Functional autonomy and 12-month mortality in older adults with proximal femoral fractures in an orthogeriatric setting: risk factors and gender differences.

BACKGROUND: Proximal femur fractures have a negative impact on loss of functional autonomy and mortality. OBJECTIVE: The aim of this retrospective study was to evaluate functional autonomy and mortality in a group of older adults with hip fractures managed in an orthogeriatric setting 12 months after discharge and to determine if gender affected outcome. METHODS: In all participants, we assessed clinical history, functional pre-fracture status using activities of daily living (ADL) and in-hospital details. At 12 months after discharge, we evaluated functional status, place of residence, hospital readmissions and mortality. RESULTS: We studied 361 women and 124 men and we observed a significant reduction in the ADL score at 6 months (1.15 ± 1.58/p < 0.001 in women and 1.45 ± 1.66/p < 0.001 in men). One-year mortality (33.1% in men and 14.7% in women) was associated with pre-fracture ADL score and reduction in ADL at 6 months (HR 0.68/95%, CI 0.48-0.97/p < 0.05 and HR 1.70/95%, CI 1.17-2.48/p < 0.01, respectively) in women, and new hospitalisations at 6 months and polypharmacy in men (HR 1.65/95%, CI 1.07-2.56/p < 0.05 and HR 1.40/95%, CI 1.00-1.96/p = 0.05, respectively) in Cox's regression model. DISCUSSION AND CONCLUSIONS: Our study suggests that functional loss in older adults hospitalised for proximal femur fractures is greatest in the first 6 months after discharge, and this increases the risk of death at 1 year. Cumulative mortality at 12 months is higher in men and appears to be related to polypharmacy and new hospital admissions 6 months after discharge.

The impact of second hip fracture on rehospitalization and mortality in older adults.

PURPOSE: Although a second hip fracture is not uncommon in the older population, the extent to which such an event may affect health-related outcomes has not been fully clarified. We aimed to evaluate the risk of new falls, functional decline, rehospitalization, institutionalization and mortality in older patients admitted for a second vs. a first hip fracture. METHODS: The sample consisted of 288 older patients admitted to the Orthogeriatric Unit of Bolzano Hospital (northern Italy) and surgically treated for a hip fracture from June 2016 to June 2017. Socio-demographic data and hospitalization-related information were collected and a multidimensional assessment was made upon admission and during the hospital stay. Fifteen months after discharge, data on mobility level, functional status, institutionalization, and new falls were obtained from personal or structured phone interviews. Information on rehospitalization and mortality was obtained from local hospital registers. RESULTS: One out of six patients (14.6 %) admitted was suffering a second hip fracture, of which only 16.7 % were on antiresorptive therapies. At the 15-month follow-up, individuals who had been treated for a second hip fracture were more likely than those treated for their first to have low mobility levels (OR = 4.13, 95 %CI:1.23-13.84), to be rehospitalized (OR = 2.57, 95 %CI:1.12-5.90), and to have a higher mortality (HR = 1.81, 95 %CI:1.05-3.12). CONCLUSIONS: The occurrence of a second hip fracture may further affect the clinical vulnerability and mortality of older adults. These results highlight the need to implement preventive action to minimize the risk of re-fracture after the first event.

Efficacy of an interdisciplinary pathway in a first level trauma center orthopaedic unit: A prospective study of a cohort of elderly patients with hip fractures.

BACKGROUND: hip fracture has negative consequences for elderly people. Alternative models of care, with respect to traditional model, were developed to minimize complications and improve functional outcomes. The interdisciplinary model in orthopaedic wards has less evidence of efficacy compared to orthogeriatric units. OBJECTIVE: to compare the efficacy (in-hospital outcomes, mortality, functional status at 6 months after discharge) of an interdisciplinary pathway, based on comprehensive geriatric assessment, compared to a traditional model of care, in hip-fractured elderly patients. DESIGN: prospective study with retrospective control group conducted in a first-level trauma center Orthopaedic Unit. SUBJECTS: 97 patients treated with the traditional model and 127 with an interdisciplinary pathway (mean age 83.9 ±â€¯7.4 vs 84 ±â€¯6.7 years, p = 0.89). METHODS: in all participants we assessed: clinical history, functional pre-fracture status utilising Activities of Daily Living (ADL), in-hospital details. At 6 months after discharge, we evaluated functional status, place of residence, hospital readmissions, mortality. RESULTS: during hospital stay, significant differences emerged in mortality and in external visits. A higher proportion of patients of the orthogeriatric group lived alone at home at 6 months and showed a lower functional decline. Comprehensive geriatric assessment was associated with the ADL score (partial R2: 0.08, p < 0.001) and with a higher probability of independent walking ability ([OR] 3.89 95% [CI] 1.73-8.74, p = 0.001). CONCLUSIONS: an interdisciplinary pathway in hip-fractured elderly patients, could reduce in-hospital mortality, improve functional recovery and increase the probability of living alone at home, at 6 months.

Influence of serum 25-hydroxyvitamin D levels, fat-free mass, and fat mass on bone density, geometry and strength, in healthy young and elderly adults.

PURPOSE: The association between serum 25-hydroxyvitamin D (25-OHD) levels and cortical/trabecular bone parameters has been explored in the elderly, but less so in younger adults; body composition may also influence bone parameters across the life span. We aimed to investigate, with peripheral quantitative computerized tomography (pQCT), the relationship between serum 25-OHD levels and bone geometry and strength and, at the same time, to explore the influence of fat mass and fat-free mass on bone parameters, for the tibia and radius, in healthy young and elderly adults. METHODS: The study involved 149 healthy adults grouped by age: 65 were under 65 years old, and 84 were older. All participants were assessed in terms of: clinical history; serum 25-OHD levels; fat-free mass (FFM) and fat mass (FM), measured with DXA; total and cortical bone cross-sectional area (CSA, CSAc), and trabecular and cortical bone mineral density (BMDt, BMDc); and fracture load x and y for the tibia and radius, measured with pQCT. RESULTS: In the younger group, the association between 25-OHD levels and bone parameters did not remain as significant for any parameters after multivariate adjustment. In the elderly, 25-OHD correlated with CSAc (partial R2 = 0.33), fracture load x (partial R2 = 0.54), and fracture load y (partial R2 = 0.46) for the radius, and marginally with BMDt (partial R2 = 0.09; B-H adjusted p < 0.05 for all) for the tibia. FFM correlated with all bone parameters in both age groups. In the elderly group alone, FM correlated with BMDt at the tibia (r = 0.25, p < 0.05), with CSA at both sites (radius r = -0.25, p < 0.05; tibia r = -0.32, p < 0.001), and with fracture load y on the radius (r = -0.22, p < 0.05). CONCLUSION: While serum 25-OHD levels correlated only weakly with bone parameters in younger adults, a significant relationship was observed for elderly people. Fat-free mass showed positive simple correlation with pQCT-derived bone parameters in both age groups except with BMDc in the younger group. Further longitudinal studies are needed to clarify these relationships.