Factors predicting 12-month outcome of elderly patients admitted with hip fracture to an acute care hospital

Elderly patients (n = 121) with hip fracture were followed to determine if: (1) outcomes measured 12 months post-fracture differed significantly from pre-fracture measures, and (2) patient characteristics on hospital admission predicted three outcomes (site of residence, function, and walking status) 12 months later. At 12 months fewer patients resided at home. They had declined functionally. Baseline cognition, residence site, function, and walking individually predicted outcomes. However, outcomes were predicted best by multiple variables. These findings can be used to educate patients, their families, and the public on outcomes and their determinants after hip fracture.     

Socio-economics on care for the elderly patients with hip fracture

We conducted research on elderly patients with hip fracture. It started with investigating relationship between the length of stay (LOS) and walking ability as the chosen indicator for outcome. We then used extended LOS that included days at transferred hospitals, and also conducted cost performance analysis. Thirdly, procedure and schedule were compared among UK, US, and Japan. We found positive relationship between LOS and walking ability. LOS required to gain final walking ability was shorter when a single hospital completed procedure. Japan had more than 3 times longer LOS than the other two countries, due to more variety of procedure and longer interval between steps. New guideline on treatment process is awaited, and outcome-based measurement should be included in calculating reimbursement.     

老年髋部骨折78例的治疗

目的探讨老年髋部骨折手术治疗的安全性和有效性。方法回顾分析78例70岁以上老年髋部骨折（股骨颈骨折和股骨粗隆间骨折）患者手术治疗经过和围手术期管理措施,根据患者体质状况和骨折类型选择相应手术方式。结果对治疗结果进行为期10～32个月的随访观察,功能恢复优良率92．3％,无早期死亡病例。结论对无手术禁忌证的老年髋部骨折,只要做好术前评估和准备,选择适当方式进行手术治疗是安全有效的,可避免长期卧床并发症,早期进行功能锻炼,促进肢体功能恢复,提高生活质量。     

老年髋部骨折患者围手术期的护理

目的总结老年髋部骨折患者围手术期的护理要点。方法 2010年6月~2013年9月对本院收治的95例老年髋部骨折患者进行人工关节置换术或内固定术,护士配合做好术前、术后围手术期护理工作。结果 95例患者术后均康复出院,住院时间11 d~28 d,平均(17.5±2.5)d,术后1例患者发生肺炎,1例患者发生切口感染,经治疗护理后治愈。结论住院期间,护士应积极做好老年患者围手术期护理,根据其心理、生理特点,做好心理护理工作,有针对性地预防和处理术后并发症,指导患者进行康复训练,其可促进患者尽快增强日常生活能力,促进康复。     

骨折类型与老年髋部骨折术后疗效分析

目的探讨老年髋部骨折类型对术后疗效的影响。方法 2007年4月至2008年11月收治老年髋部骨折患者121例。入组后根据X线表现将髋部骨折分为非移位型股骨颈骨折、移位型股骨颈骨折、稳定型股骨转子间骨折和非稳定型股骨转子间骨折四种。详细记录患者并存症、手术细节、术后并发症等。观察四组患者住院期间、术后6个月、12个月四种骨折患者的死亡率以及功能恢复情况。结果符合入选标准93例,其中不稳定型股骨转子间骨折22例,稳定型股骨转子间骨折30例,移位型股骨颈骨折19例,非移位型股骨颈骨折22例。四组患者年龄、并存症等一般情况差异无统计学意义。住院期间、术后6个月移位型股骨颈骨折患者死亡率较其他三组高,但差异无统计学意义;而术后12个月不稳定型股骨转子间骨折患者死亡率较其他三组明显升高。此外出院时移位型股骨颈骨折患者ADL评分较其他三组明显升高;术后6个月、12个月四组患者ADL评分差异无统计学意义。结论排除自身差异后,髋部骨折类型对术后疗效具有一定影响。早期(住院期间、术后6个月)移位型股骨颈骨折死亡率较其他三种类型骨折高,晚期(术后12个月)不稳定型股骨转子间骨折死亡率较其他三种类型髋部骨折高。骨折类型对术后功能恢复...     

Rehabilitation outcome of elderly patients with hip fracture and cognitive impairment

Purpose:?To assess the association between cognitive status and functional gain during a rehabilitation programme for elderly patients with hip fracture.

Method:?Prospective study in a hospital geriatric rehabilitation unit. Sixty-one consecutive patients were studied: 28 with cognitive impairment (age 87.6?±?7.2 years, Mini Mental State Examination (MMSE) score 11.25?±?5.9), 23 with possible cognitive impairment (age 83.9?±?6.8 years, MMSE 22.65?±?1.6) and 10 without cognitive impairment (age 77.6?±?7.4 years, MMSE 29.5?±?0.9). Cognitive status was assessed with the MMSE and admission and discharge functional status with the Functional Independence Measure (FIM). Functional gain was calculated by absolute FIM gain (admission FIM minus discharge FIM), relative (to maximum potential) FIM gain with the Montebello Rehabilitation Factor Score (MRFS) and analysis of covariance of the FIM (ANCOVA).

Results:?Patients without cognitive impairment had significantly higher admission FIM and discharge FIM. Cognitive status was not significantly associated with absolute functional gain. The adjusted (age, gender, sensory impairment, nutritional status, comorbidity and treatment) MRFS score of cognitively impaired patients was significantly lower (p?<?0.03). However, the functional gain related to baseline functional status (ANCOVA) was not significantly different between the groups.

Conclusions:?In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes.     

Rehabilitation outcome of elderly patients with hip fracture and cognitive impairment

PURPOSE: To assess the association between cognitive status and functional gain during a rehabilitation programme for elderly patients with hip fracture. METHOD: Prospective study in a hospital geriatric rehabilitation unit. Sixty-one consecutive patients were studied: 28 with cognitive impairment (age 87.6 +/- 7.2 years, Mini Mental State Examination (MMSE) score 11.25 +/- 5.9), 23 with possible cognitive impairment (age 83.9 +/- 6.8 years, MMSE 22.65 +/- 1.6) and 10 without cognitive impairment (age 77.6 +/- 7.4 years, MMSE 29.5 +/- 0.9). Cognitive status was assessed with the MMSE and admission and discharge functional status with the Functional Independence Measure (FIM). Functional gain was calculated by absolute FIM gain (admission FIM minus discharge FIM), relative (to maximum potential) FIM gain with the Montebello Rehabilitation Factor Score (MRFS) and analysis of covariance of the FIM (ANCOVA). RESULTS: Patients without cognitive impairment had significantly higher admission FIM and discharge FIM. Cognitive status was not significantly associated with absolute functional gain. The adjusted (age, gender, sensory impairment, nutritional status, comorbidity and treatment) MRFS score of cognitively impaired patients was significantly lower (p < 0.03). However, the functional gain related to baseline functional status (ANCOVA) was not significantly different between the groups. CONCLUSIONS: In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes.     

老年髋部骨折患者围术期感染的危险因素分析

摘要 目的 分析老年髋部骨折围术期感染现状及其危险因素。方法 采用回顾性分析方法,对我院380例住院老年髋部骨折患者临床资料进行统计分析,分析围手术期感染危险因素。结果 纳入研究的老年髋部骨折患者380例,发生围手术期感染者117例,围手术期感染率为30.79%。Logistic 多因素回归分析显示,住院天数和术后用药天数是老年髋部骨折患者发生围术期手术相关感染的独立危险因素。结论 根据发现的主要危险因素,尽早评估导尿管拔除时间,减少住院天数,合理使用抗菌药物成为防控围手术期感染的主要措施。     

高龄髋部骨折病人围术期的观察及护理

随着社会发展,人寿命延长,高龄老人越来越多,髋部骨折高龄病人也逐年增多.保守治疗时间长,往往骨折还没愈合,并发症就已夺去老人生命.现代医学观点认为:高龄不再是髋部手术的禁忌证,手术治疗目前已成为首选[1].恰当正确地做好每一个环节的护理,是保证手术成功的重要因素.我院2004年2月-2008年7月,共手术治疗此类高龄病人(≥80岁)52例,现将理方面的体会总结如下.     

高龄患者行人工髋关节置换术围手术期并发症相关因素分析

目的分析髋关节假体置换术围手术期内并发症发生的相关因素,探讨高龄患者行人工髋关节置换术的安全性和有效性.方法对63例高龄患者进行人工髋关节置换手术,平均年龄82.3岁.对患者术前进行全面评估并对围手术期内并发症发生状况进行分析.结果患者术后髋关节评分平均提高20.5分(Harris评分),38例患者围手术期内存在并发症,不同分级患者术后并发症发生率不同.结论高龄患者行人工髋关节置换术后并发症发生率高,高龄患者行人工髋关节置换术在缓解疼痛、改善髋关节功能方面具有较高安全性和可靠性.     

老年髋部骨折患者心理特征对早期康复锻炼依从性的影响

目的探讨老年髋部骨折患者心理特征对早期康复锻炼依从性的影响。方法使用医院焦虑抑郁量表、多纬度健康状况心理控制源量表、医学应对方式问卷和自制的早期康复锻炼依从性评价表,对58例老年髋部骨折术后住院患者进行调查和分析。应用Logistic回归分析心理特征与早期康复锻炼依从性的关系。结果18例患者早期康复锻炼的依从性不佳,占31．03％;患者抑郁、健康心理控制源和医学应对方式对术后早期康复锻炼依从性有显著影响（P〈0．01）。结论重视老年髋部骨折患者抑郁、健康心理控制源和医学应对方式对早期康复锻炼依从性的影响,采取针对性护理措施,最大限度地恢复和改善肢体功能。     

多学科协作下的ERAS理念在老年髋骨骨折患者围手术期护理中的应用效果

目的 探讨多学科协作下的加速康复外科(ERAS)理念在老年髋骨骨折患者围手术期护理中的应用效果.方法 选取122例老年髋骨骨折患者为研究对象,采用随机数字表法将其分为对照组和观察组,各61例.对照组给予常规围术期护理干预,观察组在对照组基础上给予多学科协作下的ERAS理念干预.比较两组的护理干预效果.结果 观察组的住院...     

老年髋部骨折伴酒精戒断综合征病人的围术期护理

随着人口的老龄化,老年性骨质疏松症发生率增加、骨脆性增加,老年人易发生骨折,髋部骨折的发生率逐年增高。髋部骨折指股骨颈和转子间骨折,尤其老年病人,轻微暴力即可发生,是骨质疏松造成的病理骨折。对于股骨转子问骨折、股骨颈骨折,根据病人不同需求、不同就医条件而采取的治疗方法不同。酒精戒断综合征（AWS）是指长期大量饮酒的酒依赖病人在突然中断饮酒或减少酒精摄入量时出现的各种精神障碍或自主神经功能紊乱,     

老年髋部骨折伴酒精戒断综合征病人的围术期护理

随着人口的老龄化,老年性骨质疏松症发生率增加、骨脆性增加,老年人易发生骨折[1],髋部骨折的发生率逐年增高.髋部骨折指股骨颈和转子间骨折,尤其老年病人,轻微暴力即可发生,是骨质疏松造成的病理骨折.     

住院老年髋部骨折术后患者康复护理需求的调查分析

目的 了解老年髋部骨折术后患者康复护理及模式需求程度、需求满足度。方法 对我院2012年1月至2012年12月行骨科手术治疗的41位老年髋部骨折患者进行问卷调查。结果 康复需求10 个维度中他人支持、出院后续康复及功能训练指导位居前3 位,护士与治疗师相结合的康复模式,也是患者最需要的。结论 护士早期给予针对性的康复训练指导和健康教育是患者迫切的需求; 康复需求程度高者, 相应需求满足率低, 其生活质量及髋关节功能恢复应成为干预的重点。     

Five-year experience with the 'Sheba' model of comprehensive orthogeriatric care for elderly hip fracture patients

Background and purpose: The Sheba model of orthogerioatric medicine is a unique model of in-hospital care for elderly hip fractured patients, based upon the concept that a hip fracture represents a geriatric, rather than an orthopedic disease. The nature and feasibility of such a comprehensive orthogeriatric unit, taking care of all surgical, medical and rehabilitation needs, in a single geriatric-based setting (rather than orthopedic-based), were questioned. The aim of the study is to describe the results of its operation during a five-year period.

Method: A retrospective charts analysis of consecutive older patients with hip fractures, admitted from the emergency unit directly to the orthogeriatric unit of a department of geriatric medicine.

Results: A total number of 592 patients were admitted. Mean age of patients was 83.2 years, mostly women. A total of 538 (91%) were treated surgically. Delay to surgery was 3.6 ± 2.9 days. A total of 65.6% were suitable for rehabilitation, and had a mean Functional Independence Measure (FIM) gain of 22.3 ± 7.9. Mean total hospital length of stay was 29.9 days and 68.7% of patients returned to their previous living residence. Rates of major complications (4.1%) and in-hospital mortality (3.2%, equivalent to 30 days mortality) were low.

Conclusions: Treatment within this unit was associated with low rates of major morbidity and mortality, short stay and acceptable functional outcomes. The data provide clinical evidence supporting the implementation of this model of comprehensive orthogeriatric care, being a practical, applicable and feasible service for elderly hip fractured patients, and covering the various needs of these patients. The present model of organization could also help in skillful use of economic resources, facilitating effective treatment strategies.