choice. Patients and families face a dif-ficult and hurried decision, often with no time to voice their concerns, or with little-to-no information on which to guide their choice. Similarly, health-care providers may experience moral distress or hesitancy to articulate other options, such as palliative care.  Is every fragility fracture a candidate for surgery, no matter what the outcome? When is it right to discuss other options with the patient? This article examines a case study via an application of a framework for ethical decision-making.

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