Orthogeriatrics prevents functional decline in hip fracture patients: report from two randomized controlled trials

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Abstract

Background

The incidence of hip fractures are expected to increase in the following years. Hip fracture patients have in addition to their fracture often complex medical problems, which constitute a substantial burden on society and health care systems. It is thus important to optimize the treatment of these patients to reduce negative outcomes. The aim of this study was to assess the effect of comprehensive orthogeriatric care (CGC) on basic and instrumental activities of daily living (B-ADL and I-ADL).

Methods

This study is based on two randomized controlled trials; the Oslo Orthogeriatric Trial and the Trondheim Hip Fracture Trial. The two studies were planned in concert, and data were pooled and analyzed using linear mixed models. I-ADL function was assessed by the Nottingham Extended ADL Scale (NEADL) and B-ADL by the Barthel ADL (BADL) at four and twelve months after surgery.

Results

Seven hundred twenty-six patients were included in the combined database, of which 365 patients received OC and 361 patients received CGC. For the primary endpoint, I-ADL at four months was better in the CGC group, with a between-group difference of 3.56 points (95 % CI 0.93 to 6.20, p = 0.008). The between-group difference at 12 months was 4.28 points (95 % CI 1.57 to 7.00, p = 0.002). For B-ADL, between-group difference scores were only statistically significant at 12 months. When excluding the patients living at a nursing home at admission, both I-ADL and B-ADL function was significantly better in the CGC group compared to the OC group at all time points.

Conclusions

Merged data of two randomized controlled trials showed that admitting hip fracture patients to an orthogeriatric care unit directly from the emergency department had a positive effect on ADL up to twelve months after surgery.

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Most cited references 36

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Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.

J M Guralnik, L Ferrucci, E Simonsick … (1995)

Functional assessment is an important part of the evaluation of elderly persons. We conducted this study to determine whether objective measures of physical function can predict subsequent disability in older persons. This prospective cohort study included men and women 71 years of age or older who were living in the community, who reported no disability in the activities of daily living, and who reported that they were able to walk one-half mile (0.8 km) and climb stairs without assistance. The subjects completed a short battery of physical-performance tests and participated in a follow-up interview four years later. The tests included an assessment of standing balance, a timed 8-ft (2.4-m) walk at a normal pace, and a timed test of five repetitions of rising from a chair and sitting down. Among the 1122 subjects who were not disabled at base line and who participated in the four-year follow-up, lower scores on the base-line performance tests were associated with a statistically significant, graduated increase in the frequency of disability in the activities of daily living and mobility-related disability at follow-up. After adjustment for age, sex, and the presence of chronic disease, those with the lowest scores on the performance tests were 4.2 to 4.9 times as likely to have disability at four years as those with the highest performance scores, and those with intermediate performance scores were 1.6 to 1.8 times as likely to have disability. Among nondisabled older persons living in the community, objective measures of lower-extremity function were highly predictive of subsequent disability. Measures of physical performance may identify older persons with a preclinical stage of disability who may benefit from interventions to prevent the development of frank disability.

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Osteoporosis in the European Union: medical management, epidemiology and economic burden

E. Hernlund, A Svedbom, M Ivergård … (2013)

Summary This report describes the epidemiology, burden, and treatment of osteoporosis in the 27 countries of the European Union (EU27). Introduction Osteoporosis is characterized by reduced bone mass and disruption of bone architecture, resulting in increased risk of fragility fractures which represent the main clinical consequence of the disease. Fragility fractures are associated with substantial pain and suffering, disability and even death for affected patients and substantial costs to society. The aim of this report was to characterize the burden of osteoporosis in the EU27 in 2010 and beyond. Methods The literature on fracture incidence and costs of fractures in the EU27 was reviewed and incorporated into a model estimating the clinical and economic burden of osteoporotic fractures in 2010. Results Twenty-two million women and 5.5 million men were estimated to have osteoporosis; and 3.5 million new fragility fractures were sustained, comprising 610,000 hip fractures, 520,000 vertebral fractures, 560,000 forearm fractures and 1,800,000 other fractures (i.e. fractures of the pelvis, rib, humerus, tibia, fibula, clavicle, scapula, sternum and other femoral fractures). The economic burden of incident and prior fragility fractures was estimated at € 37 billion. Incident fractures represented 66 % of this cost, long-term fracture care 29 % and pharmacological prevention 5 %. Previous and incident fractures also accounted for 1,180,000 quality-adjusted life years lost during 2010. The costs are expected to increase by 25 % in 2025. The majority of individuals who have sustained an osteoporosis-related fracture or who are at high risk of fracture are untreated and the number of patients on treatment is declining. Conclusions In spite of the high social and economic cost of osteoporosis, a substantial treatment gap and projected increase of the economic burden driven by the aging populations, the use of pharmacological interventions to prevent fractures has decreased in recent years, suggesting that a change in healthcare policy is warranted.

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Epidemiology and social costs of hip fracture

Stefania Maggi, Nicola Veronese (2018)

Hip fracture is an important and debilitating condition in older people, particularly in women. The epidemiological data varies between countries, but it is globally estimated that hip fractures will affect around 18% of women and 6% of men. Although the age-standardised incidence is gradually falling in many countries, this is far outweighed by the ageing of the population. Thus, the global number of hip fractures is expected to increase from 1.26 million in 1990 to 4.5 million by the year 2050. The direct costs associated with this condition are enormous since it requires a long period of hospitalisation and subsequent rehabilitation. Furthermore, hip fracture is associated with the development of other negative consequences, such as disability, depression, and cardiovascular diseases, with additional costs for society. In this review, we show the most recent epidemiological data regarding hip fracture, indicating the well-known risk factors and conditions that seem relevant for determining this condition. A specific part is dedicated to the social costs due to hip fracture. Although the costs of hip fracture are probably comparable to other common diseases with a high hospitalisation rate (e.g. cardiovascular disease), the other social costs (due to onset of new co-morbidities, sarcopenia, poor quality of life, disability and mortality) are probably greater.

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Author and article information

Contributors

Shams Dakhil:

ORCID: http://orcid.org/0000-0003-3549-4568

shams.dakhil@studmed.uio.no

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 25 March 2021

Publication date PMC-release: 25 March 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 208

Affiliations

[1 ]GRID grid.55325.34, ISNI 0000 0004 0389 8485, Department of Geriatric Medicine, , Oslo University Hospital, ; Oslo, Norway

[2 ]GRID grid.5510.1, ISNI 0000 0004 1936 8921, Institute of Clinical Medicine, , University of Oslo, ; Oslo, Norway

[3 ]GRID grid.5947.f, ISNI 0000 0001 1516 2393, Department of Neuromedicine and Movement Science, , Norwegian University of Science and Technology (NTNU), ; Trondheim, Norway

[4 ]GRID grid.55325.34, ISNI 0000 0004 0389 8485, Division of Orthopedic Surgery, , Oslo University Hospital, ; Oslo, Norway

[5 ]GRID grid.52522.32, ISNI 0000 0004 0627 3560, Orthopedic Trauma Unit, Department of Orthopedic Surgery, St. Olavs Hospital, , Trondheim University Hospital, ; Trondheim, Norway

[6 ]GRID grid.55325.34, ISNI 0000 0004 0389 8485, Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, , Oslo University Hospital, ; Oslo, Norway

[7 ]GRID grid.5947.f, ISNI 0000 0001 1516 2393, Department of Mental Health, , Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), ; Trondheim, Norway

[8 ]GRID grid.5947.f, ISNI 0000 0001 1516 2393, Department of Public Health and Nursing, , Norwegian University of Science and Technology (NTNU), ; Trondheim, Norway

[9 ]GRID grid.52522.32, ISNI 0000 0004 0627 3560, Department of Geriatrics, St. Olavs Hospital, , Trondheim University Hospital, ; Trondheim, Norway

Author information

Shams Dakhil http://orcid.org/0000-0003-3549-4568

Article

Publisher ID: 2152

DOI: 10.1186/s12877-021-02152-7

PMC ID: 7992808

PubMed ID: 33765935

SO-VID: 59525bf8-7563-44ed-ab49-0d6c400f7a36

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 3 September 2020

Date accepted : 14 March 2021

Funding

Funded by: Research Council of Norway

Funded by: Norwegian National Health Association

Funded by: FundRef http://dx.doi.org/10.13039/501100006095, Helse Sør-Øst RHF;

Funded by: Medical Student Research Program

Funded by: FundRef http://dx.doi.org/10.13039/501100004590, Helse Midt-Norge;

Funded by: St. Olav Hospital Trust

Funded by: Department of Neuromedicine and Movement science, NTNU

Funded by: SINTEF

Funded by: St. Olav Hospital Fund for Research and Innovation

Funded by: Municipality of Trondheim

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ScienceOpen disciplines: Geriatric medicine

Keywords: orthogeriatric,hip fracture,activities of daily living (adl)

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ScienceOpen disciplines: Geriatric medicine

Keywords: orthogeriatric, hip fracture, activities of daily living (adl)

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Orthogeriatrics prevents functional decline in hip fracture patients: report from two randomized controlled trials

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Hearing Loss and Restoration

Most cited references 36

Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.

Osteoporosis in the European Union: medical management, epidemiology and economic burden

Epidemiology and social costs of hip fracture

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Cited by 4

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