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1.
J Trauma Nurs ; 28(5): 290-297, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34491944

RESUMO

BACKGROUND: Catheter-associated urinary tract infection (CAUTI) is a noted complication among geriatric hip fracture patients. This complication results in negative outcomes for both the patients and the institution providing care. Screening measures to identify predisposing factors, with early diagnosis and treatment of urinary tract infection (UTI) present on admission, may lead to reduced rates of CAUTI. OBJECTIVE: The goals of this study were to determine the prevalence of UTI on admission among geriatric hip fracture patients and whether routine screening for UTI or predisposing factors at presentation resulted in reduced rates of CAUTI. METHODS: A retrospective observational study of geriatric hip fracture patients from January 2017 to December 2018 at a Level I trauma center was performed. Rates of UTI on admission and CAUTI were calculated using routine admission urinalysis. RESULTS: Of the 183 patients in the sample, 36.1% had UTI on admission and 4.4% of patients developed CAUTI. There were no significant differences in patient demographics, comorbidities, and complications between those with UTI on admission and those without. CONCLUSIONS: Urinary tract infection on admission may be present among a large portion of geriatric hip fracture patients, leading to increased rates of CAUTI. Routine screening for UTI and its predisposing factors at admission can identify these patients earlier and lead to earlier treatments and prevention of CAUTI.


Assuntos
Infecções Relacionadas a Cateter , Infecção Hospitalar , Fraturas do Quadril , Infecções Urinárias , Idoso , Cateteres , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/epidemiologia , Humanos , Estudos Retrospectivos , Centros de Traumatologia , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Infecções Urinárias/prevenção & controle
2.
BMC Musculoskelet Disord ; 22(1): 799, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530792

RESUMO

PURPOSE: This study aims primarily to investigate the outcome following surgical management of pertrochanteric fractures of patients over 90 years compared to the outcome of a control group below 90 years under special consideration of the timing of surgery. The second aim was to analyze potential risk factors for early deaths in very old patients. This study allows us to draw conclusions to minimize complications linked to this particular age segment. METHODS: The study group consisted of very old patients aged 90 years and older. Geriatric patients aged between 60 and 89 years of age were part of the control group. Type A1 pertrochanteric fractures were typically treated by dynamic hip crews, type A2 and A3 fractures by femoral nails. Full weight bearing physiotherapy was initiated on the day after surgery to improve mobility and muscle strength. RESULTS: A total of 71 patients belonged to the study group (mean age: 92.5 years ±2.3 years), whereas 223 patients formed the control group (mean age: 79.9 ± 7.4 years). The mortality rate and the number of detected and documented complications were significantly higher in the study group (p = 0.001; p = 0.009, respectively). Despite the significantly higher complication rate in the > 90-year-old patients, there was no significant difference in the mean length of in-hospital-stay between the both groups (> 90 yrs.: 12.1d; < 90 yrs.: 13.1 d) and the timing of surgery. CONCLUSION: The number of co-morbidities, number of daily-administered medications and the time between admission and surgery have no impact on the outcome. We noticed a longer period between admission and surgery in very old patients who survived. Patients with pertrochanteric fractures should be screened for multimorbidity and cognitive disorders in a standardized manner.


Assuntos
Fraturas do Quadril , Idoso , Idoso de 80 Anos ou mais , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Mortalidade Hospitalar , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
3.
BMC Musculoskelet Disord ; 22(1): 832, 2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34583660

RESUMO

BACKGROUND: Heart failure is a common adverse postoperative complication in elderly patients. It is necessary to explore the risk factors of heart after the operation of elderly patients with hip fracture during hospitalization. METHODS: Patients with hip fractures admitted to our hospital from January 1, 2019 to December 31 2020 were included, all the patients received internal fixation surgery. The characteristics of patients with and without postoperative heart failure were compared. Multivariate logistic regression analyses were applied to analyze the risk factors of heart failure in elderly patients with hip fracture. RESULTS: A total of 283 patients with hip fractures were included, the incidence of heart failure was 12.37 %. There were significant differences in the age, hypertension, anemia hypoalbuminemia and duration of surgery between heart failure and no heart failure group(all p < 0.05). There were no significant differences in the gender, BMI, diabetes mellitus, hyperlipidemia, history of heart failure, cognitive dysfunction, type of fracture, preoperative oxygen saturation, white blood cell count, platelet count, red blood cell count, creatinine, alanine aminotransferase, aspartate aminotransferase and estimated blood loss during surgery between heart failure and no heart failure group(all p > 0.05). Logistic regression analyses indicated that age ≥ 70y(OR2.446, 95% CI1.044 ~ 4.149), hypertension(OR2.152, 95% CI1.125 ~ 4.023), anemia(OR3.094, 95% CI1.294 ~ 5.907), hypoalbuminemia(OR2.377, 95% CI1.205 ~ 4.537), duration of surgery ≥ 120 min(OR1.683, 95% CI1.094 ~ 2.782) were the risk factors of heart failure in elderly patients with hip fracture(all p < 0.05). CONCLUSIONS: The incidence of postoperative heart failure in elderly patients with hip fracture is relatively high, which is the result of a combination of high-risk factors. Peri-period risk assessment and prevention of related risks are the keys to a good prognosis for patients.


Assuntos
Insuficiência Cardíaca , Fraturas do Quadril , Idoso , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco
4.
Orthopedics ; 44(5): 293-298, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34590943

RESUMO

Coronavirus disease 2019 (COVID-19) rapidly changed the landscape of health care, particularly in the New York City area. The elderly population is particularly vulnerable to both the novel coronavirus and the effects of a fracture. The goal of this study was to compare trends and outcomes of hip fracture patients during the pandemic. This was a retrospective chart review of hip fracture patients from a suburban academic hospital on Long Island, New York, who presented from March 1 to May 30, 2020. Patient COVID-19 status, demographics, and hospital outcome measures were recorded. Statistical analysis was performed using heteroscedastic t tests for quantitative variables and chi-square tests for qualitative variables. There were 82 patients in the 2020 cohort and 111 in the 2019 control group, representing a 29.9% decrease in cases. The 2020 cohort presented to the hospital an average of 2.77 days after injury compared with 1.15 days for the 2019 control group (P=.0976). Patients in the 2020 cohort were more likely to be discharged home than to rehabilitation (P<.0001) and tended to be discharged with oral anticoagulation (P=.0809). There was no increase in 1-, 3-, or 6-month complications or mortality. During the pandemic, fewer patients were admitted with hip fractures, and the time from injury to presentation doubled. Patients were significantly less likely to be discharged to rehabilitation and more were discharged with oral anticoagulants. Overall, there was no increase in complications, and these data indicate that the authors were successfully able to provide high-quality care to hip fracture patients during the pandemic. [Orthopedics. 2021;44(5):293-298.].


Assuntos
COVID-19 , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Feminino , Humanos , Tempo de Internação , Masculino , Cidade de Nova Iorque/epidemiologia , Pandemias/prevenção & controle , Alta do Paciente , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , SARS-CoV-2 , Tempo para o Tratamento , Resultado do Tratamento
5.
Nutrients ; 13(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34371911

RESUMO

BACKGROUND: The aim of this work was to assess whether the muscle thickness and echogenicity were associated with dysphagia, malnutrition, sarcopenia, and functional capacity in acute hospital admission for a hip fracture. METHODS: Observational study that assessed nutritional status by Global Leadership Initiative on Malnutrition, risk of dysphagia and sarcopenia by European Working Group on Sarcopenia in Older People and Barthel functional index. We measured muscle thickness and echogenicity of masseter, bicipital, and quadriceps rectus femoris (RF) and vastus intermedius (VI) by ultrasound. RESULTS: One hundred and one patients were included in the study (29.7% sarcopenia and 43.8% malnutrition). Logistic regression models adjusted for age, sex, and body mass index showed an inverse association of the masseter thickness with both sarcopenia (OR: 0.56) and malnutrition (OR: 0.38) and quadriceps with sarcopenia (OR: 0.74). In addition, patients at high risk of dysphagia had lower masseter thickness (p: 0.0001) while patients able to self-feeding had thicker biceps (p: 0.002) and individuals with mobility on level surfaces higher thickness of biceps (p: 0.008) and quadriceps (p: 0.04). CONCLUSION: Thickness of the masseter was associated with risk of dysphagia, biceps with the ability to self-feed, and that of the quadriceps RF-VI with mobility.


Assuntos
Composição Corporal , Fraturas do Quadril/terapia , Hospitalização , Desnutrição/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Estado Nutricional , Sarcopenia/diagnóstico por imagem , Ultrassonografia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Estado Funcional , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/epidemiologia , Humanos , Pacientes Internados , Masculino , Desnutrição/epidemiologia , Desnutrição/fisiopatologia , Músculo Esquelético/fisiopatologia , Valor Preditivo dos Testes , Prevalência , Medição de Risco , Fatores de Risco , Sarcopenia/epidemiologia , Sarcopenia/fisiopatologia , Espanha/epidemiologia
6.
Medicina (Kaunas) ; 57(8)2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34441000

RESUMO

Background: More than 750,000 fragility fractures occur in Germany every year, with an expected increase in the following years. Interdisciplinary care pathways for geriatric patients are increasingly established to improve the treatment process and outcome, but there has been only limited evaluation of their use. Objectives: This study aimed to compare patient care before and after the implementation of a geriatric trauma center (GTC) in conformity with the German Society for Trauma Surgery (DGU®). Patients and Methods: We performed a retrospective single-center cohort study, including 361 patients >70 years old with lumbar spine, pelvic, and acetabular fractures, admitted between January 2012 and September 2019. Patients were divided into a usual care cohort (UC, n = 137) before implementation and an ortho-geriatric care cohort (OGC, n = 224) after implementation of the GTC DGU®. We recorded and compared demographic data, fracture type, geriatric assessment and management, therapy, complications, and various clinical parameters, e.g., length of stay, time to surgery, hours admitted to ICU, and change in walking ability. Results: The geriatric assessment revealed significant geriatric co-morbidities and a need for geriatric intervention in 75% of the patients. With orthogeriatric co-management, a significant increase in the detection of urological complications (UC: 25.5% vs. OGC: 37.5%; p = 0.021), earlier postoperative mobilization (UC: 57.1% vs. OGC: 86.3%; p < 0.001), an increased prescription of anti-osteoporotic treatment at discharge (UC: 13.1% vs. OGC: 46.8%; p < 0.001), and lower rates of revision surgery (UC: 5.8% vs. OGC: 3.1%; p = 0.012) could be seen. Conclusions: Our results emphasize the improvement in patient care and clinical outcome by implementing a GTC DGU® and provide opportunities for future improvement in ortho-geriatric patient care.


Assuntos
Fraturas do Quadril , Centros de Traumatologia , Idoso , Certificação , Estudos de Coortes , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Estudos Retrospectivos
7.
Artigo em Inglês | MEDLINE | ID: mdl-34444529

RESUMO

Bisphosphonates are widely used in the treatment of women at risk of osteoporotic hip fracture; however, the overall effectiveness of bisphosphonates in the prevention of osteoporotic fractures has not been studied in real life. To investigate whether the use of bisphosphonates in women aged 50 years and over is associated with a decrease in hospitalization for osteoporotic hip fractures, a historical prospective cohort study was conducted between 2009 and 2016 from a permanent representative sample consisting of 1/97 of the French health insurance beneficiaries. Bisphosphonate use was defined according to medication persistence and adherence regarding bisphosphonate dispensations. The primary outcome was the hospitalization rate for osteoporotic hip fracture. Among the 81,268 women included, 2005 were exposed to bisphosphonates. The median time of bisphosphonate exposure was 12 (IQR, 3-29) and 17 (IQR, 5-42) months for the persistence and adherence definitions, respectively. Exposure to bisphosphonates was not associated with a decrease in hospitalization for hip fracture: weighted HRadherence = 0.66 (95% CI, 0.33 to 1.33); HRpersistance = 0.77 (95% CI, 0.38 to 1.57). In real life, bisphosphonate use does not appear to reduce hospitalization for hip fractures, as to date, it is probably prescribed as primary prevention and for a duration too short to be effective.


Assuntos
Difosfonatos , Fraturas do Quadril , Idoso , Difosfonatos/uso terapêutico , Feminino , França/epidemiologia , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/prevenção & controle , Hospitalização , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos
8.
Isr Med Assoc J ; 23(8): 469-474, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392619

RESUMO

BACKGROUND: Hip fractures in elderly patients are a major cause of morbidity and mortality. Variability in length of hospital stay (LOS) was evident in this population. The coronavirus disease-2019 (COVID-19) pandemic led to prompt discharge of effected patients in order to reduce contagion risk. LOS and discharge destination in COVID-19 negative patients has not been studied. OBJECTIVES: To evaluate the LOS and discharge destination during the COVID-19 outbreak and compare it with a similar cohort in preceding years. METHODS: A retrospective study was conducted comparing a total of 182 consecutive fragility hip fracture patients operated on during the first COVID-19 outbreak to patients operated on in 2 preceding years. Data regarding demographic, co-morbidities, surgical management, hospitalization, as well as surgical and medical complications were retrieved from electronic charts. RESULTS: During the pandemic 67 fragility hip fracture patients were admitted (COVID group); 55 and 60 patients were admitted during the same time periods in 2017 and 2018, respectively (control groups). All groups were of similar age and gender. Patients in the COVID group had significantly shorter LOS (7.2 ± 3.3 vs. 8.9 ± 4.9 days, P = 0.008) and waiting time for a rehabilitation facility (7.2 ± 3.1 vs. 9.3 ± 4.9 days, P = 0.003), but greater prevalence of delirium (17.9% vs. 7% of patients, P = 0.028). In hospital mortality did not differ among groups. CONCLUSIONS: LOS and time to rehabilitation were significantly shorter in the COVID group. Delirium was more common in this group, possibly due to negative effects of social distancing.


Assuntos
COVID-19 , Delírio , Fixação de Fratura , Fraturas do Quadril , Controle de Infecções , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Delírio/diagnóstico , Delírio/epidemiologia , Delírio/etiologia , Feminino , Fixação de Fratura/efeitos adversos , Fixação de Fratura/métodos , Fixação de Fratura/reabilitação , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Israel/epidemiologia , Masculino , Inovação Organizacional , Avaliação de Processos e Resultados em Cuidados de Saúde , Alta do Paciente/tendências , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Gestão de Riscos/organização & administração , SARS-CoV-2/isolamento & purificação
9.
Isr Med Assoc J ; 23(8): 479-483, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392621

RESUMO

BACKGROUND: Little is known regarding the impact of the coronavirus disease-2019 (COVID-19) pandemic on the incidence of hip fractures among older adults. OBJECTIVES: To compare the characteristics of patients with a hip fracture following a fall during the COVID-19 pandemic year and during the preceding year. METHODS: We conducted a retrospective cohort study of older patients who had undergone surgery for hip fracture repair in a major 495-bed hospital located in northern central Israel following a fall. Characteristics of patients who had been hospitalized in 2020 (pandemic year, n=136) and in 2019 (non-pandemic year, n=151) were compared. RESULTS: During the pandemic year, patients were less likely to have fallen in a nursing facility, to have had muscle or balance problems, and to have had a history of falls and fractures following a fall. Moreover, the average length of stay (LOS) in the hospital was shorter; however, the average time from the injury to hospitalization was longer. Patients were less likely to have acquired a postoperative infection or to have died. During the pandemic year, postoperative infection was only associated with prolonged LOS. CONCLUSIONS: The COVID-19 pandemic may have had a positive impact on the behavior of older adults as well as on the management of hip fracture patients. However, healthcare providers should be aware of the possible reluctance to seek care during a pandemic. Moreover, further research on the impact of the change in management during COVID-19 on hip fracture survival is warranted.


Assuntos
Acidentes por Quedas , COVID-19 , Fixação de Fratura , Fraturas do Quadril , Controle de Infecções , Complicações Pós-Operatórias , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Feminino , Fixação de Fratura/métodos , Fixação de Fratura/reabilitação , Fixação de Fratura/estatística & dados numéricos , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/etiologia , Fraturas do Quadril/cirurgia , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Israel/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação
10.
Isr Med Assoc J ; 23(8): 484-489, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392622

RESUMO

BACKGROUND: Surgery for hip fractures within 48 hours of admission is considered standard. During the lockdown period due to the coronavirus disease-2019 (COVID-19) epidemic, our medical staff was reduced. OBJECTIVES: To compare the demographics, treatment pathways, and outcomes of patients with hip fractures during the COVID-19 epidemic and lockdown with the standard at routine times. METHODS: A retrospective study was conducted of all patients who were treated surgically for hip fracture in a tertiary center during the COVID-19 lockdown period between 01 March and 01 June 2020 and the equivalent period in 2019. Demographic characteristics, time to surgery, surgery type, hospitalization time, discharge destination, postoperative complications, and 30- and 90-day mortality rates were collected for all patients. RESULTS: During the COVID-19 period, 105 patients were operated due to hip fractures compared to 136 in the equivalent period with no statistical difference in demographics. The rate of surgeries within 48 hours of admission was significantly higher in the COVID-19 period (92% vs. 76%, respectively; P = 0.0006). Mean hospitalization time was significantly shorter (10 vs. 12 days, P = 0.037) with diversion of patient discharge destinations from institutional to home rehabilitation (P < 0.001). There was a significant correlation between the COVID-19 period and lower 90-day mortality rates (P = 0.034). No statistically significant differences in postoperative complications or 30-day mortality rates were noted. CONCLUSIONS: During the COVID-19 epidemic, despite the limited staff and the lack of therapeutic sequence, there was no impairment in the quality of treatment and a decrease in 90-day mortality was noted.


Assuntos
COVID-19 , Fixação de Fratura , Fraturas do Quadril , Controle de Infecções , Complicações Pós-Operatórias , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/prevenção & controle , Feminino , Fixação de Fratura/efeitos adversos , Fixação de Fratura/métodos , Fixação de Fratura/reabilitação , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Israel/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Mortalidade , Inovação Organizacional , Avaliação de Processos e Resultados em Cuidados de Saúde , Alta do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação
11.
Artigo em Inglês | MEDLINE | ID: mdl-34360410

RESUMO

BACKGROUND: People with dementia are a high-risk group for hip fractures. Although the increased risk of hip fractures associated with antipsychotic drugs (APD) is found in older populations, little is known about the risk for people with dementia living in Asia. We aimed to investigate the association between hip fractures and the characteristics of APD use in patients with dementia. METHODS: A nested case-control analysis was conducted on a nationwide cohort in Taiwan. People with diagnoses of dementia during 2003-2012 were identified. Conditional logistic regression analysis was performed, and adjusted odds ratios (aORs) were calculated with a 95% confidence interval (CI) to estimate the risk of hip fractures. RESULTS: APD use was associated with an increased risk of hip fractures in patients with dementia; current use or combined use of first and second generations of APDs had even higher risks. Regarding the duration of APD use, a U-shape curve of hip fracture risk was noted, and the risk peaked during 0-15 days and >215 days of exposure (aOR = 1.46, 95% CI 1.37-1.57; aOR = 1.47, 95% CI 1.37-1.58; respectively). Considering the doses of APDs, the hip fracture risk was significantly increased with all four levels of the cumulative doses and average daily doses and peaked in the group with the highest average daily dose. CONCLUSIONS: The findings suggest that caution must be taken when initiating APD use in patients with dementia, even in a small dose, and mixed types of APD prescriptions should be administered with care. Furthermore, frequent evaluation of the possibility of tapering or withdrawal of the medication is necessary, as the risk does not attenuate after long-term use.


Assuntos
Demência , Fraturas do Quadril , Preparações Farmacêuticas , Idoso , Estudos de Casos e Controles , Demência/induzido quimicamente , Demência/epidemiologia , Fraturas do Quadril/induzido quimicamente , Fraturas do Quadril/epidemiologia , Humanos , Fatores de Risco
12.
Artigo em Inglês | MEDLINE | ID: mdl-34299842

RESUMO

The purpose of the present study was to estimate the risk of hip and spinal fracture after distal radius fracture. Data from the Korean National Health Insurance Service-National Sample Cohort were collected between 2002 and 2013. A total of 8013 distal radius fracture participants who were 50 years of age or older were selected. The distal radius fracture participants were matched for age, sex, income, region of residence, and past medical history in a 1:4 ratio with control participants. In the subgroup analysis, participants were stratified according to age group (50-59, 60-69, or ≥70 years) and sex (male or female). Distal radius fracture patients had a 1.51-fold and 1.40-fold higher incidence of hip fracture and spinal fracture in the adjusted models, respectively. Among males, patients of all ages had a significantly higher incidence of hip fracture, and those who were 50 to 69 years of age had a significantly higher incidence of spinal fracture. Among females, those older than 70 years had a significantly higher incidence of hip fracture, and patients of all ages had a significantly higher incidence of spinal fracture. Previous distal radius fracture has a significant impact on the risk of subsequent hip and spinal fractures.


Assuntos
Fraturas do Quadril , Fraturas do Rádio , Fraturas da Coluna Vertebral , Idoso , Feminino , Seguimentos , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/epidemiologia , Fatores de Risco , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia
13.
Clin Interv Aging ; 16: 1337-1346, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34285478

RESUMO

Purpose: Limited information exists on fall-related fractures in older adults with cerebrovascular disease. This study aimed to determine the characteristics of older adults with cerebrovascular disease who sustained fall-related fractures and identify the associated risk factors for perioperative complications. Patients and Methods: This was a cross-sectional study, which included patients with cerebrovascular disease who sustained fractures between Jan. 2017 and Dec. 2019. The collected data included demographics (age and gender), time and place of fracture occurrence, mechanism of injury, fracture location, type of cerebrovascular disease, complications, and comorbidities. Results: A total of 768 patients with 815 fractures were included; there were 253 males and 515 females, with an average age of 78.3 years. For either males or females, 80-84 years was the most commonly involved age group. Most (61.0%) patients had their fractures occurring at home and most fractures (70.7%) occurred during the daytime. Most were hip fractures and limb weakness; instability-related falls were the most common cause of fracture, making a proportion of 34.5%. Patients who suffered falls were mainly combining ischemic cerebrovascular disease. Most (85.9%) patients presented with at least one comorbid disease and the perioperative complication rate was 76.9% in total cases. Age≥80 (OR: 1.772, 95% CI: 1.236-2.540) and the number of comorbidities≥3 (OR: 1.606, 95% CI: 1.035-2.494) were found independently associated with complications, while the type of cerebrovascular disease, fracture location, and comorbidities of prior fragility fracture and respiratory disease were not significantly correlated with complications. Conclusion: Our findings highlighted that more focus on improved physical function explored in intervention setting and the importance of primary home prevention measures seems justified in China and maybe other countries as well. It is the first study that presented the epidemiological characteristics of older adults with cerebrovascular disease who later experienced a fracture.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Transtornos Cerebrovasculares/epidemiologia , Fraturas Ósseas/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Transtornos Cerebrovasculares/complicações , China/epidemiologia , Estudos Transversais , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Masculino , Fatores de Risco
14.
J Nutr Sci Vitaminol (Tokyo) ; 67(3): 153-162, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34193674

RESUMO

The world's population is aging, and the prevalence of hip fracture is rising. Vitamin D deficiency is a risk factor for hip fracture and predicts functional recovery and survival following hip fracture surgery. This cross-sectional study identified the prevalence of vitamin D deficiency in Taiwanese older patients with hip fracture and potential risk factors for vitamin D deficiency. Data from older adults with hip fracture admitted to a single medical center in Taipei, Taiwan were prospectively collected. The preoperative serum 25-hydroxyvitamin D [25(OH)D] concentration and comprehensive clinical history of each patient were examined. A multinomial logistic regression model was used to compare the clinical characteristics of deficient, insufficient, and sufficient 25(OH)D concentration groups. The cohort comprised 310 older adults with hip fracture. The mean age was 80±10 y. The deficient, insufficient, and sufficient groups comprised 180, 84, and 46 patients (58.1%, 27.1%, and 14.8%), respectively. Univariate analysis revealed significant intergroup differences in serum albumin level and body fat percentage and marginally significant differences in serum albumin, estimated glomerular filtration rate, body mass index, and comorbidities of affective or psychotic disorders. In the multinomial logistic regression model, albumin level was the only factor significantly correlated with higher 25(OH)D concentrations in the sufficient and insufficient groups compared with the deficient group. No variable, including preinjury functional status, was significantly correlated with vitamin D deficiency except malnutrition. Our findings may aid the establishment of a robust screening and treatment program for vitamin D deficiency.


Assuntos
Fraturas do Quadril , Deficiência de Vitamina D , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Fraturas do Quadril/epidemiologia , Humanos , Estudos Prospectivos , Albumina Sérica , Vitamina D , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologia
15.
BMC Health Serv Res ; 21(1): 678, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34243769

RESUMO

BACKGROUND: Reducing the economic impact of hip fractures (HF) is a global issue. Some efforts aimed at curtailing costs associated with HF include rehabilitating patients within primary care. Little, however, is known about how different rehabilitation settings within primary care influence patients' subsequent risk of institutionalization for long-term care (LTC). This study examines the association between rehabilitation setting (outside an institution versus short-term rehabilitation stay in an institution, both during 30 days post-discharge for HF) and risk of institutionalization in a nursing home (at 6-12 months from the index admission). METHODS: Data were for 612 HF incidents across 611 patients aged 50 years and older, who were hospitalized between 2008 and 2013 in Oslo, Norway, and who lived at home prior to the incidence. We used logistic regression to examine the effect of rehabilitation setting on risk of institutionalization, and adjusted for patients' age, gender, health characteristics, functional level, use of healthcare services, and socioeconomic characteristics. The models also included fixed-effects for Oslo's boroughs to control for supply-side and unobserved effects. RESULTS: The sample of HF patients had a mean age of 82.4 years, and 78.9 % were women. Within 30 days after hospital discharge, 49.0 % of patients received rehabilitation outside an institution, while the remaining 51.0 % received a short-term rehabilitation stay in an institution. Receiving rehabilitation outside an institution was associated with a 58 % lower odds (OR = 0.42, 95 % CI = 0.23-0.76) of living in a nursing home at 6-12 months after the index admission. The patients who were admitted to a nursing home for LTC were older, more dependent on help with their memory, and had a substantially greater increase in the use of municipal healthcare services after the HF. CONCLUSIONS: The setting in which HF patients receive rehabilitation is associated with their likelihood of institutionalization. In the current study, patients who received rehabilitation outside of an institution were less likely to be admitted to a nursing home for LTC, compared to those who received a short-term rehabilitation stay in an institution. These results suggest that providing rehabilitation at home may be favorable in terms of reducing risk of institutionalization for HF patients.


Assuntos
Assistência ao Convalescente , Fraturas do Quadril , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Institucionalização , Pessoa de Meia-Idade , Noruega/epidemiologia , Alta do Paciente
16.
Artigo em Inglês | MEDLINE | ID: mdl-34199045

RESUMO

Restoration of ambulatory status is considered a primary treatment goal for older patients with intertrochanteric fractures. Several surgical-related parameters were reported to be associated with mechanical failure without focusing on the functional outcomes. Our study examines the roles of both clinical and surgical parameters as prognostic factors on 1-year postoperative ambulatory outcomes, reaching a good functional outcome (the New Mobility Score: NMS ≥ 5) and returning to preinjury functional status at one year, of older patients with intertrochanteric fracture. Intertrochanteric fractures patients age ≥65 years who underwent surgical treatment at our institute between January 2017 and February 2020 were included. Of 209 patients included, 149 (71.3%) showed a good functional outcome at one year. The pre-injury ambulatory status (OR 52.72, 95%CI 5.19-535.77, p = 0.001), BMI <23 kg/m2 (OR 3.14, 95%CI 1.21-8.13, p = 0.018), Hb ≥10 g/dL (OR 3.26, 95%CI 1.11-9.57, p = 0.031), and NMS at discharge ≥2 (OR 8.50, 95%CI 3.33-21.70, p < 0.001) were identified as independent predictors for reaching a good postoperative functional outcome. Only aged ≤80 (OR 2.34, 95%CI 1.11-4.93, p = 0.025) and NMS at discharge ≥2 (OR 6.27, 95%CI 2.75-14.32, p < 0.001) were significantly associated with an ability to return to preinjury function. To improve postoperative ambulatory status, orthopedic surgeons should focus more on modifying factors, such as maintaining the preoperative hemoglobin ≥10 g/dL and providing adequate postoperative ambulation training to maximize the patients' capability upon discharge. While surgical parameters were not identified as predictors, they can still be used as guidance to optimize the operation quality.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Idoso , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Prognóstico , Estudos Retrospectivos , Tailândia/epidemiologia , Resultado do Tratamento
17.
BMJ Open ; 11(7): e047258, 2021 07 28.
Artigo em Inglês | MEDLINE | ID: mdl-34321298

RESUMO

INTRODUCTION: Hip fractures are associated with a high burden of morbidity and mortality. Globally, there is wide variation in the incidence of hip fracture in people aged 50 years and older. Longitudinal and cross-geographical comparisons of health data can provide insights on aetiology, risk factors, and healthcare practices. However, systematic reviews of studies that use different methods and study periods do not permit direct comparison across geographical regions. Thus, the objective of this study is to investigate global secular trends in hip fracture incidence, mortality and use of postfracture pharmacological treatment across Asia, Oceania, North and South America, and Western and Northern Europe using a unified methodology applied to health records. METHODS AND ANALYSIS: This retrospective cohort study will use a common protocol and an analytical common data model approach to examine incidence of hip fracture across population-based databases in different geographical regions and healthcare settings. The study period will be from 2005 to 2018 subject to data availability in study sites. Patients aged 50 years and older and hospitalised due to hip fracture during the study period will be included. The primary outcome will be expressed as the annual incidence of hip fracture. Secondary outcomes will be the pharmacological treatment rate and mortality within 12 months following initial hip fracture by year. For the primary outcome, crude and standardised incidence of hip fracture will be reported. Linear regression will be used to test for time trends in the annual incidence. For secondary outcomes, the crude mortality and standardised mortality incidence will be reported. ETHICS AND DISSEMINATION: Each participating site will follow the relevant local ethics and regulatory frameworks for study approval. The results of the study will be submitted for peer-reviewed scientific publications and presented at scientific conferences.


Assuntos
Fraturas do Quadril , Idoso , Ásia , Europa (Continente) , Fraturas do Quadril/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Retrospectivos , América do Sul
18.
Arch Osteoporos ; 16(1): 111, 2021 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-34245372

RESUMO

The annual incidence of new hip fractures increased from 2005 to 2014 in Nagasaki and females were much more affected. High-risk factors were identified as age ≥ 80 years, winter, indoors, living room, Monday, and early morning. Seven days after admission, most patients remained hospitalized and had been treated surgically. INTRODUCTION: Hip fractures are major osteoporotic fractures that reduce quality of life. In Japan, the incidence of hip fractures increased steadily from 1986 to 2014 and the number of hip fractures could be 7.3-21.3 million by 2050. This study aimed to determine the incidence of hip fractures from 2005 to 2014 in Nagasaki Prefecture and to analyze the characteristics of and risk factors for hip fracture. METHODS: Hip fractures that occurred in Nagasaki Prefecture between 2005 and 2014 were analyzed using emergency transportation records. Fracture type, age, sex, location in which fracture occurred, and risk factors for hip fracture were clarified. RESULTS: The total number of new hip fractures among individuals ≥ 35 years old was 17,395 (mean age, 82.6 years old) and the annual incidence per 100,000 population increased from 147.9 in 2005 to 235.0 in 2014. Females (79.6%) were much more commonly affected than males (20.4%) and cervical fractures were more common than trochanteric fractures in all age groups. Hip fracture tended to be associated with age ≥ 80 years, winter rather than summer, indoors rather than outdoors, and living room rather than the bathroom or toilet. Other high-risk factors were Monday as day of the week, and early morning as the time of day. Seven days after admission, 97.3% of patients were hospitalized and 78.1% of hip fractures had been treated surgically. CONCLUSION: Information on actual situations and valid preventive measures relevant to hip fracture are urgently needed.


Assuntos
Fraturas do Quadril , Qualidade de Vida , Adulto , Idoso de 80 Anos ou mais , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Incidência , Japão/epidemiologia , Masculino , Fatores de Risco
19.
Arch Osteoporos ; 16(1): 110, 2021 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-34245374

RESUMO

Fall is the major risk factor of fracture that has not been included in FRAX®. Whether different age may determine the effect of falls on FRAX® is still uncertain. This epidemiological cohort study reveals that history of fall is a significant predictor of incident fracture independent of FRAX probability, especially in subjects < 75 years old. INTRODUCTION: The Fracture Risk Assessment Tool (FRAX) calculates 10-year fracture risk using 11 clinical risk factors and bone mineral density (BMD); however, it does not include fall history in its risk assessment. Here, we investigated whether fall history is an independent risk factor on fracture prediction after adjustment of FRAX scores in two age subgroups (40-75 and ≥ 75 years). METHODS: Beginning in 2009 to 2010, 1975 people (914 men) from Taiwan were followed for 6.8 ± 1.1 years by matching them with their records in the 2008-2016 National Health Insurance databank. We validated FRAX predictive accuracy with or without fall history by Cox proportional hazards regression. RESULTS: After adjusting for FRAX risk, a history of falling was still a significant predictor of major osteoporotic fractures (MOFs) (using BMD, hazard ratio [HR], 1.47; p = 0.03; without using BMD, HR, 1.54; p = 0.01). A history of recurrent falls was also a significant predictor of both incident MOFs and hip fractures. However, when the subjects were stratified based on age group, a history of falling and recurrent falls were strong predictors of MOFs and hip fractures in the younger but not the older subgroup. CONCLUSION: A fall history can predict incident fracture independently of FRAX probability, particularly in subjects younger than 75 years old.


Assuntos
Fraturas do Quadril , Fraturas por Osteoporose , Acidentes por Quedas , Idoso , Densidade Óssea , Estudos de Coortes , Fraturas do Quadril/epidemiologia , Humanos , Masculino , Fraturas por Osteoporose/epidemiologia , Medição de Risco , Fatores de Risco
20.
BMC Geriatr ; 21(1): 440, 2021 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-34311698

RESUMO

BACKGROUND: Clinical studies indicate that strength-balance training for active fall prevention can prevent fractures in older people. The present modelling study evaluates the cost-effectiveness of fall prevention exercise (FPE) provided to independently living older people compared to no intervention in Germany. METHOD: We designed a Markov model to evaluate the cost-effectiveness of a group-based FPE-program provided to independently living people ≥75 years from the perspective of the German statutory health insurance (SHI). Input data was obtained from public databases, clinical trials and official statistics. The incremental cost-effectiveness ratio (ICER) was presented as costs per avoided hip fracture. Additionally, we performed deterministic and probabilistic sensitivity analyses and, estimated monetary consequences for the SHI in a budget impact analysis (BIA). RESULTS: For women, the costs per hip fracture avoided amounted to €52,864 (men: €169,805). Results of deterministic and probabilistic sensitivity analyses confirmed the robustness of the results. According to the BIA, for the reimbursement of FPE additional costs of €3.0 million (women) and €7.8 million (men) are expected for the SHI. CONCLUSIONS: Group-based FPE appears to be no cost-effective option to prevent fall-related hip fractures in independently living elderly. To allow a more comprehensive statement on the cost effectiveness of FPE fracture types other than hip should be increasingly evaluated in clinical trials.


Assuntos
Fraturas do Quadril , Vida Independente , Idoso , Análise Custo-Benefício , Exercício Físico , Feminino , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/prevenção & controle , Humanos , Masculino , Anos de Vida Ajustados por Qualidade de Vida
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