2/3 Canadians Do Not Receive Timely Surgery for Hip Fractures

MedicalResearch.com Interview with:

Daniel Pincus MD Department of Surgery Institute for Clinical Evaluative Sciences University of Toronto

Dr. Pincus

Daniel Pincus MD
Department of Surgery
Institute for Clinical Evaluative Sciences
University of Toronto

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We chose to look at hip fractures because is the most common reason for urgent surgery complications have be tied to wait times (and in particular wait times greater than 24 hours).

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Hip Fractures Increase Mortality Risk in Cognitively Impaired Men

MedicalResearch.com Interview with:

Ann L. Gruber-Baldini, Ph.D. Professor, Division of Gerontology Director, Program in Epidemiology and Human Genetics  Department of Epidemiology & Public Health University of Maryland School of Medicine

Dr. Ann Gruber-Baldini

Ann L. Gruber-Baldini, Ph.D.
Professor, Division of Gerontology
Director, Program in Epidemiology and Human Genetics
Department of Epidemiology & Public Health
University of Maryland School of Medicine 

MedicalResearch.com: What is the background for this study?

Response: While men make up only about 25% of all hip fractures, the number of men who fracture their hip is increasing and we know men are more likely to die than women after a hip fracture. It is also known that those with cognitive impairments, typically due to delirium and Alzheimer’s disease and related dementia, are more likely to do more poorly after the fracture. The impact of both sex and cognition on outcomes after hip fracture has not been fully explored.

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More Hip Fractures in Elderly on Antidepressants

MedicalResearch.com Interview with:

Sanna Torvinen-Kiiskinen MSc (Pharm.), PhD student, Kuopio Research Centre of Geriatric Care and School of Pharmacy University of Eastern Finland

Sanna Torvinen-Kiiskinen

Sanna Torvinen-Kiiskinen
MSc (Pharm.), PhD student,
Kuopio Research Centre of Geriatric Care and School of Pharmacy
University of Eastern Finland

MedicalResearch.com: What is the background for this study?

Response: Antidepressants are widely used among elderly persons, especially persons with Alzheimer’s disease. They are used not only for treatment for major depression, but for treatment of anxiety, insomnia and chronic pain as well as behavioral symptoms caused by dementia.

However, antidepressants, as well as other psychotropic drugs, may cause sedation, confusion, orthostatic hypotension and hyponatremia, which increase the risk of falling and fractures. Because of changes in pharmacodynamics and pharmacokinetics due to aging, older persons are at the higher risk of those adverse events.

The aim of our study was to investigate whether antidepressant use is associated with an increased risk of hip fracture among community-dwelling persons with and without Alzheimer’s disease.

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Hip Fractures: Comprehensive Geriatric Care Improved Outcomes and Reduced Costs

Ingvild Saltvedt PhD Department of Neuroscience, Norwegian University of Science and Technology, Medical Faculty Trondheim, Norway MedicalResearch.com Interview with:
Ingvild Saltvedt PhD

Department of Neuroscience, Norwegian University of Science and Technology,
Medical Faculty Trondheim, Norway

Medical Research: What is the background for this study? What are the main findings?

Dr. Saltvedt: Hip fracture patients are often old, frail and have many comorbidities. When treated with a traditional orthopaedic approach the outcomes are often poor, and many patients get functionally impaired with reduced ability to walk independently and impairment in daily life activities and with high costs for the society.  In many ways these patients are geriatric patients with hip-fractures. It has previously been shown that acutely sick geriatric patients benefit from treatment in geriatric wards and different kind of  orthogeriatric treatment models where orthopaedic surgeons and geriatricians collaborate have been studied and have shown beneficial results on short term outcomes. In the present study patients home-dwelling hip-fracture patients were randomised to orthogeriatric treatment or traditional orthopaedic treatment from admission to the hospital and during the entire stay except for the surgery that was performed similar in both groups. The study focused on long-term outcomes and also on use of health care services and cost-effectiveness.  Patients in the orthogeriatric group got comprehensive geriatric assessment and treatment performed by an interdisciplinary team that emphasised early mobilisation and rehabilitation and started discharge planning early. In the orthopaedic group traditional treatment according to national and international guidelines was offered.

The primary endpoint was mobility at four months, that was better in the orthogeriatric group than in the orthopaedic group, the same difference was also shown at 12 months. In addition there were differences in instrumental activities of daily living and personal activities of daily living, quality of life and fear of falling, all differences were statistically and clinically significant and in favour of the orthoegeriatric group. The length of hospital stay was 1,7 days longer in the geriatric group, while there was no differences in days spent in hospital during one year of follow-up. One of four orthogeriatric patients were discharged directly home as compared to one of ten in the orthopaedic group. The orthopaedic group spent more days in nursing homes and rehabilitation institutions during one year of follow-up. The treatment was cost-effective in favour of the orthogeriatric group.
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