Older patients with hip fractures: evaluation of a long-term specialist orthopaedic medicine service in their outcomes.

AIMS: To evaluate the long-term outcomes of a specialist orthopaedic medicine service in older patients up to 12 months after hip fracture. METHODS: All patients over the age of 65 years admitted with hip fracture under the shared care of geriatricians and orthopaedic surgeons over a 6-month period were identified in an initial audit. A follow-up postal questionnaire was sent to those patients asking about their place of domicile, level of functioning, compliance with osteoporosis treatment, and whether they had sustained further fractures in the 12 months following discharge from hospital. Mortality was also recorded. RESULTS: The 1-year mortality of the 149 patients discharged from hospital following their hip fracture (who were identified in the initial audit) was 18.8%. There were 69 (46.3%) responses to the questionnaire. The mean age of respondents was 81.3 years (range 66-98 years). At discharge, only 5 of 69 (7.2%) patients were independent in their walking, 13 (18.8%) walked with the aid of a stick, 39 (56.5%) with a frame, 7 (10.1%) required supervision, and 5 (7.2%) were immobile. Excluding those who were immobile prior to their hip fracture, 31 of 64 (48.4%) of patients regained their pre-morbid level of mobility at 12 months. At discharge, 27 of 69 (39.1%) patients were independent with activities of showering, dressing, and toileting--with 42 of 64 (65.6%) independent at 12 months. At discharge, 57 of 69 (82.6%) patients were on calcium and vitamin D, and 5 (7.2%) on alendronate. At 12 months, 50 of 64 (78.1%) remained on calcium, 40 (62.5%) on vitamin D, and 26 (40.6%) on alendronate. Five of 64 (7.8%) patients experienced a total of 11 further osteoporotic fractures at 12 months, but no further hip fractures. Of respondents discharged home, 44 of 50 (88%) remained at home at 12 months. CONCLUSIONS: Shared care between geriatricians and orthopaedic surgeons for older hip fracture patients appears to be associated with a reduced 1-year mortality, improved treatment of osteoporosis, and return to home. Many patients, however, continue to have impaired function and mobility.

Shared care between geriatricians and orthopaedic surgeons as a model of care for older patients with hip fractures.

AIMS: To evaluate the effect of shared care between geriatricians and orthopaedic surgeons as a model of care for older patients with hip fractures. METHODS: All patients over the age of 65 years are under the shared care of an orthopaedic surgeon and geriatrician (the Ortho-Medicine Service) when they are admitted to the Orthopaedic Service, Christchurch Hospital, New Zealand. This retrospective case records audit includes all patients over the age of 65 years with hip fracture admitted to this service over a 6-month period from December 2002 to June 2003. RESULTS: There were 150 patients. The median age was 83 years (range 66-99 years). Median total length of stay was 23 days. Median time delay until theatre was 43.5 hours. Inpatient mortality was 0.7%. Of 97 patients admitted from home, 86(88.6%) returned home, 6 (6.2%) went to rest home care, and 5 (5.2 %) went to hospital level care. Of 43 patients admitted from rest home care, 40 (93%) returned to rest home care, and 3 (7.0 %) were discharged to hospital level care. Three patients admitted from rest home dementia care and six patients admitted from hospital level care were discharged back to their pre-morbid place of domicile. At discharge, 86.8% of patients were on Vitamin D supplementation and over 80% were on calcium. Only 10.6% were discharged on bisphosphonates. CONCLUSIONS: Shared care between geriatricians and orthopaedic surgeons for older people with hip fractures is associated with a low in-patient mortality, with the majority returning to their pre-morbid place of domicile. Length of stay has increased. Most patients are discharged on treatment for osteoporosis.