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Consequences of a hip fracture among old people
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2017. , p. 99
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1923
Keywords [en]
Hip fracture, geriatric care, home rehabilitation, interdisciplinary rehabilitation, randomized control trial, accidental falls, complications, cause of death, walking ability, length of stay
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:umu:diva-142128ISBN: 978-91-7601-786-9 (print)OAI: oai:DiVA.org:umu-142128DiVA, id: diva2:1159509
Public defence
2017-12-15, Vårdvetarhusets aula, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-11-24 Created: 2017-11-22 Last updated: 2018-12-18Bibliographically approved
List of papers
1. Co-morbidities, complications and causes of death among people with femoral neck fracture: a three-year follow-up study
Open this publication in new window or tab >>Co-morbidities, complications and causes of death among people with femoral neck fracture: a three-year follow-up study
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2016 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, article id 120Article in journal (Refereed) Published
Abstract [en]

Background: The poor outcome after a hip fracture is not fully understood. The aim of the study was to describe the prevalence of co-morbidities, complications and causes of death and to investigate factors that are able to predict mortality in old people with femoral neck fracture. Methods: Data was obtained from a randomized, controlled trial with a 3-year follow-up at Umea University Hospital, Sweden, which included 199 consecutive patients with femoral neck fracture, aged >= 70 years. The participants were assessed during hospitalization and in their homes 4, 12 and 36 months after surgery. Medical records and death certificates were analysed. Results: Multivariate analysis revealed that cancer, dependence in P-ADL (Personal Activities of Daily Living), cardiovascular disease, dementia at baseline or pulmonary emboli or cardiac failure during hospitalization were all independent predictors of 3-year mortality. Seventy-nine out of 199 participants (40 %) died within 3 years. Cardiovascular events (24 %), dementia (23 %), hip-fracture (19 %) and cancer (13 %) were the most common primary causes of death. In total, 136 participants suffered at least one urinary tract infection; 114 suffered 542 falls and 37 sustained 56 new fractures, including 13 hip fractures, during follow-up. Conclusion: Old people with femoral neck fracture have multiple co-morbidities and suffer numerous complications. Thus randomized intervention studies should focus on prevention of complications that might be avoidable such as infections, heart diseases, falls and fractures.

Keywords
Hip fracture, Cause of death, Complications
National Category
Geriatrics Nursing
Identifiers
urn:nbn:se:umu:diva-123051 (URN)10.1186/s12877-016-0291-5 (DOI)000377191100002 ()27260196 (PubMedID)
Available from: 2016-08-15 Created: 2016-06-27 Last updated: 2018-06-07Bibliographically approved
2. Evaluation of a fall-prevention program in older people after femoral neck fracture: a one-year follow-up
Open this publication in new window or tab >>Evaluation of a fall-prevention program in older people after femoral neck fracture: a one-year follow-up
2008 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 19, no 6, p. 801-809Article in journal (Refereed) Published
Abstract [en]

A randomized, controlled fall-prevention study including 199 patients operated on for femoral neck fracture reduced inpatient falls and injuries. No statistically significant effects of the intervention program could be detected after discharge. It seems that fall-prevention must be part of everyday life in fall-prone old people. Introduction This study evaluates whether a postoperative multidisciplinary, multifactorial fall-prevention program performed by a geriatric team that reduced inpatient falls and injuries had any continuing effect after discharge. The intervention consisted of staff education, systematic assessment and treatment of fall risk factors and vitamin D and calcium supplementation. Methods The randomized, controlled trial with a one-year follow-up at Umea University Hospital, Sweden, included 199 patients operated on for femoral neck fracture, aged >= 70 years. Results After one year 44 participants had fallen 138 times in the intervention group compared with 55 participants and 191 falls in the control group. The crude postoperative fall incidence was 4.16/1,000 days in the intervention group vs. 6.43/1,000 days in the control group. The incidence rate ratio was 0.64 (95% CI: 0.40-1.02, p = 0.063). Seven new fractures occurred in the intervention group and 11 in the control group. Conclusion A team applying comprehensive geriatric assessment and rehabilitation, including prevention and treatment of fall-risk factors, reduced inpatient falls and injuries, but no statistically significant effects of the program could be detected after discharge. It seems that fall-prevention must be part of everyday life in fall-prone elderly.

Keywords
Accidental falls, Geriatric care, Hip fracture, Intervention, Randomized control trial
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-97037 (URN)10.1007/s00198-007-0507-9 (DOI)000257382200008 ()18030411 (PubMedID)
Available from: 2014-12-09 Created: 2014-12-09 Last updated: 2018-06-07Bibliographically approved
3. Effects of Geriatric Interdisciplinary Home Rehabilitation on Walking Ability and Length of Hospital Stay After Hip Fracture: A Randomized Controlled Trial
Open this publication in new window or tab >>Effects of Geriatric Interdisciplinary Home Rehabilitation on Walking Ability and Length of Hospital Stay After Hip Fracture: A Randomized Controlled Trial
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2016 (English)In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 5, p. 464.e9-464.e15Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate if Geriatric Interdisciplinary Home Rehabilitation could improve walking ability for older people with hip fracture compared with conventional geriatric care and rehabilitation. A secondary aim was to investigate the postoperative length of hospital stay (LOS).

Design: Randomized controlled trial.

Setting: Geriatric ward, ordinary housing, and residential care facilities.

Participants: People operated on for a hip fracture (n = 205), aged 70 or older, including those with cognitive impairment, and living in the north of Sweden.

Intervention: Home rehabilitation with the aim of early hospital discharge that was individually designed and carried out by an interdisciplinary team for a maximum of 10 weeks. Special priority was given to prevention of falls, independence in daily activities, and walking ability both indoors and outdoors.

Measurements: Walking ability and the use of walking device was assessed in an interview during the hospital stay. These assessments were repeated along with gait speed measurements at 3- and 12-month follow-up. The length of the hospital stay after the hip fracture was recorded.

Results: No significant differences were observed in walking ability, use of walking device, and gait speed at the 3- and 12-month follow-up between the groups. At 12 months, 56.3% of the intervention group and 57.7% of the control group had regained or improved their prefracture walking ability. The median postoperative LOS in the geriatric ward was 6 days shorter for the intervention group (P = .003).

Conclusion: Participants receiving Geriatric Interdisciplinary Home Rehabilitation regained walking ability in the short-and long-term similar to those receiving conventional geriatric care and rehabilitation according to a multifactorial rehabilitation program. The intervention group had a significantly shorter postoperative LOS in the hospital.

Keywords
Hip fracture, home rehabilitation, interdisciplinary rehabilitation, walking ability, geriatrics, length of stay
National Category
Geriatrics Physiotherapy Nursing
Identifiers
urn:nbn:se:umu:diva-121563 (URN)10.1016/j.jamda.2016.02.001 (DOI)000375217300026 ()26975205 (PubMedID)
Available from: 2016-06-30 Created: 2016-06-03 Last updated: 2018-06-07Bibliographically approved
4. Effects of geriatric interdisciplinary home rehabilitation on complications and readmissions after hip fracture: a randomized controlled trial
Open this publication in new window or tab >>Effects of geriatric interdisciplinary home rehabilitation on complications and readmissions after hip fracture: a randomized controlled trial
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2019 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 33, no 1, p. 64-73Article in journal (Refereed) Published
Abstract [en]

Objective: This pre-planned secondary analysis of geriatric interdisciplinary home rehabilitation, which was initially found to shorten the postoperative length of stay in hospital for older individuals following hip fracture, investigated whether such rehabilitation reduced the numbers of complications, readmissions, and total days spent in hospital after discharge during a 12-month follow-up period compared with conventional geriatric care and rehabilitation.

Design: Randomized controlled trial.

Setting: Geriatric department, participants' residential care facilities, and ordinary housing.

Subjects: Individuals aged ⩾70 years with acute hip fracture (n = 205) were included.

Intervention: Geriatric interdisciplinary home rehabilitation was individually designed and aimed at early discharge with the intention to prevent, detect, and treat complications after discharge.

Main measures: Complications, readmissions, and days spent in hospital were registered from patients' digital records and interviews conducted during hospitalization and at 3- and 12-month follow-up visits.

Results: No significant difference in outcomes was observed. Between discharge and the 12-month follow-up, among participants in the geriatric interdisciplinary home rehabilitation group (n = 106) and control group (n = 93), 57 (53.8%) and 44 (47.3%) had complications (P = 0.443), 46 (43.4%) and 38 (40.9%) fell (P = 0.828), and 38 (35.8%) and 27 (29.0%) were readmitted to hospital (P = 0.383); the median total days spent in hospital were 11.5 and 11.0 (P = 0.353), respectively.

Conclusion: Geriatric interdisciplinary home rehabilitation for older individuals following hip fracture resulted in similar proportions of complications, readmissions, and total days spent in hospital after discharge compared with conventional geriatric care and rehabilitation.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Falls, home rehabilitation, randomized controlled trial, hip fracture
National Category
Geriatrics Physiotherapy
Identifiers
urn:nbn:se:umu:diva-142127 (URN)10.1177/0269215518791003 (DOI)000454521300008 ()30064264 (PubMedID)2-s2.0-85052213545 (Scopus ID)
Note

Originally included in thesis in manuscript form with title: "Geriatric interdisciplinary home rehabilitation - effects on complications and readmissions after hip fracture: a randomized controlled trial"

Available from: 2017-11-22 Created: 2017-11-22 Last updated: 2019-01-14Bibliographically approved

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