Older patients with hip fractures: evaluation of a long-term specialist orthopaedic medicine service in their outcomes.
OBJECTIVE
To evaluate the long-term outcomes of a specialist orthopaedic medicine service in older patients up to 12 months after hip fracture.


METHODS
All patients over the age of 65 years admitted with hip fracture under the shared care of geriatricians and orthopaedic surgeons over a 6-month period were identified in an initial audit. A follow-up postal questionnaire was sent to those patients asking about their place of domicile, level of functioning, compliance with osteoporosis treatment, and whether they had sustained further fractures in the 12 months following discharge from hospital. Mortality was also recorded.


RESULTS
The 1-year mortality of the 149 patients discharged from hospital following their hip fracture (who were identified in the initial audit) was 18.8%. There were 69 (46.3%) responses to the questionnaire. The mean age of respondents was 81.3 years (range 66-98 years). At discharge, only 5 of 69 (7.2%) patients were independent in their walking, 13 (18.8%) walked with the aid of a stick, 39 (56.5%) with a frame, 7 (10.1%) required supervision, and 5 (7.2%) were immobile. Excluding those who were immobile prior to their hip fracture, 31 of 64 (48.4%) of patients regained their pre-morbid level of mobility at 12 months. At discharge, 27 of 69 (39.1%) patients were independent with activities of showering, dressing, and toileting--with 42 of 64 (65.6%) independent at 12 months. At discharge, 57 of 69 (82.6%) patients were on calcium and vitamin D, and 5 (7.2%) on alendronate. At 12 months, 50 of 64 (78.1%) remained on calcium, 40 (62.5%) on vitamin D, and 26 (40.6%) on alendronate. Five of 64 (7.8%) patients experienced a total of 11 further osteoporotic fractures at 12 months, but no further hip fractures. Of respondents discharged home, 44 of 50 (88%) remained at home at 12 months.


CONCLUSIONS
Shared care between geriatricians and orthopaedic surgeons for older hip fracture patients appears to be associated with a reduced 1-year mortality, improved treatment of osteoporosis, and return to home. Many patients, however, continue to have impaired function and mobility.
Thwaites
John
J
Older Persons Health, The Princess Margaret Hospital, Christchurch. john.thwaites@cdhb.govt.nz
Mann
Fazal
F
Gilchrist
Nigel
N
McKie
John
J
Sainsbury
Richard
R
D000203:Activities of Daily Living; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D005853:Geriatrics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000458:organization & administration*; D006620:Hip Fractures / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration*; D008137:Longitudinal Studies; D008297:Male; D051346:Mobility Limitation; D009520:New Zealand / Q000453:epidemiology; D009985:Orthopedics / Q000458:organization & administration* / Q000706:statistics & numerical data; D010024:Osteoporosis / Q000453:epidemiology / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017678:Sex Distribution; D016019:Survival Analysis