Peggy P Ríos-Germán1,2, Alicia Gutierrez-Misis3,4, Rocío Queipo3,5, Cristina Ojeda-Thies6, Pilar Sáez-López3,7, Teresa Alarcón8,3, Angel Otero Puime3,4, Paloma Gómez-Campelo3, Laura Navarro-Castellanos3, Juan Ignacio González-Montalvo8,3,4. 1. Department of Geriatric Medicine, Geriatric Service, Hospital Universitario La Paz, Paseo La Castellana 261, 28046, Madrid, Spain. peggypaola.rios@salud.madrid.org. 2. La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain. peggypaola.rios@salud.madrid.org. 3. La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain. 4. Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain. 5. European University of Madrid, Madrid, Spain. 6. Department of Traumatology and Orthopaedic Surgery, Hospital Universitario, 12 de Octubre, Madrid, Spain. 7. Department of Geriatric Medicine, Hospital Universitario Fundación de Alcorcón, Madrid, Spain. 8. Department of Geriatric Medicine, Geriatric Service, Hospital Universitario La Paz, Paseo La Castellana 261, 28046, Madrid, Spain.
Abstract
PURPOSE: One in four hip fracture patients comes from an aged care facility. This study aimed to compare the characteristics of these subjects with their community-dwelling counterparts at baseline, during hospitalization and 1-month post-fracture. METHODS: We analyzed data from a cohort of older adults admitted with hip fractures to 75 Spanish hospitals, collected prospectively in the Spanish National Hip Fracture Registry between 2016 and 2018. We classified participants according to pre-fracture residence: community dwellers vs. aged care facilities residents. We collected demographic records at baseline, along with variables relating to in-hospital evolution and discharge to geriatric rehabilitation units. Patients or relatives were interviewed at 1-month follow-up. RESULTS: Out of 18,262 patients, 4,422 (24.2%) lived in aged care facilities. Aged care facilities residents were older (median age: 89 vs. 86 years), less mobile (inability to walk independently: 20.8% vs. 9.4%) and had more cognitive impairment (Pfeiffer's SPMSQ > 3, 75.3% vs. 34.8%). They were more likely to receive conservative treatment (5.4% vs. 2.0%) and less likely to be mobilized early (58.2% vs. 63.0%). At discharge, they received less vitamin D supplements (68.5% vs. 72.4%), less anti-osteoporotic medication (29.3% vs. 44.3%), and were referred to geriatric rehabilitation units less frequently (5.4% vs. 27.5%). One-month post-fracture, 45% of aged care facilities residents compared to 28% of community dwellers experienced a severe gait decline. Aged care facilities residents had a higher one-month mortality (10.6% vs. 6.8%). CONCLUSION: Hip fracture patients from aged care facilities are more vulnerable than their community-dwelling peers and are managed differently both during hospitalization and at discharge. Gait decline is disproportionately higher among those admitted from aged care.
PURPOSE: One in four hip fracture patients comes from an aged care facility. This study aimed to compare the characteristics of these subjects with their community-dwelling counterparts at baseline, during hospitalization and 1-month post-fracture. METHODS: We analyzed data from a cohort of older adults admitted with hip fractures to 75 Spanish hospitals, collected prospectively in the Spanish National Hip Fracture Registry between 2016 and 2018. We classified participants according to pre-fracture residence: community dwellers vs. aged care facilities residents. We collected demographic records at baseline, along with variables relating to in-hospital evolution and discharge to geriatric rehabilitation units. Patients or relatives were interviewed at 1-month follow-up. RESULTS: Out of 18,262 patients, 4,422 (24.2%) lived in aged care facilities. Aged care facilities residents were older (median age: 89 vs. 86 years), less mobile (inability to walk independently: 20.8% vs. 9.4%) and had more cognitive impairment (Pfeiffer's SPMSQ > 3, 75.3% vs. 34.8%). They were more likely to receive conservative treatment (5.4% vs. 2.0%) and less likely to be mobilized early (58.2% vs. 63.0%). At discharge, they received less vitamin D supplements (68.5% vs. 72.4%), less anti-osteoporotic medication (29.3% vs. 44.3%), and were referred to geriatric rehabilitation units less frequently (5.4% vs. 27.5%). One-month post-fracture, 45% of aged care facilities residents compared to 28% of community dwellers experienced a severe gait decline. Aged care facilities residents had a higher one-month mortality (10.6% vs. 6.8%). CONCLUSION: Hip fracture patients from aged care facilities are more vulnerable than their community-dwelling peers and are managed differently both during hospitalization and at discharge. Gait decline is disproportionately higher among those admitted from aged care.
Authors: P P Ríos-Germán; R Menéndez-Colino; R Ramírez Martin; T Alarcón; R Queipo; A Otero Puime; J I González-Montalvo Journal: Rev Esp Geriatr Gerontol Date: 2019-02-22
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