These findings confirm the important role of serum albumin in assessing in-hospital health status and defining its role as a strong predictor of early and late mortality after hospital discharge. They also emphasize the effects of comorbidity and functional impairment on long-term mortality after hip fracture. Identifying these predictive factors may be helpful in improving case management during hospital stay and more accurate discharge planning.
Hip fracture (HF) is a common event in older adults and is associated with significant morbidity, mortality, reduction of quality of life and costs for the healthcare systems. The expected rise in the total number of HF worldwide, due to improvements in life expectancy, and the growing awareness of HF detrimental consequences have led to the development and implementation of models of care alternative to the traditional ones for the acute and post-acute management of HF older adults. These services were set to streamline hospital care, minimize inhospital complications, provide early discharge, improve short- and long-term functional and clinical outcomes, and reduce healthcare costs associated with hip and other fragility fractures. The main feature that distinguishes these models is the different healthcare professional that retains the responsibility and leadership during the acute and post-acute phases. This narrative review has been conceived to provide a brief description of the models implemented in the last twenty years, to describe their potential beneficial effects on the shortand long-term outcomes, and to define the strengths and limitations of these models. On the basis of available studies, it seems that the more complex and sophisticated services, characterized by a multidisciplinary approach with a co-leadership (geriatrician and orthopedic surgeon) or a geriatrician leadership demonstrated to produce better outcomes compared to the traditional or simplest models.
Hip fracture (HF) is a major health care problem in the Western world, associated with significant morbidity, mortality and loss of function. Its incidence is expected to increase as the population ages. The authors discuss the role of a coordinated multidisciplinary team in the management of patients during hospital stay, at discharge and during rehabilitation. Orthogeriatric care should not just be viewed as a multidisciplinary activity, but as a radical alternative to the traditional model of care, an alternative based on all those strategies in which evidence shows an improvement in outcomes in the fractured elderly. Therefore, key points of the care are early surgery, immediate mobilization, prevention and management of delirium, pain and malnutrition, as well as an integrated and multidisciplinary approach. Comprehensive geriatric assessment is useful in identifying frail elderly and in providing information that is essential in formulating clinical recommendations and making care plans. In each hospital, the orthogeriatric unit should represent a center of excellence for treating elderly patients with major fractures. However, when an orthogeriatric project is implemented, it is essential that detailed data about the case-mix of patients, process of care and outcomes are collected, to compare the results with historical data and to be able to participate in audit processes.
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