title: Geriatric intervention in elderly patients with hip fracture in an orthopedic ward.
abstract: BACKGROUND
  Hip fracture is a common cause of long hospital stay in the elderly. Approximately one third of these patients die within the first year. As a consequence geriatric and orthopedic collaboration (orthogeriatrics) has been organized in different ways. The aim of this study is to evaluate the efficiency of a multidisciplinary geriatric in-hospital intervention on patient outcome.
  
  
  METHODS
  A total of 495 elderly hip fracture patients consecutively admitted to orthopedic surgery, were followed. Data were based on medical records. The intervention group (n=233) was compared to a historical cohort group (n=262) receiving traditional orthopedic treatment. Intervention program was based on initial physical and mental screening and evaluation, geriatric-focused care, and early discharge planning. The intervention was provided by a multidisciplinary geriatric team. After discharge, follow-up home-visits by a physiotherapist were performed, except for patients discharged to nursing homes, due to a 24-hour staff and easy access to the GP.
  
  
  RESULTS
  Median length of stay was reduced from 15 to 13 days. More patients began treatment with calcium/vitamin-D and bisphosphonate (p=sig). There was no difference in hemoglobin variation between the time of admission and three to six months post admission, and no difference in three-month readmissions (odds ratio (OR) = 1.09 [95%CI: 0.71;1.67]). Discharge destination was unchanged (OR=0.93 [95%CI: 0.52; 1.65]). In-hospital mortality was 8% in the intervention group vs. 6% (p=0.48), in the control group. Three-month mortality was 16% in the intervention group vs. 15% (p=0.39), in the control group. In the intervention group, residents from nursing homes had a higher three-month mortality (OR=2.37 [95% CI: 0.99; 5.67]), and the risk of new fractures within two years decreased from 9.5% to 7.7%, though not statistically significant.
  
  
  CONCLUSIONS
  Our study indicates that co-management of hip fracture patients by orthopedic surgeons and geriatricians may be associated with a reduction in length of hospital stay without negatively affecting major patient outcomes. The concept should be further developed particularly among the frail elderly.
authors.affiliation: Department of Geriatrics, Aarhus University Hospital, DK-8000 Aarhus, Denmark. meregreg@rm.dk
authors.forename: Merete
authors.initials: M
authors.lastname: Gregersen
authors.forename: Marianne Metz
authors.initials: MM
authors.lastname: Mørch
authors.forename: Kjeld
authors.initials: K
authors.lastname: Hougaard
authors.forename: Else Marie
authors.initials: EM
authors.lastname: Damsgaard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002136:Calcium, Dietary / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D003266:Continuity of Patient Care; D003718:Denmark; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000628:therapy*; D006699:Home Care Services; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes; D010024:Osteoporosis / Q000188:drug therapy / Q000453:epidemiology; D010348:Patient Care Team; D010351:Patient Discharge; D010359:Patient Readmission; D018802:Patient-Centered Care; D012189:Retrospective Studies; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D004164:Diphosphonates; D014807:Vitamin D