Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 140 No. 3334 (2010)

Outcomes of elderly hip fracture patients in the Swiss healthcare system

  • M Pretto
  • R Kaelin
  • V Muri-John
  • N Suhm
DOI
https://doi.org/10.4414/smw.2010.13086
Cite this as:
Swiss Med Wkly. 2010;140:w13086
Published
16.08.2010

Summary

Problem and questions: The consequences for elderly patients with hip fractures are well known. In Switzerland, the introduction of diagnosis related groups (DRG) will bring additional challenges. New models of care, such as Geriatric Fracture Centres (GFC), may be the key to minimising negative outcomes. This study documents outcomes of hip fracture patients in the Swiss healthcare system, for use as baseline data prior to DRG- and GFC-implementation, and compares them to results reported in the literature, for example by Cooper (1997).

Methods: This was a prospective cohort quality assurance survey with a one-year follow-up. Outcomes were mortality, living situation, required support and mobility. All patients 65 years of age or older with a proximal femoral fracture were included. Data were analysed by descriptive and interferential statistics.

Results: From 272 patients, 70% were community dwelling pre-fracture. Overall, one-year mortality was 22%. Pre-fracture community dwelling patients had better outcomes than nursing home patients with a one-year mortality rate of 12%. A total of 83% of pre-fracture community dwelling patients still lived in the community after one year but more needed help with activities of daily living (ADL) or mobility. Patients with dementia, ADL- and mobility dependency pre-fracture were significantly more at risk for being newly admitted to a nursing home.

Conclusions: Our results reflect the clinical reality of the hip fracture population in Switzerland. Results one year after fracture were comparable to study findings in different health care systems. Our findings provide important baseline data prior to the implementation of DRG and GFC.

References

  1. Bundesamt für Gesundheit. Osteoporose und Stürze im Alter. Ein Public-Health-Ansatz, Bern, 2004.
  2. Levers MJ, Estabrooks CA, Ross Kerr JC. Factors contributing to frailty: literature review. J Adv Nurs. 2006;56(3):282–91.
  3. Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007;62(7):738–43.
  4. Ellis G, Langhorne P. Comprehensive geriatric assessment for older hospital patients. Br Med Bull. 2004;71:45–59.
  5. Cooper C. The crippling consequences of fractures and their impact on quality of life. Am J Med. 1997;103(2A):12S–7S; discussion 7S–9S.
  6. Koval K, Skovron ML, Aharonoff GB, Zuckerman JD. Predictors of functional recovery after hip fracture in the elderly. Clin Orthopaedics and Related Res. 1998;348:22–8.
  7. Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, et al. Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci. 2000;55(9):M498–507.
  8. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40(5):373–83.
  9. Woods NF, LaCroix AZ, Gray SL, Aragaki A, Cochrane BB, Brunner RL, et al. Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative Observational Study. J Am Geriatr Soc. 2005;53(8):1321–30.
  10. U.S. Congress Office of Technology Assessment. Hip Fracture Outcomes in People Age 50 and over – Background paper, 1994. Washington, DC: U.S. Government Printing Office, July 1994.
  11. Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ. Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury 2008;39(10):1157–63.
  12. Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int. 2009.
  13. Paksima N, Koval KJ, Aharanoff G, Walsh M, Kubiak EN, Zuckerman JD, et al. Predictors of mortality after hip fracture: a 10-year prospective study. Bull NYU Hosp Jt Dis. 2008;66(2):111–7.
  14. Edelstein D, Aharonoff G, Karp A, Capla E, Zuckerman J, Koval K. Effect of Postoperative Delirium on Outcome after Hip Fracture. Clin Orthop. 2004;1(422):195–200.
  15. Koval KJ, Maurer SG, Su ET, Aharonoff GB, Zuckerman JD. The effects of nutritional status on outcome after hip fracture. J Orthop Trauma. 1999;13(3):164–9.
  16. Olofsson B, Stenvall M, Lundstrom M, Svensson O, Gustafson Y. Malnutrition in hip fracture patients: an intervention study. J Clin Nurs. 2007;16(11):2027–38.
  17. Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br. 1993;75(5):797–8.
  18. Marcantonio ER, Kiely DK, Simon SE, John Orav E, Jones RN, Murphy KM, et al. Outcomes of older people admitted to postacute facilities with delirium. J Am Geriatr Soc. 2005;53(6):963–9.
  19. Parker MJ, Palmer CR. Prediction of rehabilitation after hip fracture. Age Ageing. 1995;24(2):96–8.
  20. Specht-Leible N, Schultz U, Kraus B, Meeder PJ, Quentmeier A, Ewerbeck V, et al. Case management and functional outcome in persons aged 65 years and over with hip fracture. Unfallchirurg. 2003;106 (3):207–14.
  21. Penrod JD, Litke A, Hawkes WG, Magaziner J, Koval KJ, Doucette JT, et al. Heterogeneity in hip fracture patients: age, functional status, and comorbidity. J Am Geriatr Soc. 2007;55(3):407–13.
  22. Huusko TM, Karppi P, Avikainen V, Kautiainen H, Sulkava R. Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia. Bmj. 2000;321(7269):1107–11.
  23. Cameron ID. Coordinated multidisciplinary rehabilitation after hip fracture. Disabil Rehabil. 2005;27(18-19):1081–90.
  24. Oliver D. Medical input, rehabilitation and discharge planning for patients with hip fracture: Why traditional models are not fit for purpose and how things are changing. Anaesthesia & Critical care. 2005;16:11–22.
  25. Pretto M, Muri-John V, Suhm N, Frank M, Kressig RW, Spirig R. Frakturen bei Betagten: Multidisziplinäre Behandlung und Betreuung. Krankenpflege. 2009;(9):32–3.
  26. Suhm N, Pretto M, Frank M, Conzelmann M, Tyndall A, Vogt T, et al. Moderne Alterstraumatologie: Interdisziplinäre & Interprofessionelle Behandlung im «Kompetenznetzwerk Altersfrakturen». Med J. 2009;3:16–20.