Introduction: Cognitive impairment can hinder a fracture patient’s capacity to consent to surgery and negatively impact their postoperative recovery and rehabilitation. National guidelines recommend screening for cognitive impairment upon admission, and the Abbreviated Mental Test Score (AMTS) is a commonly used tool for this. This project aimed to assess current practice regarding documentation of AMTS among frail fracture patients upon admission and to improve AMTS documentation following a simple intervention. Methods: Baseline data were obtained by inpatient chart review throughout November to December 2018 in a district general hospital with emergency fracture services. All patients admitted with a fragility hip fracture and patients over 65 years with any fracture were included. National guidelines and baseline results were then distributed among junior doctors. Following an intervention, further data were collected throughout January to February 2019. Results: Preintervention, 40 suitable patients (mean age: 82 years) were identified; 9 (22.0%) of whom had an AMTS recorded upon admission. Among the hip fracture subgroup (n = 25), 7 (26.9%) had an AMTS recorded. Postintervention, 39 patients (mean age: 80 years) were identified; 15 (38.5%) of whom had an AMTS recorded. Among the hip fracture subgroup (n = 30), 11 (36.7%) had an AMTS recorded. Statistical analysis demonstrated a significant improvement in AMTS documentation both among the overall cohort ( P = .001) and hip fracture patients ( P = .019). No significant association was found between AMTS documentation and patient age ( P = .566), grade of admitting doctor ( P = .058), or prior cognitive/mental health disorder ( P = .256). Discussion: A small yet significant improvement in AMTS documentation among elderly/hip fracture patients was observed following distribution of educational material. Further work should explore the effect of cognitive impairment on outcomes related to orthopedic injuries beyond hip fractures.

Falls are being acknowledged as having far reaching consequences for the quality of life of the aged; yet there are not many studies conducted in India. This paper attempts to provide some insights on the effects of falls on the life of the elderly and also for the caregivers. Objective: The broad objective of the study is to understand the effects of falls among the elderly population. It helps in interpreting the causes and the effect of falls in the future life of the elderly people. It ultimately sheds some light on how the falls of the elderly affect the life of their caregivers as well. Methods: Qualitative research was carried out in Thrissur district of Kerala among those who experienced falls between the time period of January 2015 to January 2016. The data was collected in the month of May 2016. In-depth interviews with victims of falls and their care givers were conducted. Key informant interviews were also used as a method for collecting data. Results: The findings of the study revealed that age was a major risk factor in falls. Other risk factors such as history of falls and non-communicable diseases also played a significant role in contributing to falls among the elderly. As a result of falls, majority of the respondents opted for treatment in private hospitals which ultimately resulted in high healthcare expenditure. Restriction of activities among majority of the respondents were reported as a consequence of falls, which resulted in change in attitude of the elderly people, mostly leading to loss of confidence along with an increase in fear of fall. The caregivers were mainly involved in assisting the elderly in their routine activities. There was a constant need of support and assistance for the elderly for performing their activities which to some extent was burdensome to the caregivers. Conclusions: Falls among the elderly are resulting in people getting affected not only physically but psychologically as well. The ultimate consequence is more social withdrawal and less activities resulting in a change in attitude of the elderly. The health awareness among the people of Kerala also results in people seeking quality treatment which most of them considers, is available in private hospitals. This ultimately results in increased healthcare expenditure which turns out to be a burden on the productive population especially in a scenario where majority of the elderly is remaining uninsured.