Informal care after hip fracture: prospective cohort.

BACKGROUND: Hip fracture is very common and it has life-shattering consequences for older persons. After discharge the older persons need help with even basic everyday activities from formal and informal caregivers. In Scandinavia formal care are well-developed however the presence of informal caregivers likely reflect on the amount of formal care and wears on the informal caregivers. This study explore how often and how much informal care (IC) older persons receive after hip fracture. METHOD: We contacted 244 community-dwelling older persons every two weeks the first twelve weeks after discharge after hip fracture and asked them if they received care from family and/or friends and how much. We used non-parametric statistics and level of significance was 95%. RESULTS: The proportion of older persons receiving IC was 90% and the median amount of IC was 32 hours (IQR 14-66). The number of older persons who received IC was highest the first four weeks after discharge and so was the amount of hours of IC. The older persons that were high-dependence on IC received a median of 66 (IQR 46-107) hours compared to the low-dependent of 11 hours (IQR 2-20). CONCLUSION: IC is very frequent, especially the first two to four weeks after discharge. The median IC was 32 hours from discharge to the 12-week follow-up. However, this figure tended to rise for persons with, among other, reduced functionality and those residing with a partner. IMPLICATIONS: With respect to local differences, the findings in this study are likely applicable to other Scandinavian countries. We strongly suggest that the variation in older person need for informal caregiver be given consideration in the prioritisation of resources. TRIAL REGISTRATION: This prospective cohort study of informal care, was part of a cluster-randomised stepped-wedge clinical controlled trial. Written consent was obtained required by regional ethics committee S-20200070. Data was collected in accordance with the Danish Data Protection Agency (20-21854).

Cost-Effectiveness of Physical Rehabilitation and Care of Older Home-Dwelling Persons after Hip Fracture: A Systematic Review and Narrative Synthesis.

OBJECTIVE: To provide a systematic review of the literature and knowledge base of cost per quality-adjusted life year of physical rehabilitation and care of older persons after hip fracture. MATERIAL AND METHODS: A research librarian assisted in searching 9 databases (14 May to 27 May 2021), with exclusion of studies on cognitively impaired or institutionalized individuals. A stepwise selection process was conducted by 2 authors, study quality was assessed using Drummond et al.'s checklist, and comparison between different countries was assessed using Welte et al.'s checklist. RESULTS: Three studies were included, which employed 3 different interventions initiated at 3 different postoperative time-points. One high-quality study demonstrated that comprehensive geriatric assessment was cost-effective compared with coordinated care. The other 2 studies did not find the interventions studied to be cost-effective, and both studies were deemed to be of moderate quality. CONCLUSION: The body of evidence on the cost-effectiveness of physical rehabilitation and care after hip fracture is limited and heterogeneous, with only 1 high-quality study. Thus, stakeholders perform decision-making with a limited knowledge base of the cost-effectiveness of physical rehabilitation and care. We recommend researchers to assess cost-per-QALY.

Rehabilitation for life: the effect on physical function of rehabilitation and care in older adults after hip fracture-study protocol for a cluster-randomised stepped-wedge trial.

BACKGROUND: A hip fracture is a serious event for older adults, given that approximately 50% do not regain their habitual level of physical function, and the mortality rate is high, as is the number of readmissions. The gap in healthcare delivery, as separated into two financial and self-governing sectors, might be a contributing cause of inferior rehabilitation and care for these patients. Therefore, we aim to assess the effect of continuous and progressive rehabilitation and care across sectors for older adults after hip fracture. METHODS/DESIGN: The project is designed as a stepped-wedge cluster randomised controlled trial. The study population of patients are older adults 65 years of age and above discharged after a hip fracture and healthcare professionals in primary and secondary care (municipalities and hospitals). Healthcare professionals from different sectors (hospital and municipalities) will be engaged in the empowerment-orientated praxis, through a workshop for healthcare professionals with knowledge sharing to the older adults using a digital health application (app). The rehabilitation intervention consists of 12 weeks of progressive resistance exercises initiated 1-2 days after discharge. To improve communication across sectors, a videoconference involving the patient and physiotherapists from both sectors will be conducted. On day, 3 after discharge, an outreach nurse performs a thorough assessment including measurement of vital signs. A hotline to the hospital for medical advice is a part of the intervention. The intervention is delivered as an add-on to the usual rehabilitation and care, and it involves one regional hospital and the municipalities within the catchment area of the hospital. The primary outcome is a Timed Up and Go Test 8 weeks post-surgery. DISCUSSION: Using a stepped-wedge design, the intervention will be assessed as well as implemented in hospital and municipalities, hopefully for the benefit of older adults after hip fracture. Furthermore, the collaboration between the sectors is expected to improve. TRIAL REGISTRATION: The study is approved by the Regional Scientific Ethics Committees of Southern Denmark (S-20200070) and the Danish Data Protection Agency (20-21854). Registered 9 of June 2020 at ClinicalTrials.gov, NCT04424186 .

A passive apparatus for controlled-flux delivery of biocides: hydrogen peroxide as an example.

A new test method has been developed to estimate the required release rate of hydrogen peroxide (H2O2) to prevent marine biofouling. The technique exploits a well-defined concentration gradient of biocide across a cellulose acetate membrane. A controlled flux of H2O2, an environmentally friendly biocide, was obtained. Larvae of the barnacle, Balanus improvisus, were subjected to known release rates of H2O2 from a surface, under laboratory conditions. It was found that the distribution of settled larvae was not significantly different from the controls when H2O2 fluxes of 5-8 microg cm(-2) day(-1) were applied. However, release rates of 40 microg cm(-2) day(-1) significantly displaced the distribution of settled larvae towards the area of the chamber farthest away from the membrane. Membrane tests in seawater (Jyllinge Harbour, Denmark) for over 16 weeks showed that release rates of H2O2 of approximately 2800 microg cm(-2) day(-1) deterred biofouling efficiently. A H2O2 release rate of about 224 microg cm(-2) day(-1) resulted in some slime formation, but it was less than that on the H2O2-free control. It appears that to obtain efficient resistance to biofouling in natural seawater requires much higher membrane release rates of H2O2 (factor of between 5 and 50) than laboratory membrane exposure assays using barnacle larvae.