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Hip fracture management: tailoring care for the older patient.

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.

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  • 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