Abstract

Hip fracture is a potentially devastating condition for older adults. Hip fracture leads to pain and immobilization with complications ranging from delirium to functional loss and death. Although a mainstay of treatment is orthopedic repair, a multidisciplinary comanagement approach, including medical specialists and rehabilitation, may maximize patient recovery. Using the case of Mr W, an older man who sustained a fall and hip fracture, we present evidence-based components of care both in the hospital and outpatient settings. Preoperatively, clinicians should correct medical abnormalities and consider the appropriateness, timing, and type of surgical repair in the context of the patient's life expectancy and goals of care. Perioperative care should include prophylaxis with antibiotics, chemoprophylaxis for venous thromboembolism, and correction of major clinical abnormalities prior to surgery. Pain control, delirium, and pressure ulcer prevention are important inpatient care elements. Multidisciplinary models incorporating these care elements can decrease complications during inpatient stay. Rehabilitation strategies should be tailored to patient needs; early mobilization followed by rehabilitation exercises in institutional, home, and group settings should be considered to maximize restoration of locomotive abilities. Attention to care transitions is necessary and treatment for osteoporosis should be considered. The road to recovery for hip fracture patients is long and most patients may not regain their prefracture functional status. Understanding and anticipating issues that may arise in the older patient with hip fracture, while delivering evidence-based care components, is necessary to maximize patient recovery.

Links

Publisher Full Text

Authors

Hung WW, Egol KA, Zuckerman JD, Siu AL

Institution

Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA. william.hung@mssm.edu

Source

JAMA : the journal of the American Medical Association 307:20 2012 May 23 pg 2185-94

MeSH

Accidental Falls
Age Factors
Aged
Aged, 80 and over
Delirium
Female
Hip Fractures
Humans
Inpatients
Male
Orthopedic Procedures
Pain
Patient Care Planning
Patient Discharge
Physical Therapy Modalities
Preoperative Care
Pressure Ulcer
Recovery of Function
United States

Pub Type(s)

Case Reports
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22618926