Association of Social Support with Rehabilitation Outcome among Older Adults with Hip Fracture Surgery: A Prospective Cohort Study at Post-Acute Care Facility in Asia.

OBJECTIVES: There is growing interest in the role of social support during the recovery after hip fractures. The research to date has been mainly focused on structural support, with few studies concerned with functional support. This study examined the effects of both functional and structural aspects of social support on rehabilitation outcomes among older adults with hip fracture surgery. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: Consecutive older adults (≥60 years) with hip fracture surgery who underwent inpatient rehabilitation in a post-acute care facility in Singapore between January 11, 2021, and October 30, 2021 (n = 112). METHODS: We administered the Medical Outcome Study-Social Support Survey (MOS-SSS) to assess perceived functional support of patients and used living arrangement as an indicator for structural support. Participants were followed up over the inpatient stay at the post-acute care facility until discharge; thereafter, rehabilitation efficiency (REy) and rehabilitation effectiveness (REs) were evaluated. Multiple linear regressions were performed to examine the associations of MOS-SSS score and living arrangement with REy and REs, respectively, adjusting for age, gender, ethnicity, comorbidity, body mass index, prefracture function, type of fracture, and length of stay. RESULTS: Perceived functional support had positive associations with rehabilitation outcomes. A 1-unit increase in MOS-SSS total score was associated with 0.15 units (95% CI 0.03-0.3, P = .029) greater gain in physical function after a typical 1-month stay, and 0.21 units (95% CI 0.01-0.41, P = .040) higher achievement in potential functional improvement upon discharge. In contrast, no association was observed between structural support and rehabilitation outcomes. CONCLUSIONS AND IMPLICATIONS: Perceived functional support may significantly impact the recovery of older adults with hip fracture during the inpatient rehabilitation process, independent of structural support. Our findings suggest the potential of incorporating interventions enhancing perceived functional support of patients into the post-acute care model for hip fracture.

Impact of malnutrition in surgically repaired hip fracture patients admitted for rehabilitation in a community hospital: A cohort prospective study.

BACKGROUND: Malnutrition is common and associated with adverse outcomes in geriatric patients with hip fractures. The study aims to evaluate the relationship between the nutritional status and rehabilitation efficiency and functional outcome on discharge in postoperative hip fracture patients. METHODS: We prospectively evaluated 172 postoperative hip fracture patients who were admitted to the community hospital from November 2019 to November 2020. Nutritional status was assessed by the 7-point Subjective Global Assessment (SGA) within 48 h of admission. Patients were assessed for rehabilitation efficiency and functional outcome at the end of their inpatient stay. RESULTS: There were 172 patients recruited with 100 (58.1%) malnourished and 72 (41.9%) well-nourished patients. Patients in the malnourished group were significantly older, needed walking aid assistance prior to sustaining hip fracture, cognitively impaired and had more comorbidities. Malnourished patients had lower rehabilitation efficiency scores (0.27, 95% CI -0.12 - 0.67 vs 1.32, 95% CI 0.88-1.76) and poorer functional outcomes on discharge (OR 21.5, 95% CI 2.45-188.7, p-value <0.001), after adjustment for pre- and post-fracture confounders. CONCLUSION: Malnutrition was present in more than half the postoperative hip fracture patients admitted to a community hospital in Singapore. This study showed that poor nutritional status is associated with significantly lower rehabilitation efficiency and functional outcome on discharge in hip fracture patients. Given the medical, social and economic stakes relating to hip fractures, it is essential to recognise and treat malnutrition in the hospital and community.

Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review.

BACKGROUND: Hip fracture is an important and prevalent medical condition associated with adverse outcomes. The aim of this article is to systematically review and summarise the predictors of poor functional outcomes and mortality for patients with hip fractures. METHODS: We conducted a systemic literature search using PubMed, EMBASE and Cochrane Library. We included English peer-reviewed cohort studies that examined predictors of poor functional outcomes (such as independence in Activities of Daily Living) and mortality for patients with hip fracture published in the past 15 years (from 1 Jan 2004 up to 30 May 2019). Two independent researchers evaluated the articles for eligibility. Consensus on the eligibility was sought and a third researcher was involved if there was disagreement. A standardised form was used to extract relevant data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. RESULTS: We retrieved 4339 and included 81 articles. We identified two emerging predictors of poor functional outcomes and mortality for patients with hip fractures: low hand grip strength and frailty in line with an emerging concept of "physical performance". The predictors identified in this systematic review can be grouped into 1) medical factors, such as presence of co-morbidities, high American Society of Anesthesiologists (ASA) grade, sarcopenia, 2) surgical factors including delay in operation (e.g. > 48 h), type of fracture s, 3) socio-economic factors which include age, gender, ethnicity, and 4) system factors including lower case-volume centers. CONCLUSIONS: This systematic review identified multiple significant predictors of poor functional outcomes and mortality, with the hand grip strength and frailty being important emerging predictors in the most recent literature. These predictors would further inform healthcare providers of their patients' health status and allow for early intervention for modifiable predictors.

A case report of an atypical presentation of pyogenic iliopsoas abscess.

BACKGROUND: Iliopsoas abscess is a collection of pus in the iliopsoas muscle compartment. It can be primary or secondary in origin. Primary iliopsoas abscess occurs as a result of hematogenous or lymphatic seeding from a distant site. This is commonly associated with a chronic immunocompromised state and tends to occur in children and young adults. Secondary iliopsoas abscess occurs as a result of the direct spread of infection to the psoas muscle from an adjacent structure, and this may be associated with trauma and instrumentation in the inguinal region, lumbar spine, or hip region. The incidence of iliopsoas abscess is rare and often the diagnosis is delayed because of non-specific presenting symptoms. CASE PRESENTATION: We describe a patient with iliopsoas abscess who presented to the Emergency Department at X Hospital on three separate occasions with non-specific symptoms of thigh pain and fever before finally being admitted for treatment. This case illustrates how the diagnosis can be delayed due to its atypical presentation. Hence, highlighting the need for clinicians to have a high index of clinical suspicion for iliopsoas abscess in patients presenting with thigh pain and fever. CONCLUSION: The classic triad of fever, flank pain, and hip movement limitation is presented in only 30% of patients with iliopsoas abscess. Clinicians should consider iliopsoas abscess as a differential diagnosis in patients presenting with fever and thigh pain. The rare condition with the varied clinical presentation means that cross-sectional imaging should be considered early to reduce the risk of fulminant sepsis.

Masquerade of Falls and Depression, and Transitions of Care

Falls in an elderly require a comprehensive bio-psycho-social approach to evaluate for the root causes. These may be multi-factorial, and we need to deal with most of them, if not all, in order to effectively reduce the risk for falls. Frailty is a marker of poor functional outcomes. Sarcopenia is a major modifiable risk factor for frailty. There are various community programmes providing a comprehensive range of services to keep the elderly physically, mentally, and socially active. Communication with primary care physicians is important to ensure smooth transition back into the community, optimal management of chronic diseases and minimal re-admission.

A case series of atypical presentation of Zika Virus infection in Singapore.

BACKGROUND: The World Health Organization's and Centers for Disease Control and Prevention's definition of Zika infection are symptoms of fever, rash, joint pain, myalgia, headache and conjunctivitis. The diagnosis of Zika infection is based on the clinical history, physical examination and laboratory investigations which includes blood and urine Zika virus Polymerase Chain Reaction. CASE PRESENTATION: Two patients presented with atypical presentation of Zika infection to Sengkang Health, Alexandra Hospital during the recent Zika outbreak in Singapore in August 2016. Madam A presented with isolated generalized rash with no fever, joint pain, myalgia, headache or conjunctivitis. Mr. B presented with isolated fever of 39.4 °C with no rash, joint pain, myalgia, headache or conjunctivitis. Both patients' blood Zika Polymerase Chain Reactions were positive at the time of presentation. CONCLUSION: The described case reports illustrated the challenges that our community Family Physicians faced in diagnosing patients infected with Zika virus. Coupled with the knowledge that most patients are asymptomatic, Family Physicians need to have a high index of clinical suspicion for early identification of patients infected with Zika virus, so as to institute timely treatment and appropriate measures to mitigate the outbreak of Zika infection in the community. Appropriate epidemiological measures such as ensuring prompt and thorough contact tracing of the cases are instrumental in the control of this public health problem.