The Clinical Pathway with Regional Alliance (CPRA) system for proximal femoral fractures in the southern region of Ibaraki prefecture: comparison of the proportion of patients who return to living at home from acute care and rehabilitation (kaihukuki) hospitals / Journal of Rural Medicine

Objective: We investigated whether elderly patients treated for a proximal femoral fracture would be able to return home.Patients and Methods: The subjects of this study were 834 patients. We defined the acute care hospital group as patients who returned home from the acute care hospital and the kaihukuki group as patients who were transferred from an acute care hospital to a rehabilitation hospital. We recorded the proportion of patients who returned home. We also analyzed walking ability and the Barthel index (BI) of patients.Results: After 2013, the proportion of patients who returned home from the acute care hospital fell below 20%. The proportion of patients who returned home from the kaihukuki hospital stayed within the 75–85% range. The BI before injury and at discharge was 86 and 76 points, respectively, in the acute care hospital group. The acute care hospital group included patients who walked without an aid before the injury or when leaving the hospital. In the kaihukuki group, the BI before an injury, at admission, and at discharge from the rehabilitation hospital was 85, 56, and 74 points, respectively. In the kaihukuki group, the ability of patients to walk recovered more slowly than that of patients in the acute care hospital group.Conclusion: Walking ability and BI are important factors for determining whether patients with a proximal femoral fracture are able to return home.

Elderly Patients with Proximal Femoral Fracture Who Returned to Living at Home with Their Spouse / 日本農村医学会雑誌

　　We investigated whether elderly patients who were treated for proximal femoral fracture and who lived with an elderly spouse in the community were able to return home and walk. We identified 85 patients aged over 65 years with proximal femoral fracture treated between January 2007 and December 2013 who were living with only their spouse. We recorded the number (proportion) of patients who were directly discharged to home and the duration of hospitalization, and their walking ability before the injury and at the time of discharge. We also investigated whether dementia and age affected the ability to return home. Thirty-two patients (36%) returned home directly from an acute care hospital, and 35 patients (83%) returned home directly from a rehabilitation hospital. The mean duration of hospitalization was 31 days (range, 17-71 days) at an acute care hospital, and 61 days (range, 5-143 days) at a rehabilitation hospital. The walking ability of all patients was worse at the time of discharge. Dementia and increasing age were each associated with not being able to return home.