Start-up of an orthogeriatric unit in a specialized general hospital

The aging of the Spanish population has led to an increasingly greater number of hip fractures attended by the Spanish Healthcare System in the last years. Those patients, due to their fragility, need special professional attention and consequently, Orthogeriatric Units (UOG) have achieved the highest benefits.The main purpose of this research project is to evaluate the principle variables associated to the elderly affected of hip fracture staying in a new Orthogeriatric Unit created at the Hospital Nuestra Señora de Candelaria in Tenerife, Spain. A descriptive study of the elderly patients diagnosed of hip fracture staying in a conventional Orthopedic Ward was conducted, focusing specifically in those who were transferred to the UOG. The main items to describe were: total time of in-hospital staying, type of hip fracture and the kind of surgery selected, physiotherapist sessions in the conventional Orthopedic Ward, in the UOG and in Home Hospitalization Unit (HADO) as well as the total number of patients that needed to continue ambulatory physiotherapist sessions. As a conclusion, early start of physiotherapist sessions inside the hospital, completed in the UOG and/or in HADO, along with counseling and professional assessment to families and patients, reduced a very high percentage of their need for ambulatory ongoing rehabilitation.

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Start-up of an orthogeriatric unit in a specialized general hospital

European Journal of Investigation in Health, Psychology and Education ◽

10.1989/ejihpe.v1i1.89 ◽

2014 ◽

Vol 5 (1) ◽

pp. 43-53

Author(s):

Mª de los Ángeles Cruz ◽

Manuel Lillo

Keyword(s):

Hip Fracture ◽

The Elderly ◽

Descriptive Study ◽

Early Start ◽

Start Up ◽

Number Of Patients ◽

Professional Assessment ◽

Spanish Healthcare System ◽

Very High ◽

Orthopedic Ward

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Perioperative pain management in elderly patients with а proximal femoral fracture: evidence review

Pain medicine ◽

10.31636/pmjua.v4i4.2 ◽

2020 ◽

Vol 4 (4) ◽

pp. 42-49

Author(s):

Anastasiia Romanenko ◽

Юрій Кучин ◽

Катерина Бєлка ◽

Ігор Токар

Keyword(s):

Hip Fracture ◽

Pain Management ◽

Elderly Patients ◽

Femoral Fracture ◽

Adverse Drug Events ◽

Perioperative Period ◽

The Elderly ◽

Proximal Femoral Fracture ◽

Nerve Blocks ◽

Number Of Patients

The purpose of this article is to compare different methods of analgesia during perioperative period in elderly patients with а proximal femoral fracture. The incidence of hip fracture is high and also rises with the age, for example, In Great Britain, number of patients with a hip fracture will be approximately 100 000 in 2033, and it’s also associated with significant healthcare financing. Nevertheless, effective pain management is a big challenge for clinicians because of considerable problems in geriatric patients, including age, physiological changes in the elderly, preexisting comorbidities, cognitive impairment, high risk of delirium, problems with rehabilitation and probability of an independent life [12]. Opioids are still the main option for hip fracture pain management, despite differences in pharmacokinetics and pharmacodynamics in elderly patients, which are correlated with high frequency of side effects. Opioid-related adverse drug events are associated with worse patient outcomes such as morbidity, mortality and length of stay increase. Therefore, peripheral nerve blocks as part of multimodal analgesic technique can provide more effective pain control after hip fracture. Comprehensive literature searches focus on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anesthesia for hip fracture surgery.

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Descriptive study of all Danish patients undergoing emergency exploratory laparotomies in the period 2003–2014

Scandinavian Journal of Public Health ◽

10.1177/1403494819875271 ◽

2020 ◽

Vol 48 (3) ◽

pp. 243-249

Author(s):

Sarah A. Toftlund ◽

Ismail Gögenur ◽

Lau C. Thygesen

Keyword(s):

High Risk ◽

Exploratory Laparotomy ◽

The Elderly ◽

Descriptive Study ◽

Small Sample ◽

Logistic Regression Models ◽

Number Of Patients ◽

National Patient ◽

Study Population ◽

Small Sample Sizes

Aim: Emergency exploratory laparotomy is a high-risk procedure, but most studies are based on small sample sizes, and no nationwide studies have reported the number of patients and the mortality risk. This descriptive study reports the prevalence, incidence and 30- and 365-day mortality of all patients undergoing emergency exploratory laparotomies in Denmark from 2003 to 2014. Methods: The study population is based on the Danish National Patient Register, which includes all patient contacts with Danish hospitals, including patients undergoing emergency surgery. All patients were followed in registers on mortality. Rates and proportions were estimated using Poisson and logistic regression models. Results: The number of prevalent patients was 15,330 through the period (2003–2014) of whom 13,795 were incident patients. Prevalence increased with age and peaked at 1% for the 80- to 84-year-old age group. The overall incidence was 27 per 100,000 person-years, which strongly increased with age (87 per 100,000 person-years among men and 85 per 100,000 person-years among women). The 30-day mortality was 16.5% and the 365-day mortality was 23.1%. Both increased strongly with age and did not improve over the study period. Both 30- and 365-day mortality were higher among unmarried patients compared to married patients. Conclusions: Emergency exploratory laparotomies are common high-risk procedures especially for the elderly population. These results can be used to focus on better postoperative care to reduce the mortality.

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Neuropsychiatric Symptoms and Antipsychotic Therapy in the Elderly Patients with Dementia

Psychiatry ◽

10.30629/2618-6667-2020-18-4-6-15 ◽

2020 ◽

Vol 18 (4) ◽

pp. 6-15

Author(s):

I. V. Kolykhalov

Keyword(s):

Neuropsychiatric Symptoms ◽

The Elderly ◽

Psychotic Symptoms ◽

Mixed Dementia ◽

Short Term ◽

Antipsychotic Therapy ◽

Dementia Patients ◽

Frequency Of Use ◽

Number Of Patients ◽

High Incidence

The objective of the study was to investigate syndromal-nosological specificities of neuropsychiatric symptoms (NPS) and the frequency of use of antipsychotics in patients with various types of dementias, institutionalized to geriatric units of mental hospitals.Patients and methods: a total of 106 in-patients of three psychogeriatric units were examined. The median age of patients is 75 years [69; 80].The diagnostic distribution of patients at the time of the examination was as follows: in 33 subjects (31.1%) Alzheimer’s disease (AD) was diagnosed, in 25 (23.6%) - mixed dementia (MD), in 32 (30.2%) - vascular dementia (VD) and in 16 (15.1%) patients had dementia of complex origin (DCO).Results: a high incidence (54.7%) of NPS was found in patients with dementia of various origins. The greatest number of patients with behavioral and psychotic symptoms was found in AD and MD. The proportion of dementia patients with such disorders in each of these types of dementia is about 70%, while in CGD and VD, the proportion of patients with NPS is noticeably smaller (30% and 40%, respectively). For the treatment of NPS, antipsychotics were most often prescribed, but their use caused adverse events (AEs) in 1/3 of cases. Patients with VD are most susceptible to the development of AE, and AD patients are the least susceptible.Conclusion: the study showed that NPS are one of the important components of dementia, regardless of the nosology and stage of the disease. The treatment of NPS in dementia is particularly challenging because, although the symptoms cause significant distress, there are currently no effective alternative therapies. The risk of AE can be minimized by carefully considering the indications for prescribing antipsychotics and their short-term use, regular monitoring of the patient’s condition, and educating caregivers.

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The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽

10.1177/1460408620949725 ◽

2021 ◽

pp. 146040862094972

Author(s):

Ahmed Fadulelmola ◽

Rob Gregory ◽

Gavin Gordon ◽

Fiona Smith ◽

Andrew Jennings

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Hospital Admissions ◽

The Elderly ◽

Primary Outcome Measure ◽

Time To Death ◽

Significant Difference ◽

The Mean ◽

The Impact ◽

Mean Time

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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Letter to the Editor: Microbiota in the Respiratory System—A Possible Explanation to Age and Sex Variability in Susceptibility to SARS-CoV-2

Microbiology Insights ◽

10.1177/1178636120988604 ◽

2021 ◽

Vol 14 ◽

pp. 117863612098860

Author(s):

Vishal Shah

Keyword(s):

Respiratory System ◽

Elderly Population ◽

Age Groups ◽

The Elderly ◽

Elderly Adult ◽

Human Respiratory Tract ◽

System A ◽

Number Of Patients ◽

Children And Young Adults ◽

Age And Sex

The Human respiratory tract is colonized by a variety of microbes and the microbiota change as we age. In this perspective, literature support is presented for the hypothesis that the respiratory system microbiota could explain the differential age and sex breakdown amongst COVID-19 patients. The number of patients in the older and elderly adult group is higher than the other age groups. The perspective presents the possibility that certain genera of bacteria present in the respiratory system microbiota in children and young adults could be directly or through eliciting an immune response from the host, prevent full-fledged infection of SARS-CoV-2. The possibility also exists that the microbiota in older adults and the elderly population have bacteria that make it easier for the virus to cause infection. I call upon the scientific community to investigate the link between human microbiota and SARS-CoV-2 susceptibility to further understand the viral pathogenesis.

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SAT0476 COMPLIANCE AND PERSISTENCE OF ANTI-OSTEOPOROTIC TREATMENTS IN PATIENTS WITH HIP FRACTURE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2633 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1194.2-1195

Author(s):

S. Paredes ◽

M. Guinovart ◽

A. Basco ◽

C. Llop

Keyword(s):

Hip Fracture ◽

Health Service ◽

Hospital Discharge ◽

Treatment Time ◽

Osteoporotic Fractures ◽

Main Diagnosis ◽

Pharmacological Treatments ◽

Cross Sectional ◽

Good Compliance ◽

Number Of Patients

Background:Osteoporotic fractures have a high health and economic impact. The best strategy to minimize the incidence of fractures is, certainly, the prevention of these that includes pharmacological treatments. However, long-term discontinuation treatment and sub-optimal compliance of the treatment are common.Objectives:The aim of the study is to quantify the therapeutic compliance and permanence of the osteoporosis pharmacological treatments for patients who were discharged from hospitals in Catalonia with hip fracture during 2017.Methods:From the Hospital Discharge Database of the Catalan Health Service, all patients who had been discharged during 2017 were selected with the main diagnosis of femur fracture, according to the coding CIM-9. The consumption of drugs to assess compliance and permanence was obtained from the Catalan Health Service pharmacy Database. The study period was 18 months from the date of hospital discharge. Patients who died, moved to other areas or switched their treatment were excluded from the study. Good compliance was considered when sufficient drug was obtained to cover 80% of the time since treatment was prescribed until the end of the study period. In the case of denosumab, good post-fracture compliance was considered when the treatment time was remained at least 12 months. Permanence was considered positive if a drug had been obtained during the last three months of the study period. To compare the differences in compliance and permanence between the patients treated with different drugs, the chi-square statistic was used, considering statistically significant differences if p<0.05.Results:8,354 patients were discharged with the main diagnosis of hip fracture. Of these, 1,712 patients (20.49%) were treated after been discharged. After applying the exclusion criteria, the final sample was made up of 1,327 patients. 81,54% were women, and the median age was 84,79 years.The most commonly used treatments were bisphosphonates (69%), denosumab (23%) and teriparatide (7%)The results of good compliance and permanence of treatment were those described in the table.nCompliancePermanenceAlendronate86363,27%64,77%Alendronate+colecalciferol2774,07%81,48%Ibandronate366,67%100%Risedronate2339,13%60,87%Raloxifene1100%100%Bazedoxifene10%0%Teriparatide9976,77% (*)73,74%Denosumab31076,77% (*)74,52% (*)(*) p<0.05 for total bisphosphonates and for alendronateConclusion:The results obtained suggest that a small number of patients were treated after a hip fracture (20.49%) in addition the instituted treatments are followed in a suboptimal way. It is necessary to investigate which factors may lead to the detection of potential non-compliant patients. It seems appropriate to consider drugs that facilitate compliance and permanence of treatment.Our results suggest that denosumab and teriparatide improve compliance compared with oral bisphosphonates.The introduction of specific plans and cross-sectional health structures between levels of care should lead to improve detection, treatment and compliance in patients with osteoporosis.Disclosure of Interests:SILVIA PAREDES Consultant of: Amgen, Lilly, Ferrer, Roche, Novartis; BMS, Maria Guinovart: None declared, Aida Basco: None declared, Carles Llop: None declared

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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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