Risk Analysis for Second Hip Fracture in Patients After Hip Fracture Surgery: A Nationwide Population-Based Study

Objectives

The current treatment program for fragility hip fractures (HFx) emphasizes a combination of early surgery, rehabilitation, and tertiary prevention strategy for osteoporosis; however, the effect is unclear and little information is available on the risk factors predicting the occurrence of a second hip fracture (SHFx). The aim of this study was to explore the incidence, risk factors, and subsequent mortality of SHFx in patients after their first hip fracture surgery (HFxS).

Design, Setting, and Participants

We performed a nationwide population-based longitudinal observational study using the National Health Insurance Research Database (NHIRD) of Taiwan with a logistic regression model analysis. Of 87,415 patients undergoing HFxS during the period 2004 to 2007, we identified 8027 patients who had sustained an SHFx for analyses.

Measurements

Data collected included patient characteristics (demographics, comorbidities, and concurrent medication use), incidence and hazard ratios of SHFx after HFxS, and subsequent age-specific mortality.

Results

The overall incidence of SHFx was 9.18% and the age-specific mortality was increased 1.6- to 2.2-fold in patients with SHFx compared with those without after HFxS in this 7-year longitudinal study. The identified risk factors included age (AOR = 1.84, 95% CI: 1.24–2.89), female gender (AOR = 1.12, 95% CI: 1.03–2.30), obesity (AOR = 2.89, 95% CI: 1.81–3.01), diabetes (AOR = 3.85, 95% CI: 2.54–4.05), arterial hypertension (AOR = 2.45, 95% CI: 1.83–2.62), hyperlipidemia (AOR = 2.77, 95% CI: 1.27–3.19), stroke/TIA (AOR = 2.85, 95% CI: 2.20–3.23), blindness/low vision (AOR = 3.09, 95% CI: 2.54–3.73), and prolonged use of analgesics and anti-inflammatory medications (all AOR ≥ 3.05, all P values ≤.012). Bisphosphonate therapy after HFxS had a significant negative risk association with the development of an SHFx (20.8% vs 32.3%, P = .023; AOR = 2.24, 95% CI: 1.38–2.90).

Conclusion

We concluded that the occurrence of an SHFx and subsequent mortality in patients after HFxS is rather high. An understanding of the risk factors predicting the occurrence of an SHFx provides a valuable basis to improve health care for geriatric populations.     

老年人髋部骨折术后并发症预防及康复护理

随着人口老龄化的迅速发展，生活水平的提高，长寿之人也随之增多，老年人髋部骨折临床较多见，主要包括股骨颈及股骨粗隆间骨折。人工髋关节置换术、DHS及PFNA已被认为是治疗老年人髋部骨折的最佳治疗手段。其除了能改善患者关节活动度及稳定性外，还能够有效地缓解疼痛，提高肢体的功能状态，改善总体生存质量。老年人髋部骨折术后并发症包括感染、坠积性肺炎，肺栓塞、髋关节脱位、下肢静脉血栓形成、褥疮等，及时的处理、预防，减少并发症及康复护理是骨科治疗和护理的重要部分，护理人员必须运用科学的方法，对不同患者，不同训练时期的康复训练有针对性指导，并加强与医生、患者及家属的沟通，才能保证病人手术的成功。此外还要掌握老年人护理的特殊性，从而提高老年人护理工作效果，使这类病人术后得到早日康复。     

Nutritional Strategies in the Management of Alzheimer Disease: Systematic Review With Network Meta-Analysis

Background

Alzheimer disease (AD) is the major cause of dependency and disability in the elderly. Numerous studies have sought to achieve its prevention and/or management examining a role for modifiable risk factors, such as nutrition. This work aims to investigate the effects of food and/or nutrients in the management of AD at different stages.

Machine Learning Algorithms to Predict Mortality and Allocate Palliative Care for Older Patients With Hip Fracture

ObjectivesTo evaluate a machine learning model designed to predict mortality for Medicare beneficiaries aged >65 years treated for hip fracture in Inpatient Rehabilitation Facilities (IRFs).DesignRetrospective design/cohort analysis of Centers for Medicare & Medicaid Services Inpatient Rehabilitation Facility–Patient Assessment Instrument data.Setting and ParticipantsA total of 17,140 persons admitted to Medicare-certified IRFs in 2015 following hospitalization for hip fracture.MeasuresPatient characteristics include sociodemographic (age, gender, race, and social support) and clinical factors (functional status at admission, chronic conditions) and IRF length of stay. Outcomes were 30-day and 1-year all-cause mortality. We trained and evaluated 2 classification models, logistic regression and a multilayer perceptron (MLP), to predict the probability of 30-day and 1-year mortality and evaluated the calibration, discrimination, and precision of the models.ResultsFor 30-day mortality, MLP performed well [acc = 0.74, area under the receiver operating characteristic curve (AUROC) = 0.76, avg prec = 0.10, slope = 1.14] as did logistic regression (acc = 0.78, AUROC = 0.76, avg prec = 0.09, slope = 1.20). For 1-year mortality, the performances were similar for both MLP (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.96) and logistic regression (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.95).Conclusion and ImplicationsA scoring system based on logistic regression may be more feasible to run in current electronic medical records. But MLP models may reduce cognitive burden and increase ability to calibrate to local data, yielding clinical specificity in mortality prediction so that palliative care resources may be allocated more effectively.     

Sundown Syndrome,Sleep Quality,and Walking Among Community-Dwelling People With Alzheimer Disease

Purposes

Sundown syndrome and sleep disturbances cause people with Alzheimer disease (PAD) and caregivers suffering. Studies have indicated that physical exercise could have a positive impact on sundown syndrome, yet no research has ever explored the relationship between walking and sundown syndrome. The aims of this study were to examine the relationship between sundown syndrome and sleep quality, and determine whether the severity of dementia, sleep quality, and weekly duration of walking influenced sundown syndrome, and to assess differences in sundown syndrome and sleep quality in relation to the accompanying walker and weekly duration of walking among people with Alzheimer disease living in the community.

The Role of Prefracture Health Status in Physical and Mental Function After Hip Fracture Surgery

Objectives

To examine the associations of 3 measures of prefracture health status (physical function, mental function, and comorbidity count) with trajectories of physical and mental function at 1.5, 3, 6, and 12 months after hip fracture surgery.

Weight Loss and Nutritional Considerations in Alzheimer Disease

ABSTRACT

Weight loss is a common problem among both community-dwelling and institutionalized older adults with Alzheimer disease (AD) and is associated with mortality, morbidity, disease progression, and poor quality of life. The causes of weight loss in this population are multifaceted and include loss of appetite secondary to deterioration of brain regions associated with feeding behavior and functional and behavioral problems associated with AD that make it difficult for individuals to consume adequate energy. The most common weight management strategy is to provide high-energy nutritional supplements to individuals at risk of weight loss. Supplementation is generally effective but tends to be least beneficial for those with the lowest body mass indices. Environmental and social interventions related to mealtimes and feeding are also important.     

Effectiveness of Hip Protectors to Reduce Risk for Hip Fracture from Falls in Long-Term Care

ObjectiveTo generate evidence of the effectiveness of hip protectors to minimize risk of hip fracture at the time of falling among residents of long-term care (LTC) by contrasting rates of hip fractures between falls with and without hip protectors.DesignA 12-month, retrospective cohort study. We retrospectively reviewed fall incident reports recorded during the 12 months prior to baseline in participating homes.Setting and participantsA population-based sample comprising all residents from 14 LTC homes owned and operated by a single regional health authority, who experienced at least 1 recorded fall during the 12-month study.ResultsAt baseline, the pooled mean (standard deviation) age of residents in participating homes was 82.7 (11.3) years and 68% were female. Hip protectors were worn in 2108 of 3520 (60%) recorded falls. Propensity to wear hip protectors was associated with male sex, cognitive impairment, wandering behavior, cardiac dysrhythmia, use of a cane or walker, use of anti-anxiety medication, and presence of urinary and bowel incontinence. The incidence of hip fracture was 0.33 per 100 falls in falls with hip protectors compared with 0.92 per 100 falls in falls without hip protectors, representing an unadjusted relative risk (RR) of hip fracture of 0.36 (95% confidence interval 0.14–0.90, P = .029) between protected and unprotected falls. After adjusting for propensity to wear hip protectors, the RR of hip fracture was 0.38 (95% confidence interval 0.14–0.99, P = .048) during protected vs unprotected falls.Conclusions and implicationsHip protectors were worn in 60% of falls, and the risk of hip fracture was reduced by nearly 3-fold by wearing a hip protector at the time of falling. Given that most clinical trials have failed to attain a similar level of adherence, our findings support the need for future research on the benefits of dissemination and implementation strategies to maximize adherence with hip protectors in LTC.     

动力髋螺钉治疗老年人股骨转子间骨折的疗效评价

目的评价动力髋螺钉（DHS）治疗老年人股骨转子间骨折的临床疗效。方法对天津医科大学第二医院收治并采用DHS治疗的43例老年股骨转子间骨折患者进行随访,分析其治疗效果。结果随访6～18个月,术后6月所有患者骨折愈合良好,平均临床愈合时间为3．9个月,患髋关节功能优27例（62．8％）,良15例（34．9％）,差1例（2．3％）,优良率达97．7％。结论运用DHS治疗老年人股骨转子间骨折,能取得理想的治疗效果,是值得推广的内固定方法。     

全髋关节和双极人工股骨头置换术用于老年股骨颈骨折治疗的对比观察

目的：研究并分析全髋关节和双极人工股骨头置换术治疗老年股骨颈骨折的效果。方法：选择本院收治的60例老年股骨颈骨折患者为研究对象,按随机数字表法分为观察组与对照组,观察组采用全髋关节术进行治疗,对照组采用双极人工股骨头置换术进行治疗,对两组治疗疗效进行详细记录与分析。结果：两组在手术时间、术中出血量、引流量与住院时间以及手术1年优良率方面比较差异均无统计学意义（P＞0.05）;两组手术第2年与第3年手术优良率组间比较差异有统计学意义（P＜0.05）。结论：全髋关节置换术与双极人工股骨头置换术近期疗效相当,但全髋关节置换术的远期疗效优于双极人工股骨头置换术,该种手术方式值得在临床中推广和使用。     

Risk Factors for Hip Fracture and a Possible Effect Modification by Hormone Replacement Therapy. The Danish Nurse Cohort Study

Objective: To identify risk factors for hip fracture and to examine whether hormone replacement therapy (HRT) modifies the effect of these risk factors. Design: Prospective cohort study. Setting: The Danish Nurse Cohort Study. Participants: 14,015 female nurses aged 50 years and above who in 1993 completed a questionnaire on general health and lifestyle issues, reproductive history including information on HRT, and family history of osteoporosis and personal history of a wrist fracture. Outcome measures: End-point was the first-ever hip fracture registered in the Danish National Hospital Register during the period from 1993 to 1999. Results: During the follow-up period 245 hip fractures were identified. Ever users of HRT had a lower risk of hip fracture (hazard ratio 0.69; 0.50–0.94). Women reporting a poor health (hazard ratio 2.01; 1.30–3.11), restrictions in daily activities (hazard ratio 1.52; 1.05–2.21), low body mass index (hazard ratio 1.65; 0.98–2.77), and leisure time sedentary physical activity (hazard ratio 1.88; 1.30–2.70) were main identified risk factors for hip fracture. HRT did not modify the effect of risk factors on the risk of hip fracture. Conclusion: This study confirms that women with a frail health are at increased hip fracture risk and that ever use of HRT decreases the risk of hip fracture. HRT did not modify the effect of these risk factors, indicating that the preventive effect of this therapy is independent of risk factors.     

The Broken Lens of BPSD: Why We Need to Rethink the Way We Label the Behavior of People Who Live With Alzheimer Disease

For the past 20 years, the behaviors of people who live with dementia (PLWD) that others find challenging or problematic have primarily been ascribed to Alzheimer disease and related dementias and have been assessed through the biomedical lens of Behavioral and Psychological Symptoms of Dementia (BPSD). This has led to the root causes of these behaviors being overlooked, which in turn leaves them unaddressed. Further, using the artificial construct of BPSD has led to many PLWD being inappropriately prescribed (off-label) medications that are largely ineffective in resolving the behaviors because they do nothing to remedy the underlying psychosocial and environmental causes. The fact that many of the behaviors we call BPSD are normal human responses to particular sets of circumstances can be relatively easily demonstrated by directly observing the individual behaviors of PWLD, and putting them in context, as well as by asking ourselves how we would respond under similar conditions. Re-evaluating the use of the construct of BPSD, and replacing it with a person-centered rather than disease-focused approach will result in better care as well as healthier and happier long-term care residents and staff.     

髋关节置换治疗老年性股骨颈骨折临床分析

目的：探讨在老年性股骨颈股骨折中进行髋关节置换术的临床作用。方法：选取本科室2009年1月-2013年1月收治的90例老年股骨颈股骨折患者,按照随机数字表法将其分为对照组和观察组各45例,其中对照组采用双极人工股骨头置换术治疗,观察组采用人工全髋关节置换术治疗,观察比较两组的治疗效果及手术时间、术中出血量、引流量、住院时间的差异。结果：观察组的手术时间明显长于对照组,术中出血量明显高于对照组,差异均有统计学意义（P〈0.05）,但两组引流量和住院时间的比较差异均无统计学意义（P〉0.05）。观察组的优良率95.56%（43/45）明显高于对照组的66.67%（30/45）,且随访3年的优良率均明显高于对照组,差异均有统计学意义（P〈0.05）。其中观察组第1年与第3年的优良率比较差异无统计学意义（P〉0.05）,而对照组第1年与第3年的优良率比较差异有统计学意义（P〈0.05）。结论：经临床研究证明,全髋关节置换术治疗效果以及远期疗效均明显优于双极人工股骨头置换术,但手术时间以及出血量均明显多于双极人工股骨头置换术,因此可根据患者具体机体情况来选择合适的手术方法。     

Cost-Effectiveness of Fondaparinux Compared with Enoxaparin as Prophylaxis against Venous Thromboembolism in Patients Undergoing Hip Fracture Surgery

OBJECTIVE: To evaluate the cost-effectiveness of fondaparinux relative to enoxaparin as prophylaxis against venous thromboembolism (VTE) in patients undergoing hip fracture surgery. METHODS: A decision analysis model was created to simulate the impact of fondaparinux 2.5 mg once daily relative to enoxaparin 30 mg twice daily on patient outcomes and costs over various time points up to 5 years after surgery. Probabilities for the analysis were estimated for a hypothetical cohort of 1000 patients undergoing hip fracture surgery in the United States receiving either fondaparinux or enoxaparin according to comparative trial results. Resource use and costs (2003 dollars) were obtained from large health-care databases. Outcome measures were rates of symptomatic VTE events, health-care costs, and incremental cost-effectiveness ratios. RESULTS: Fondaparinux is estimated to prevent an additional 30 VTE events (per 1000 patients) at 3 months compared with enoxaparin, producing savings of 103 dollars at discharge, 290 dollars over 1 month, 361 dollars over 3 months, and 466 dollars over 5 years. The results remain robust to clinically plausible variation in input parameters and assumptions. CONCLUSIONS: Fondaparinux improves outcomes and is cost-saving over a broad range of assumptions compared with enoxaparin for prophylaxis of VTE after hip fracture surgery.     

Age,Sex, and Dose Effects of Nonbenzodiazepine Hypnotics on Hip Fracture in Nursing Home Residents

Objective

The Food and Drug Administration recommends a reduced dose of nonbenzodiazepine hypnotics in women, yet little is known about the age-, sex-, and dose-specific effects of these drugs on risk of hip fracture, especially among nursing home (NH) residents. We estimated the age-, sex-, and dose-specific effects of nonbenzodiazepine hypnotics on the rate of hip fracture among NH residents.

全髋关节置换术治疗老年股骨颈骨折效果分析

目的观察人工股骨头置换术与全髋关节置换术治疗老年股骨颈骨折的临床价值。方法随机将本院2017年9月—2018年9月收治的60例股骨颈骨折老年患者分为两组,每组30例。对照组行人工股骨头置换术,观察组行全髋关节置换术。观察两组优良率、并发症发生率。结果(1)观察组髋关节功能恢复优良率(93.33%)明显高于对照组(70.00%),差异有统计学意义(P<0.05);(2)观察组并发症发生率(6.67%)明显优于对照组(26.67%),差异有统计学意义(P<0.05)。结论全髋关节置换术能够有效治疗股骨颈骨折,不仅有利于快速恢复髋关节功能,且并发症发生率低,手术安全性高,可作为治疗股骨颈骨折的一线方案。     

某传染病医院患者医院感染危险因素及其风险级别分析

目的探讨传染病患者医院感染危险因素及其风险级别。方法对2018年度332例医院感染病例进行回顾性调查,开展病例对照研究将t检验或χ2检验筛选出的P<0.2的有临床意义的变量,用于构建Logistic回归模型,确定医院感染的危险因素,并利用OR值对其风险级别进行排序。结果排除了其他混杂因素的影响后,发现长期卧床、采用激素治疗、血管导管植入、穿刺是该传染病医院患者发生医院感染的独立危险因素,其风险级别依次是血管导管植入(2.4)>长期卧床(2.0)>采用激素治疗(1.7)>穿刺(1.6)。结论对存在血管导管植入、长期卧床、采用激素治疗或穿刺等危险因素的患者,按照风险级别,提前进行针对性干预,可提高医院感染防控效能。