Counseling, quality of life, and acute postoperative pain in elderly patients with hip fracture

Abstract

IntroductionHip fractures represent one of the most important causes of morbidity and mortality in elderly people. Anxiety and depression affect their quality of life and increase pain severity, and have adverse effects on functional recovery. Recent World Health Organization guidelines emphasize that therapeutic regimes need to be individualized and combined with psychological support. This study was launched with the primary endpoint of assessing if and to what extent client-centered therapy affects the perception of pain, reduces anxiety and depression, and increases the quality of life of elderly patients with hip fracture.Materials and methodsForty patients were admitted to the Orthopedic and Trauma Surgery ward for hip fracture. Patients were randomly divided into two subgroups: (1) case (group C), had to receive patient-centered counseling throughout the hospitalization; and (2) control (group NC), receiving the analgesic treatment without receiving counseling. Short Form-36-item Health Survey Questionnaire, State–Trait Anxiety Inventory, and Hamilton Rating Scale for Depression scores were recorded before any treatment, at discharge, and after 30 days. Pain levels were evaluated by means of Visual Analog Scale every 12 hours during the hospitalization from the day of surgery until day 5.ResultsThe hierarchical clustering analysis identified before any treatment were two clusters based on different physical functioning perceptions and role limitations, which were due to physical and emotional problems. Counseling did have a positive impact on quality of life on all patients, but in a more relevant way if patients were low functioning upon admittance to the ward. Anxiety and depression decreased in patients undergoing counseling, and their pain levels were lower than among patients not receiving it.ConclusionThis study reveals that hip fracture patients can be clustered on the basis of Short Form-36 baseline scores. Counseling affects the evolution of mental and physical status in these patients, and the major benefit is reported in patients whose quality of life perception is worse after the trauma. Decreasing anxiety and depression levels, as well as more satisfying pain management, assessed by means of specific tests, confirm the effectiveness of counseling in elderly patients with hip fracture.

Understanding the role of social factors in recovery after hip fractures: A structured scoping review

“…Included studies were two randomised controlled trials, one cross-sectional exploratory study, one retrospective observational cohort study, one record linkage study and 14 prospective cohort studies. The overall sample size of the included papers ranged from 40 to 171,570 participants (Gambatesa et al, 2013;Thorne, Johansen, Akbari, Williams, & Roberts, 2016), and the mean age of participants ranged from 76.6 (SD: 7.4) to 85.5 States of America (see Figure 2). All studies collected data on post-fracture outcomes except for two studies that also looked at pre-fracture subjective recalled outcomes (Cobey et al, 1976;Mortimore et al, 2008).…”

“…3. Other outcomes: There were six articles investigated other outcomes including: pain, measured by visual analogue scale (VAS) (Orive et al, 2016), health-related quality of life as measured by the SF-36 total score (Gambatesa et al, 2013), hospital length of stay in days (Kristensen et al, 2017;Landeiro et al, 2016) and two articles that investigated the effect on institutionalisation after hip fracture (Hongisto et al, 2016;Marottoli et al, 1994). Table 3 summarises all outcome measures in included studies.…”

“…test of a relationship) of associations (and/or significant differences) of social factors and recovery. Eighteen (n = 18) out of the 23 reports indicated that there is a significant association between the given social factor(s) under investigation and recovery outcomes after hip fractures or significant difference in recovery based on these factors (Allegrante et al, 2007;Cobey et al, 1976;Cree et al, 2001;Cresi, 2001; Gambatesa et al, 2013;Kristensen et al, 2017;Landeiro et al, 2016;Magaziner et al, 1990;Oh & Feldt, 2000;Orive et al, 2016;Shin et al, 2016;Thorne et al, 2016). The remaining five reports indicated that there is no significant association, correlation or significant difference with respect to the social factor and functional outcome under investigation (Egan et al, 1992;Marottoli et al, 1992Marottoli et al, , 1994Morghen et al, 2011;Sylliaas et al, 2012).…”

“…One article looked at various aspects of social support, including social network size, number of sources of emotional or task support, marital status and social activities, and only being married was significantly associated with not being institutionalised post hip fracture (Marottoli et al, 1994). Counselling, as a social intervention, was found to significantly impact health-related quality of life of hip fracture patients (Gambatesa et al, 2013). Finally, social isolation was significantly associated with delayed hospital discharge after the facture (Landeiro et al, 2016).…”

Increased Risk of Major Depression in the Three Years following a Femoral Neck Fracture–A National Population-Based Follow-Up Study

“…[17] In this study, we further extended the observation period. Most major depressive episodes (34.5%) occurred within the first 200 days following a femoral neck fracture.…”