umu.sePublikasjoner
Endre søk
RefereraExporteraLink to record
Permanent link

Direct link
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annet format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annet språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Malnutrition in hip fracture patients: an intervention study.
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.ORCID-id: 0000-0002-3754-5026
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Ortopedi.
Vise andre og tillknytning
2007 (engelsk)Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 16, nr 11, s. 2027-2038Artikkel i tidsskrift (Fagfellevurdert) Published
sted, utgiver, år, opplag, sider
2007. Vol. 16, nr 11, s. 2027-2038
HSV kategori
Identifikatorer
URN: urn:nbn:se:umu:diva-8289DOI: 10.1111/j.1365-2702.2006.01864.xPubMedID: 17419798OAI: oai:DiVA.org:umu-8289DiVA, id: diva2:147960
Tilgjengelig fra: 2008-01-16 Laget: 2008-01-16 Sist oppdatert: 2018-06-09bibliografisk kontrollert
Inngår i avhandling
1. Old people with femoral neck fracture: delirium, malnutrition and surgical methods - an intervention program
Åpne denne publikasjonen i ny fane eller vindu >>Old people with femoral neck fracture: delirium, malnutrition and surgical methods - an intervention program
2007 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Hip fracture is a global and a growing public health problem. More women than men sustain hip fractures, the incidence increases exponentially with age and mean age is above 80. About one third of hip-fracture patients suffer from dementia and are prone to develop acute confusional state (delirium). Delirium is one of the most common complications after hip-fracture surgery, and seriously impacts on morbidity and mortality. Malnutrition is also common in hip-fracture patients and is associated with postoperative complications, such as delayed healing of the wound, infections and decubitus ulcers. Arthroplasty is usually preferred procedure in displaced femoral neck fractures but is, however, controversial in patients with dementia due to the fear of dislocation of the prosthesis.

The aims of this thesis are to identify risk factors for delirium and the impact of delirium on rehabilitation outcome, to evaluate whether a postoperative multi-factorial intervention program could reduce delirium, to investigate the effect of a nutritional intervention and to evaluate complications, functional outcome and mortality regarding two surgical methods, hemiarthroplasty (HAP) and internal fixation (IF), in old patients with femoral neck fracture.

Thirty-eight out of 61 consecutive patients (62%) were delirious on admission to hospital or developed postoperative delirium. An increased risk of postoperative delirium was found among hip-fracture patients with dementia and/or depression. Delirious patients were hospitalized longer, were more dependent in their activities of daily living, had poorer psychological well-being and suffered more complications than non-delirious patients.

A postoperative multi-factorial and multidisciplinary intervention program reduced the incidence, at 55% vs 75% (p=0.003), and number of days with delirium, 5 vs 10 days (p=0.009). Postoperative complications were also reduced; decubitus ulcers 9% vs 22% (p= 0.010), urinary tract infections 31% vs 51% (p=0.005), falls 12% vs 27% (p=0.007), and the mean hospitalization period was 10 days shorter in the intervention group (p=0.030). Malnutrition was common among all these patients (53 %) and associated with postoperative complications such as decubitus ulcers and delirium. However, the nutritional intervention had no effect on nutritional parameters at four months, nevertheless men had better nutritional outcomes than women.

A higher proportion of patients with dementia operated on using HAP had regained their pre-fracture ability to walk independently at the one-year follow up compared with those operated on using IF. Six of 83 patients dislocated their HAP during hospitalization and during an episode of delirium, none had dementia. No difference in mortality between the surgical methods was seen. Dementia per se should not be a reason to disqualify patients from being treated with the most appropriate surgical method.

It is clinically important to discriminate between dementia and delirium, since delirium can be prevented and treated even in patients with dementia. Old patients undergoing surgery have special needs that are not always catered for in ordinary orthopaedic or surgical wards. The special care for these patients should include: a combined nursing and medical care based on comprehensive geriatric assessments, systematic prevention, detection and treatment of postoperative complications such as delirium, hypoxemia, urinary tract infections, pain, malnutrition and an active rehabilitation. It is obvious that improved quality of care reduces patient suffering and seemingly the costs for society.

sted, utgiver, år, opplag, sider
Umeå: Kirurgisk och perioperativ vetenskap, 2007. s. 89
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1093
Emneord
delirium, hip fracture, older people, orthopaedics, internal fixation, arthroplasty cognitive impairment, dementia, nursing, rehabilitation, femoral neck fracture, RCT, intervention, geriatric team, malnutrition, nurses
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-1049 (URN)978-91-7264-286-7 (ISBN)
Disputas
2007-04-13, Sal B, Tandläkarhögskolan, 9 tr, 901 85, Umeå, 09:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2007-03-22 Laget: 2007-03-22 Sist oppdatert: 2018-06-09bibliografisk kontrollert

Open Access i DiVA

Fulltekst mangler i DiVA

Andre lenker

Forlagets fulltekstPubMedhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=17419798&dopt=Citation

Personposter BETA

Olofsson, BirgittaStenvall, MichaelLundström, MariaSvensson, OlleGustafson, Yngve

Søk i DiVA

Av forfatter/redaktør
Olofsson, BirgittaStenvall, MichaelLundström, MariaSvensson, OlleGustafson, Yngve
Av organisasjonen
I samme tidsskrift
Journal of Clinical Nursing

Søk utenfor DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric

doi
pubmed
urn-nbn
Totalt: 696 treff
RefereraExporteraLink to record
Permanent link

Direct link
Referera
Referensformat
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annet format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annet språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf