Summary
Hip fractures are a serious public health issue with major consequences, especially for frail community dwellers. This study found a poor prognosis at 6 months post-trauma with regard to life ...expectancy and rehabilitation to pre-fracture independency levels. It should be realized that recovery to pre-trauma functioning is not a certainty for frail community-dwelling patients.
Introduction
Proximal femoral fractures are a serious public health issue in the older patient. Although a significant rise in frail community-dwelling elderly is expected because of progressive aging, a clear overview of the outcomes in these patients sustaining a proximal femoral fracture is lacking. This study assessed the prognosis of frail community-dwelling patients who sustained a proximal femoral fracture.
Methods
A multicenter retrospective cohort study was performed on frail community-dwelling patients with a proximal femoral fracture who aged over 70 years. Patients were considered frail if they were classified as American Society of Anesthesiologists score ≥ 4 and/or a BMI < 18.5 kg/m
2
and/or Functional Ambulation Category ≤ 2 pre-trauma. The primary outcome was 6-month mortality. Secondary outcomes were adverse events, health care consumption, rate of institutionalization, and functional recovery.
Results
A total of 140 out of 2045 patients matched the inclusion criteria with a median age of 85 (P
25
–P
75
80–89) years. The 6-month mortality was 58 out of 140 patients (41%). A total of 102 (73%) patients experienced adverse events. At 6 months post-trauma, 29 out of 120 (24%) were readmitted to the hospital. Out of the 82 surviving patients after 6 months, 41 (50%) were unable the return to their home, and only 32 (39%) were able to achieve outdoor ambulation.
Conclusion
Frail community-dwelling older patients with a proximal femoral fracture have a high risk of death, adverse events, and institutionalization and often do not reobtain their pre-trauma level of independence. Foremost, the results can be used for realistic expectation management.
Abstract Background Hip fractures are common in the elderly and have a high risk of early mortality. Identification of patients at high risk of early mortality could contribute to enhanced quality of ...care. A simple scoring system is essential for preoperative identification of patients at high risk of early mortality in clinical practice. Of risk models published, The Nottingham Hip Fracture Score (NHFS) shows the most promising results so far. However, there is still room for improvement. Methods A cohort study including 850 patients was conducted over a period of 5,5 yr. The NHFS was adjusted for cognitive impairment (NHFS-a) and tested. Patients who died within 30 days following hip fracture surgery (early mortality group) were compared to survivors. Independent risk factors for early mortality were assessed. A new hip fracture score for frail elderly was developed: the Almelo Hip Fracture Score (AHFS). The NHFS-a and the AHFS were compared for accuracy and predictive validity. Results Sixty-four (7.5%) patients died within 30 days following hip fracture surgery. The AHFS predicts the risk of early mortality better than the NHFS-a (p < 0.05). Using cut-off points of AHFS ≤ 9 and AHFS ≥ 13, patients could be divided into a low, medium or high risk group. The area under the curve improved with the AHFS compared to the NHFS-a (0.82 versus 0.72). The likelihood ratio test reveals a significantly better fit of the AHFS in comparison with the NHFS-a (p < 0.001). Conclusions The AHFS can identify frail elderly at high risk of early mortality following hip fracture surgery accurately. With the AHFS, the patient can be classified into the low, medium or high risk group, which contributes to enhanced quality of care in clinical practice.
Radiation-resistant advanced silicon carbide (SiC/SiC) composites have been developed as a promising candidate of the high-temperature operating advanced fusion reactor. With the completion of the ...‘proof-of-principle’ phase in development of ‘nuclear-grade’ SiC/SiC composites, the R&D on SiC/SiC composites is shifting toward the more pragmatic phase, i.e., industrialization of component manufactures and data-basing. In this paper, recent advances and issues in (1) development of component fabrication technology including joining and functional coating, e.g., a tungsten overcoat as a plasma facing barrier, (2) recent updates in characterization of non-irradiated properties, e.g., strength anisotropy and chemical compatibility with solid lithium-based ceramics and lead-lithium liquid metal breeders, and (3) irradiation effects are specifically reviewed. Importantly high-temperature neutron irradiation effects on microstructural evolution, thermal and electrical conductivities and mechanical properties including the fiber/matrix interfacial strength are specified under various irradiation conditions, indicating seemingly very minor influence on the composite performance in the design temperature range.
Summary
To improve the quality of care and reduce the healthcare costs of elderly patients with a hip fracture, surgeons and geriatricians collaborated intensively due to the special needs of these ...patients. After treatment at the Centre for Geriatric Traumatology (CvGT), we found a significant decrease in the 1-year mortality rate in frail elderly patients compared to the historical control patients who were treated with standard care.
Introduction
The study aimed to evaluate the effect of an orthogeriatric treatment model on elderly patients with a hip fracture on the 1-year mortality rate and identify associated risk factors.
Methods
This study included patients, aged 70 years and older, who were admitted with a hip fracture and treated in accordance with the integrated orthogeriatric treatment model of the CvGT at the Hospital Group Twente (ZGT) between April 2008 and October 2013. Data registration was carried out by several disciplines using the clinical pathways of the CvGT database. A multivariate logistic regression analysis was used to identify independent risk factors for 1-year mortality. The outcome measures for the 850 patients were compared with those of 535 historical control patients who were managed under standard care between October 2002 and March 2008.
Results
The analysis demonstrated that the 1-year mortality rate was 23.2 % (
n
= 197) in the CvGT group compared to 35.1 % (
n
= 188) in the historical control group (
p
< 0.001). Independent risk factors for 1-year mortality were male gender (odds ratio (OR) 1.68), increasing age (OR 1.06), higher American Society of Anesthesiologists (ASA) score (ASA 3 OR 2.43, ASA 4–5 OR 7.05), higher Charlson Comorbidity Index (CCI) (CCI 1–2 OR 1.46, CCI 3–4 OR 1.59, CCI 5 OR 2.71), malnutrition (OR 2.01), physical limitations in activities of daily living (OR 2.35), and decreasing Barthel Index (BI) (OR 0.96).
Conclusion
After integrated orthogeriatric treatment, a significant decrease was seen in the 1-year mortality rate in the frail elderly patients with a hip fracture compared to the historical control patients who were treated with standard care. The most important risk factors for 1-year mortality were male gender, increasing age, malnutrition, physical limitations, increasing BI, and medical conditions. Awareness of risk factors that affect the 1-year mortality can be useful in optimizing care and outcomes. Orthogeriatric treatment should be standard for elderly patients with hip fractures due to the multidimensional needs of these patients.
Becker muscular dystrophy (BMD) is the milder allelic variant of Duchenne muscular dystrophy, with higher dystrophin levels. To anticipate on results of interventions targeting dystrophin expression ...it is important to know the natural variation of dystrophin expression between different muscles and over time. Dystrophin was quantified using capillary Western immunoassay (Wes) in the anterior tibial (TA) muscle of 37 BMD patients. Variability was studied using two samples from the same TA biopsy site in nine patients, assessing nine longitudinal TA biopsies, and eight simultaneously obtained vastus lateralis (VL) muscle biopsies. Measurements were performed in duplicate with two primary antibodies. Baseline dystrophin levels were correlated to longitudinal muscle strength and functional outcomes. Results showed low technical variability and high precision for both antibodies. Dystrophin TA levels ranged from 4.8 to 97.7%, remained stable over a 3-5 year period, and did not correlate with changes in longitudinal muscle function. Dystrophin levels were comparable between TA and VL muscles. Intra-muscle biopsy variability was low (5.2% and 11.4% of the total variability of the two antibodies). These observations are relevant for the design of clinical trials targeting dystrophin production, and may urge the need for other biomarkers or surrogate endpoints.
Quality indicators are used to measure quality of care and enable benchmarking. An overview of all existing hip fracture quality indicators is lacking. The primary aim was to identify quality ...indicators for hip fracture care reported in literature, hip fracture audits, and guidelines. The secondary aim was to compose a set of methodologically sound quality indicators for the evaluation of hip fracture care in clinical practice. A literature search according to the PRISMA guidelines and an internet search were performed to identify hip fracture quality indicators. The indicators were subdivided into process, structure, and outcome indicators. The methodological quality of the indicators was judged using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. For structure and process indicators, the construct validity was assessed. Sixteen publications, nine audits and five guidelines were included. In total, 97 unique quality indicators were found: 9 structure, 63 process, and 25 outcome indicators. Since detailed methodological information about the indicators was lacking, the AIRE instrument could not be applied. Seven indicators correlated with an outcome measure. A set of nine quality indicators was extracted from the literature, audits, and guidelines. Many quality indicators are described and used. Not all of them correlate with outcomes of care and have been assessed methodologically. As methodological evidence is lacking, we recommend the extracted set of nine indicators to be used as the starting point for further clinical research. Future research should focus on assessing the clinimetric properties of the existing quality indicators.
•The Fracture Mobility Score is a simple tool to measure mobility of hip fracture patients.•The Fracture Mobility Score has now been proven to be a valid score to measure the mobility of hip fracture ...patients.•Compared to other mobility scores the Fracture Mobility Score has a lower registration load.•The validation and the lower registration load may encourage other national hip fracture registries to start using the Fracture Mobility Score.
The Parker Mobility Score has proven to be a valid and reliable measurement of hip fracture patient mobility. For hip fracture registries the Fracture Mobility Score is advised and used, although this score has never been validated. This study aims to validate the Fracture Mobility Score against the Parker Mobility Score.
The Dutch Hip Fracture Audit uses the Fracture Mobility Score (categorical scale). For the purpose of this study, five hospitals registered both the Fracture Mobility Score and the Parker Mobility Score (0–9 scale) for every admitted hip fracture patient in 2018. The Spearman correlation between the two scores was calculated. To test whether the correlation coefficient remained stable among different patient subgroups, analyses were stratified according to baseline patient characteristics.
In total 1,201 hip fracture patients were included. The Spearman correlation between the Fracture Mobility Score and Parker Mobility Score was strong: 0.73 (p = < 0.001).
Stratified for gender, age, ASA score, dementia, Index of Activities of Daily Living (KATZ-6 ADL score), living situation and nutritional status, the correlation coefficient varied between 0.40–0.84. For patients aged 90 and over and having an ASA score of III-IV who suffered from dementia, had a KATZ-6 ADL score of 1–6, lived in an institution and/or were malnourished, the correlation was moderate.
The Fracture Mobility Score is overall strongly correlated with the Parker Mobility Score and can be considered as a valid score to measure hip fracture patient mobility. This may encourage other hip fracture audits to also use the Fracture Mobility Score, which would increase the uniformity of mobility score results among national hip fracture audits and decrease the overall registration load.
To investigate early predictors for discharge to a geriatric rehabilitation department at a skilled nursing home in older patients after hospitalization for hip fracture surgery.
Retrospective cohort ...study.
Data from 21,176 patients with hip fracture aged ≥70 years, who were registered in the Dutch Hip Fracture Audit database between January 1, 2017, and December 31, 2019, were included.
Patients were categorized into 3 discharge groups: home (n=7326), rehabilitation (n=11,738), and nursing home (n=2112). Age, gender, Pre-Fracture Mobility Score (PFMS), premorbid Katz index of independence in Activities of Daily Living (Katz-ADL), history of dementia, American Society of Anesthesiologists physical status classification (ASA score), type of anesthesia, fracture type, surgical treatment, and cotreatment by a geriatrician were gathered. Multinomial regression analysis was used to assess for early predictors.
Higher age, poor premorbid mobility, lower premorbid Katz-ADL, no history of dementia, ASA score 3-5, general anesthesia, intramedullary implant, and cotreatment by a geriatrician were independent predictors for discharge to geriatric rehabilitation vs discharge home. Identical predictors were found for discharge to a nursing home vs discharge home. History of dementia and premorbid Katz-ADL were distinguishing factors; a higher premorbid Katz-ADL and a history of dementia were associated with a higher risk of discharge to a nursing home vs discharge home. The multinomial regression model correctly predicted 86%, 38.6%, and 2.4% of the patients in the rehabilitation group, home group, and nursing home group, respectively.
This study showed that age, PFMS, premorbid Katz-ADL, surgical treatment, ASA score, type of anesthesia, history of dementia, and cotreatment by a geriatrician were independent early predictors for discharge to geriatric rehabilitation vs discharge home in older patients after hip fracture surgery. Identical predictors were found as predictors for discharge to a nursing home vs discharge home, except for history of dementia and premorbid Katz-ADL.
Abstract Background Depression later in life may have a more somatic presentation compared with depression earlier in life due to chronic somatic disease and increasing age. This study examines the ...influence of the presence of chronic somatic diseases and increasing age on symptom dimensions of late-life depression. Methods Baseline data of 429 depressed and non-depressed older persons (aged 60–93 years) in the Netherlands Study of Depression in Old Age were used, including symptom dimension scores as assessed with the mood, somatic and motivation subscales of the Inventory of Depressive Symptomatology-Self Report (IDS-SR). Linear regression was performed to investigate the effect of chronic somatic diseases and age on the IDS-SR subscale scores. Results In depressed older persons a higher somatic disease burden was associated with higher scores on the mood subscale ( B =2.02, p =0.001), whereas higher age was associated with lower scores on the mood ( B =−2.30, p <0.001) and motivation ( B =−1.01, p =0.006) subscales. In depressed compared with non-depressed persons, a higher somatic disease burden showed no different association with higher scores on the somatic subscale (F(1,12)=9.2; p =0.003; partial η2 =0.022). Limitations Because the IDS-SR subscales are specific for old age, it was not feasible to include persons aged <60 years to investigate differences between earlier and later life. Conclusions It seems that neither higher somatic disease burden nor higher age contributes to more severe somatic symptoms in late-life depression. In older old persons aged ≥70 years, late-life depression may not be adequately recognized because they may show less mood and motivational symptoms compared with younger old persons.
Summary
The AHFS
90
was developed for the prediction of early mortality in patients ≥ 90 years undergoing hip fracture surgery. The AHFS
90
has a good accuracy and in most risk categories a good ...calibration. In our study population, the AHFS
90
yielded a maximum prediction of early mortality of 64.5%.
Purpose
Identifying hip fracture patients with a high risk of early mortality after surgery could help make treatment decisions and information about the prognosis. This study aims to develop and validate a risk score for predicting early mortality in patients ≥ 90 years undergoing hip fracture surgery (AHFS
90
).
Methods
Patients ≥ 90 years, surgically treated for a hip fracture, were included. A selection of possible predictors for mortality was made. Missing data were subjected to multiple imputations using chained equations. Logistic regression was performed to develop the AHFS
90
, which was internally and externally validated. Calibration was assessed using a calibration plot and comparing observed and predicted risks.
Results
One hundred and two of the 922 patients (11.1%) died ≤ 30 days following hip fracture surgery. The AHFS
90
includes age, gender, dementia, living in a nursing home, ASA score, and hemoglobin level as predictors for early mortality. The AHFS
90
had good accuracy (area under the curve 0.72 for geographic cross validation). Predicted risks correspond with observed risks of early mortality in four risk categories. In two risk categories, the AHFS
90
overestimates the risk. In one risk category, no mortality was observed; therefore, no analysis was possible. The AHFS
90
had a maximal prediction of early mortality of 64.5% in this study population.
Conclusion
The AHFS
90
accurately predicts early mortality after hip fracture surgery in patients ≥ 90 years of age. Predicted risks correspond to observed risks in most risk categories. In our study population, the AHFS
90
yielded a maximum prediction of early mortality of 64.5%.
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