‘Nonagenarians’ with a hip fracture: is a different orthogeriatric treatment strategy necessary?

Abstract

Nonagenarians differ from patients aged 70-79 and 80-89 years in baseline characteristics, complication and mortality rates. Differences increased gradually with age. The results of this study can be used, in combination with the Almelo Hip Fracture Score, to deliver efficiently targeted orthogeriatric treatment to the right patient group. Purpose In previous literature, elderly with a hip fracture are frequently defined as ≥ 70 years. However, given the ageing population and the rapidly increasing number of 'nonagenarians' (aged ≥ 90 years), the question rises whether this definition is still actual. The aim of this study is to determine whether nonagenarians show differences compared to patients aged 70-79 years and patients aged 80-89 years in terms of patient characteristics, complications and mortality rate. Methods From April 2008 until December 2016, hip fracture patients aged ≥ 70 years treated according to our orthogeriatric treatment model were included. Patients were divided into three different groups based on age at admission: 70-79 years, 80-89 years and ≥ 90 years. Patient characteristics, risk of early mortality, complications and outcomes were analysed. Risk factors for 30-day mortality in nonagenarians were determined. Results A total of 1587 patients were included: 465 patients aged 70-80 years, 867 patients aged 80-90 years and 255 patients aged ≥ 90 years. Nonagenarians were more often female and had a lower haemoglobin level at admission. Prefracture, they were more often living in a nursing home, were more dependent in activities of daily living and mobility and had a higher risk of early mortality calculated with the Almelo Hip Fracture Score (AHFS). Post-operative, nonagenarians suffer significantly more often from delirium and anaemia. The 30-day mortality and 1-year mortality were significantly higher. Differences increased gradually with age. Conclusion Nonagenarians differ from patients aged 70-79 and 80-89 years in baseline characteristics, complication and mortality rates. Differences increased gradually with age. The results of this study can be used, in combination with the Almelo Hip Fracture Score, to deliver efficiently targeted orthogeriatric treatment to the right patient group.

The prediction of early mortality following hip fracture surgery in patients aged 90 years and older: the Almelo Hip Fracture Score 90 (AHFS90)

“…A better prediction might be possible in a study population with higher mortality rates. De Groot et al (2020) showed that the oldest hip fracture patients (i.e., 90 years and older, the so-called nonagenarians) have a significantly higher 30-day mortality rate of 13.3% compared to their younger peers (4.3% and 8.5% in patients aged 70–79 years and 80–89 years, respectively) [ 15 ]. Developing a risk score in patients 90 or older could improve the prediction.…”

Acetabular fractures treatment needs in the elderly and nonagenarians

“…There have been different reports of bad prognostic factors (female gender, osteoporosis, higher age, complex fracture patterns) when choosing an operative treatment ( 13 , 14 ). But due to the fact that in the elderly and nonagenarian population comorbidities, resiliencies and lifestyles differ immensely and the life expectation is not calculatable; all authors concluded that an individual decision-making is most important ( 7 , 53 ).…”

24-hours mortality in seniors hospitalised with medical conditions

“…Publikované sú informácie o včasnej letalite seniorov s konkrétnym ochorením -napr. infarktom myokardu (2-4), chlopňovými chybami (5-6), srdcovým zlyhaním (7-8), redukovanou funkciou obličiek (9)(10)(11)(12), cievnou mozgovou príhodou (13)(14)(15), infekciami (16)(17), zlomeninou (18)(19)(20), neopláziami (21)(22)(23)(24)(25), delíriom (26), pričom sú často viazané na konkrétny druh vykonanej liečby. Hodnotenie M24 je pritom publikované zriedkavejšie ako pri dlhších časových intervaloch, a to aj pri akútnych chorobách.…”