Immediate Admission Of Hip Fractured Patients Improves Mobility

Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive geriatric or aged care in a dedicated ward improves mobility at four months, compared with the usual orthopaedic care.

      According to a study published in the February 2015 edition of the Lancet Journal, the results suggested that the treatment of older patients with hip fractures should be organised as orthogeriatric care.

      It said most patients with hip fractures were characterised by older age of 70 years plus, frailty, and functional deterioration, and their long-term outcomes were poor with increased costs.

       The study, which was made available to the Ghana News Agency on Monday, compared the effectiveness and cost-effectiveness of giving these patients comprehensive geriatric care in a dedicated geriatric ward versus the usual orthopaedic care.

          The researchers did a prospective, single-centre, randomised, parallel-group, and controlled trial.

          Between April 18, 2008, and December 30, 2010, the research team randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department, to achieve the required sample of 400 patients.

          According to the study dubbed: “Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial,” randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes.  

          It said the primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) four months after surgery for the fracture.

          It explained that the type of treatment was not concealed from the patients or staff delivering the care, and assessors were only partly masked to the treatment during follow-up.

          The researchers observed that this trial was registered with, number NCT00667914.

          The study assessed 1077 patients for eligibility, and excluded 680 mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years.

          Of the remaining patients, the researchers randomly assigned 198 to comprehensive geriatric care and 199 to orthopaedic care.

          It noted that at four months, 174 patients remained in the comprehensive geriatric care group and 170 in the orthopaedic care group; the main reason for dropout was death.

          According to the study, the mean SPPB scores at four months were 5·12 for comprehensive geriatric care and 4·38 for orthopaedic care between-group difference 0·74, 95 per cent.

          The research was funded by the Norwegian Research Council, Central Norway Regional Health Authority, St Olav Hospital Trust and Fund for Research and Innovation, Liaison Committee between Central Norway Regional Health Authority and the Norwegian University of Science and Technology.

          The rest are the Department of Neuroscience at the Norwegian University of Science and Technology, Foundation for Scientific and Industrial Research at the Norwegian Institute of Technology and the Municipality of Trondheim.

          The Lancet is the world's leading independent general medical journal. The journal's coverage is international in focus and extends to all aspects of human health.