ABSTRACT
Low-trauma hip fracture in old age leads to impairment, increased need of care and mortality. Rehabilitation should start in the department for traumatology and accompany the patient through different settings until the pretraumatic status is reached. Besides the surgical procedure and the medical management of an aged person with complex disease and polypharmacy, the multidisciplinary rehabilitation process is an important factor for regaining ability for self-care and autonomous decisions. Pain management supports the process. The ideal setting is not clear yet. Besides established rehabilitation facilities for elderly people, including the departments for 'Akutgeriatrie/Remobilisation', the 'Outreach Geriatric Remobilisation' project offers new perspectives. It was designed to remobilise patients with multimorbidity in their own homes.
Subject(s)
Cooperative Behavior , Hip Fractures/rehabilitation , Interdisciplinary Communication , Osteoporotic Fractures/rehabilitation , Postoperative Complications/rehabilitation , Aged , Aged, 80 and over , Ambulatory Care , Combined Modality Therapy , Comorbidity , Frail Elderly , Humans , Pain Management , Rehabilitation CentersABSTRACT
Hip fracture in older patients is a major health concern. 20-25 % of hip fracture patients will die in the first year after the trauma (Lane, Clin Orthop Relat Res 471(8):2711, 2013). Postoperative venous thrombosis and gastrointestinal stress-ulcer bleeding are frequent complications with a high case-fatality rate particularly in older patients. Thromboprophylaxis and stress ulcer prophylaxis are important and well established measures to decrease postoperative complications and the mortality rate in this high-risk population.The working group on orthogeriatrics of the Austrian Society on Geriatrics and Gerontology (ÖGGG) is composed of geriatricians who work as trauma surgeons, internists, anaestesists and nurses. A thorough literature search was done, using the terms "orthogeriatrics" and "hip fracture" in combination with "stress ulcer", "gastrointestinal bleeding" and "thrombosis", "thromboprophylaxis". The data was collected, discussed and evaluated in several adjustment meetings of the group and summarized in this article.
Subject(s)
Hemostasis, Surgical/methods , Hip Fractures/surgery , Osteoporotic Fractures/surgery , Peptic Ulcer Hemorrhage/prevention & control , Postoperative Complications/prevention & control , Stress, Psychological/complications , Venous Thrombosis/prevention & control , Aged , Aged, 80 and over , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Austria , Health Status Indicators , Hip Fractures/blood , Hip Fractures/mortality , Humans , Osteoporotic Fractures/blood , Osteoporotic Fractures/mortality , Peptic Ulcer Hemorrhage/blood , Peptic Ulcer Hemorrhage/mortality , Postoperative Complications/blood , Postoperative Complications/mortality , Survival Rate , Venous Thrombosis/blood , Venous Thrombosis/mortalityABSTRACT
OBJECTIVE: The objective of this prospective randomized controlled study was to investigate the effect of nutritional supplementation on postoperative oxidative stress and duration of hospitalization in elderly patients with hip fracture. METHODS: A total of fourteen women (= SG) with hip fracture received individually adapted supplements enriched with protein and antioxidants postoperatively, nine served as unsupplemented controls (= CG). Blood samples were taken preoperatively (T1), on the day of discharge from hospital (T2) and three weeks thereafter (T3). Plasma concentrations of albumin and total protein (TP) were measured by autoanalysis, advanced oxidation protein products (AOPP) and the total antioxidant capacity (TAC) were determined photometrically. Malondialdehyde (MDA) levels were analyzed by HPLC. RESULTS: Postoperatively, there was a significant (T1 > T2, p< 0.01) decrease in plasma albumin, TP and TAC, followed by a significant (p< 0.05) increase in the period T2-T3 in the CG, but not in the SG. This resulted in significant differences in TP (T2: SG > CG, p< 0.05) and TAC (T2: SG > CG, p< 0.01) between the investigated groups. Postoperatively, the plasma levels of AOPP and MDA increased significantly (T1 < T2, p< 0.01) in both groups, and remained at the significantly (AOPP: T1 < T3, p< 0.05; MDA: T1 < T3, p< 0.01) elevated level in the CG, but not in the SG (T2 > T3, p< 0.01). Consequently, the oxidant markers MDA and AOPP were significantly positively (p< 0.01), TAC and albumin significantly negatively (p< 0.05) related to duration of hospital stay in both groups. CONCLUSIONS: Individualized nutritional supplementation may reduce postoperative oxidative stress and shorten duration of hospitalization in patients with hip fracture.
