Comparison of the prognosis among different age groups in elderly patients with hip fracture

Abstract

Background:The outcome of treatment of hip fractures in different age groups in the elderly population is largely unknown. Hence, we stratified elderly patients with hip fracture into age groups and compared the prognosis in various age groups.Materials and Methods:Among 459 patients with hip fracture treated at our hospital from 1997, 430 patients aged 65 years or above at the time of injury were studied. The patients comprised 98 males and 332 females and the ages at injury ranged from 65 to 103 years (mean 83.4 years). There were 167 cases of femoral neck fracture and 263 cases of trochanteric fractures. Surgery was performed in 383 cases, while 47 cases were treated conservatively. The subjects were classified by age into young-old for those aged 65-74 years (group A, n = 55), middle-old for those aged 75-84 years (group B, n = 172), old-old for those aged 85-94 (group C, n = 180), and oldest-old for those aged 95 years or above (group D, n = 23). The functional and survival prognosis at discharge in each group was investigated.Results:Numbers of patients who were ambulatory at discharge among those ambulatory before injury were 43 of 49 (87.8%) in group A, 113 of 152 (74.3%) in group B, 86 of 138 (62.3%) in group C, and 5 of 14 (35.7%) in group D, showing worse recovery of walking ability as age advanced. Among those ambulatory before injury, 42 patients in group A, 139 patients in group B, 130 patients in group C, and 12 patients in group D underwent surgery and of these patients, 38 patients (90.5%) in group A, 109 patients (78.4%) in group B, 83 patients (63.8%) in group C, and 5 patients (41.7%) in group D were ambulatory at discharge. On the other hand, the numbers of patients who were ambulatory at discharge among those receiving conservative treatment were 5 of 7 (71.4%) in group A, 4 of 13 (30.8%) in group B, 3 of 8 (37.5%) in group C, and 0 of 2 (0%) in group D, showing better walking ability in surgical patients than in conservatively treated patients even in the elderly. There were two in-hospital deaths in group B, 11 in group C, and two in group D. Five of the 15 deaths were inoperable cases due to poor performance status at admission.Conclusion:Walking ability at discharge and survival prognosis worsened as age advanced. On the other hand, since surgical cases achieved better walking ability than conservatively treated cases, efforts should be made to achieve better functional prognosis even in the old-olds, including surgery together with early ambulation and rehabilitation.

Factors Influencing The Six-Month Mortality Rate In Patients With A Hip Fracture

“…We could not demonstrate that the age of the patient played a significant role in the prediction of mortality after a hip fracture, which was the case with other studies ( 11 , 32 ). However, we did find that a poor cognitive status was a significant predictive factor and this has also been shown in previous work ( 22 , 29 , 33 ).…”

Survival of Nonagenarian Patients With Hip Fractures: A Cohort Study

“…Our data, like that of other studies, 15 suggest that surgical treatment remains the best option, even for nonagenarian patients. Even though mortality is high, the hospitalization period long and the functional prognosis is limited, the rate of surgical complications is acceptable.…”

Outcomes of an accelerated nonsurgical management protocol for hip fractures in the elderly

“…Age alone has been shown to be a poor prognostic factor for walking ability at discharge and survival, regardless of whether they underwent surgical or nonsurgical treatment. 10 In our cohort, older age and longer length of stay are the two main factors that affect both functional and radiological outcomes. We proposed that this can be explained by decreased musculature and strength required for ambulation due to a more advanced age and further deconditioning as an inpatient and not contributed by comorbidities and dementia as expected.…”