The Aftermath of Hip Fracture: Discharge Placement, Functional Status Change, and Mortality

Bentler, Suzanne E.; Liu, Li; Obrizan, Maksym; Cook, Elizabeth; Wright, Kara; Geweke, John; Chrischilles, Elizabeth A.; Pavlik, Claire; Wallace, Robert B.; Ohsfeldt, Robert L.; Jones, Michael P.; Rosenthal, Gary E.; Wolinsky, Fredric D.

doi:10.1093/aje/kwp266

Cited by 390 publications

(319 citation statements)

References 32 publications

(39 reference statements)

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“…These results contrast with similar analyses of Medicare beneficiaries with hip fracture because a lower proportion of veterans were discharged to nursing homes (15% vs 58%) and more were discharged to home (68% vs 9%-14%) [23]. Both patient and system factors may explain these differences.…”

Section: Discussioncontrasting

confidence: 72%

Determinants of postsurgical discharge setting for male hip fracture patients

et al. 2013

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Abstract-Veterans hospitalized for hip fracture repair may be discharged to one of several rehabilitation settings, but it is not known what factors influence postsurgical discharge setting. The purpose of the study was to examine the patient, facility, and market factors that influence the choice of postsurgical discharge setting. Using a retrospective cohort design, we linked 11,083 veterans who had hip fracture surgeries in a Department of Veterans Affairs (VA) hospital from 1998 to 2005 as assessed by the VA National Surgical Quality Improvement Program dataset with administrative data. The factors associated with five postdischarge settings were analyzed using multinomial logistic regression. We found that few veterans (0.8%) hospitalized for hip fracture were discharged with home health. Higher proportions of veterans were discharged to a nursing home (15.4%), to outpatient rehabilitation (18.8%), to inpatient rehabilitation (16.9%), or to home (48.2%). Patients were more likely to be discharged to nonhome settings for VA-provided rehabilitation if they had total function dependence, had American Society of Anesthesiologists class 4 or 5, had surgical complications prior to discharge, or lived in counties with lower nursing home bed occupancy rates. Future research should compare postsurgical and longer-term morbidity, mortality, and healthcare utilization across these rehabilitation settings.

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Section: Discussioncontrasting

confidence: 72%

Determinants of postsurgical discharge setting for male hip fracture patients

et al. 2013

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“…Hip fractures are a particular threat to independence and well-being, leading to institutionalization in 20%-30% and with a 1-year mortality rate of 26%. 66 In the period after a hip fracture, 15% of older adults meet criteria for major depression, and half will have elevated depressive symptoms. 67 In some individuals, a high level of distress immediately after the injury improves over time.…”

Section: Depression Antidepressants and Fracturesmentioning

confidence: 99%

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

Iaboni

Flint

2013

The American Journal of Geriatric Psychiatry

225

178

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Depression and falls have a significant bidirectional relationship. Excessive fear of falling, which is frequently associated with depression, also increases the risk of falls. Both depression and fear of falling are associated with impairment of gait and balance, an association that is mediated through cognitive, sensory, and motor pathways. The management of depression in fall-prone individuals is challenging, since antidepressant medications can increase the risk of falls, selective serotonin reuptake inhibitors may increase the risk of fragility fractures, and data are lacking about the effect of fall rehabilitation programs on clinically significant depression. Based on the current state of knowledge, exercise (particularly Tai Chi) and cognitive-behavioral therapy should be considered for the first-line treatment of mild depression in older fallers. Antidepressant medications are indicated to treat moderate to severe depression in fall-prone individuals, but with appropriate precautions including low starting dose and slow dose titration, use of psychotropic monotherapy whenever possible, and monitoring for orthostatic hypotension and hyponatremia. To date, there have been no recommendations for osteoporosis monitoring and treatment in individuals prescribed antidepressant medications, beyond the usual clinical guidelines. However, treatment of the older depressed person who is at risk of falls provides the opportunity to inquire about his or her adherence with osteoporosis and fracture-prevention guidelines. KeywordsAntidepressants; depression; falls; fear of falling; fractures One-third of community-dwelling seniors fall each year, with half of these individuals falling more than once. Ten percent of all falls result in a major injury, which can lead to institutionalization and death. 1 Falls often result in a fear of further falls, leading to fearrelated restriction of activities: this activity restriction has been associated with subsequent impairment in balance, mobility, and disability. 2,3 Send correspondence and reprint requests to Alastair

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“…(10) In a study of 1327 patients with incident hip fracture, the risk of prior CVD was twice that of 3170 patients without hip fracture. (11) One recent study reported that hip fracture is associated with an increased risk of subsequent stroke.…”

Section: Introductionmentioning

confidence: 99%

Hip fracture and risk of acute myocardial infarction: A nationwide study

Chiang

Liu

Chen

et al. 2012

Journal of Bone and Mineral Research

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Osteoporotic fractures are associated with increased mortality risk. However, little data are available on the risk of acute myocardial infarction (AMI) after hip fracture. Therefore, we investigated whether hip fracture increased the risk of AMI in a large, nationwide cohort study. We obtained data from 8758 patients diagnosed with hip fracture from 2000 to 2009 and from 4 matched controls for each patient from the Longitudinal Health Insurance Database (LHID 2000), Taiwan. Controls were matched for age, sex, comorbid disorders, and enrollment date. All subjects were followed up from the date of enrollment until AMI, death, or the end of data collection (2009). Cox's regression model adjusted for age, sex, comorbid disorders, and medication was used to assess independent factors determining the risk of development of AMI. As expected, despite the matching, the hip fracture patients had more risk factors for AMI at baseline. A total of 8758 subjects with hip fractures and 35,032 controls were identified. Among these patients, 1183 (257 hip fracture patients and 926 controls) developed AMI during the median 3.2-year (interquartile range 1.4 to 5.8 years) follow-up period. Patients with hip fractures had a higher incidence of AMI occurrence when compared with controls (8.7/1000 person-years versus 6.82/1000 person-years). Multivariate analysis adjusted for baseline covariates indicated that hip fracture was associated with a greater risk for AMI development (hazard ratio [HR] ¼ 1.29; 95% confidence interval [CI] 1.12-1.48; p < 0.001). We conclude that hip fracture is independently associated with a higher risk of subsequent AMI. ß

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The Aftermath of Hip Fracture: Discharge Placement, Functional Status Change, and Mortality

Cited by 390 publications

References 32 publications

Determinants of postsurgical discharge setting for male hip fracture patients

Determinants of postsurgical discharge setting for male hip fracture patients

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

Hip fracture and risk of acute myocardial infarction: A nationwide study

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