title: Patient and system factors of mortality after hip fracture: a scoping review.
abstract: BACKGROUND
  Several patient and health system factors were associated with the risk of death among patients with hip fracture. However, without knowledge of underlying mechanisms interventions to improve survival post hip fracture can only be designed on the basis of the found statistical associations.
  
  
  METHODS
  We used the framework developed by Arksey and O'Malley and Levac et al. for synthesis of factors and mechanisms of mortality post low energy hip fracture in adults over the age of 50 years, published in English, between September 1, 2009 and October 1, 2014 and indexed in MEDLINE. Proposed mechanisms for reported associations were extracted from the discussion sections.
  
  
  RESULTS
  We synthesized the evidence from 56 articles that reported on 35 patient and 9 system factors of mortality post hip fracture. For 21 factors we found proposed biological mechanisms for their association with mortality which included complications, comorbidity, cardiorespiratory function, immune function, bone remodeling and glycemic control.
  
  
  CONCLUSIONS
  The majority of patient and system factors of mortality post hip fracture were reported by only one or two articles and with no proposed mechanisms for their effects on mortality. Where reported, underlying mechanisms are often based on a single article and should be confirmed with further study. Therefore, one cannot be certain whether intervening on such factors may produce expected results.
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada. sheehakj@mail.ubc.ca.
authors.forename: K J
authors.initials: KJ
authors.lastname: Sheehan
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Sobolev
authors.affiliation: Centre for Hip Health and Mobility, Vancouver, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Chudyk
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Stephens
authors.affiliation: Centre for Hip Health and Mobility, Vancouver, Canada.|Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Guy
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000072599:Cardiorespiratory Fitness / Q000502:physiology; D016330:Frail Elderly; D038321:Glycemic Index / Q000502:physiology; D006620:Hip Fractures / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors
keywords: Hip fracture; Mortality; Patient factors; Scoping review; System factors