RESUMO
OBJECTIVE: To investigate causes and course off all-related hip fractures in elderly individuals admitted to a hospital. MATERIAL AND METHOD: The authors collected data from older patients admitted with fall-related hip fractures. The cause and the clinical course of falls were evaluated by consultants in geriatric medicine. All patients were followed-up until discharge from the hospital. RESULTS: Falls usually occurred indoors (78.6%) during the daytime (67.5%). Only 27.5% of the falls were attributable to purely extrinsic causes. Neurological, musculoskeletal, and visual problems along with orthostatic hypotension were the leading causes of falls in the present study. Women demonstrated more intrinsic causes (41.9% vs. 28.9%), such as musculoskeletal (33.9% vs. 11.1%), and visual impairment (21.0% vs. 11.1%), whereas falls involving men were more likely to be caused by orthostatic hypotension (21.8% vs. 8.1%). Most patients received surgical treatment (92.5%). The most common complications during the hospital stay were delirium (45%). The modified Rankin Scale of 2-5 at discharge was noted in 46.3% ofpatients, and mortality was 3.8%. The median length of hospital stay was 15 days (7-75 days). The direct costs of in-hospital care were 2,427.2 (761.9-8,348.6) US dollars for general wards, and 3,739.1 (1,333.6-11,871.7) US dollars for special wards. CONCLUSION: Intrinsic causes (pure and combined with extrinsic) lead to falls with hip fractures more often than purely extrinsic causes. Women and men had different etiologies for falls. Hip fracture leads to a number of in-hospital complications and significantfunctional impairment. Preventive strategies following the present study would likely lead to more accurate and beneficial outcomes.
Assuntos
Acidentes por Quedas/estatística & dados numéricos , Fraturas do Quadril/epidemiologia , Hipotensão Ortostática/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Fraturas do Quadril/etiologia , Hospitalização , Hospitais , Humanos , Hipotensão Ortostática/epidemiologia , Tempo de Internação , Masculino , Fatores de Risco , Tailândia/epidemiologiaRESUMO
OBJECTIVE: To determine the incidence and associated factors of delirium in older patients admitted with hip fracture. MATERIAL AND METHOD: Eighty patients with fall-related hip fracture who admitted to orthopedics wards in Siriraj Hospital were recruited. Baseline characteristics, functional ability and cognitive status, treatment-related factors, clinical outcomes, length of stay, and direct medical cost were evaluated. Delirium was diagnosed by experienced geriatricians using DSM-IV RESULTS: Thirty-six patients (45%,) developed delirium. Hyperactive and hypoactive delirium was 24:12 patients. Preoperative and postoperative delirium was developed in 18:18 patients. Age, TMSE score on admission, modified IQCODE score, premorbid mRS, receiving NSAIDs around the clock postoperatively, and sedative drug use were significantly different between the non-delirium and delirium groups in multivariate logistic regression analysis. Patients with delirium did not have significantly higher postoperative complications, hospital length ofstay, functional status (mRS) at discharge, mortality, and direct cost of the treatment in hospital. CONCLUSION: Delirium is common in elderly hip fracture undergoing hip repair. Age, premorbid function, dementia/cognitive impairment, NSAIDs, and sedative use were associated factors of delirium. Identifying those with high-risk factors should be routinely performed rigorously and strategies to reduce delirium incidence and severity should be planned and conducted.