Hip fracture. Preliminary results supporting significative correlations between the psychological wellbeing of patients and their relative caregivers

Background and aim. Hip fracture is one of the major causes of loss of self-sufficiency in older patients. The associated caregiving rehabilitation task often falls to the lot of a member of the patient’s family. Our study aims at assessing the relationship between the psychological well-being of patients with hip fracture and their caregivers. Methods. The study was carried-out on 53 elderly patients with hip fracture and their primary caregivers. The Mini Mental State Examination (patient), Activities of Daily Living (patient), Instrumental Activities of Daily Living (patient), Geriatric Depression Scale (patient), Psychological General Well-Being Index (patient/caregiver) and the Caregiver Burden Inventory (caregiver) were administered to each participant. Results. The results revealed significant correlations between stress levels and the psychological well-being of hip-fracture patients and relative caregivers. In particular, the Caregiver Burden Inventory’s total score was negatively related to the patient’s Psychological General Well-Being Index score (p < 0.05) and with Anxiety (p < 0.05), Depressed Mood (p < 0.01), Positive Well-being (p < 0.05) and General Health (p < 0.05) subscale scores, as well as with the patient’s Activities of Daily Living (p < 0.05) score. Patients’ Psychological General Well-Being Index scores were related to the caregivers’ General Health subscale (p < 0.01), and negatively related to Caregiver Burden Inventory Time Dependence (p < 0.05) and Social Burden (p < 0.05) subscales, as well as with the Geriatric Depression Scale score (p < 0.05). Conclusion. A mutual relationship seems to exist between a patient’s psychological well-being and his/her caregiver’s burden. These findings highlight the importance of a bio-psychosocial approach to both patients and caregivers

Nutritional status and nutritional treatment are related to outcomes and mortality in older adults with hip fracture

Malnutrition is very prevalent in geriatric patients with hip fracture. Nevertheless, its importance is not fully recognized. The objective of this paper is to review the impact of malnutrition and of nutritional treatment upon outcomes and mortality in older people with hip fracture. We searched the PubMed database for studies evaluating nutritional aspects in people aged 70 years and over with hip fracture. The total number of studies included in the review was 44, which analyzed 26,281 subjects (73.5% women, 83.6 ± 7.2 years old). Older people with hip fracture presented an inadequate nutrient intake for their requirements, which caused deterioration in their already compromised nutritional status. The prevalence of malnutrition was approximately 18.7% using the Mini-Nutritional Assessment (MNA) (large or short form) as a diagnostic tool, but the prevalence was greater (45.7%) if different criteria were used (such as Body Mass Index (BMI), weight loss, or albumin concentration). Low scores in anthropometric indices were associated with a higher prevalence of complications during hospitalization and with a worse functional recovery. Despite improvements in the treatment of geriatric patients with hip fracture, mortality was still unacceptably high (30% within 1 year and up to 40% within 3 years). Malnutrition was associated with an increase in mortality. Nutritional intervention was cost effective and was associated with an improvement in nutritional status and a greater functional recovery. To conclude, in older people, the prevention of malnutrition and an early nutritional intervention can improve recovery following a hip fracture

Mitigating Delirium for the Elderly Post-Operatively Without Medication

Background: Often occurring after surgery, or hospitalization, the development of delirium in older adults, initiates a cascade of events culminating in loss of independence, increased morbidity and mortality, and high health care costs (Oh, et al., 2017). Objective: The purpose of this quality improvement (QI) project was to adapt and implement best practices using HELP for managing older patients with postoperative delirium through the existing 1:1 observation structure and implementing cognitive care strategies. The 1:1 sitter roles and responsibilities were redesigned to include non-pharmacological, multicomponent interventions. Methods: The QI project used a pre-test post-test intervention design comparing groups before and after the intervention measuring: 1) hours of 1:1 care; 2) number of interventions used; 3) patient length of stay; and 4) use of psychotropic drugs. Data was collected using a standard patient checklist and customized reports. Results: There was a statistically significant difference in the number of observation hours between the pre-(n=32) and post-intervention (n=33) groups (p\u3c .05), with a mean score of 124.1 versus 62.3 hours respectively; a significant difference in length of stay (p\u3c0.05) with a mean score of 142.6 versus 218.9 hours respectively; a significant difference in the number of medications given (p \u3c .001) with a mean score of 0.9 versus 0 respectively; and a significant difference in the number of interventions utilized (p \u3c .001) with a mean score of 4.7 versus 8 respectively. Conclusions: This project indicated that the adapted non-pharmacologic HELP model interventions resulted in decreased 1:1 sitter hours, overall length of stay and medication use in postoperative delirious patients

An interdisciplinary intervention for older Taiwanese patients after surgery for hip fracture improves health-related quality of life

Abstract Background The effects of intervention programs on health-related quality of life (HRQOL) of patients with hip fracture have not been well studied. We hypothesized that older patients with hip fracture who received our interdisciplinary intervention program would have better HRQOL than those who did not. Methods A randomized experimental design was used. Older patients with hip fracture (N = 162), 60 to 98 years old, from a medical center in northern Taiwan were randomly assigned to an experimental (n = 80) or control (n = 82) group. HRQOL was measured by the SF-36 Taiwan version at 1, 3, 6, and 12 months after discharge. Results The experimental group had significantly better overall outcomes in bodily pain (&#946; = 9.38, p = 0.002), vitality (&#946; = 9.40, p &lt; 0.001), mental health (&#946; = 8.16, p = 0.004), physical function (&#946; = 16.01, p &lt; 0.001), and role physical (&#946; = 22.66, p &lt; 0.001) than the control group at any time point during the first year after discharge. Physical-related health outcomes (physical functioning, role physical, and vitality) had larger treatment effects than emotional/mental- and social functioning-related health outcomes. Conclusions This interdisciplinary intervention program may improve health outcomes of elders with hip fracture. Our results may provide a reference for health care providers in countries using similar programs with Chinese/Taiwanese immigrant populations. Trial registration NCT01052636http://deepblue.lib.umich.edu/bitstream/2027.42/78259/1/1471-2474-11-225.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78259/2/1471-2474-11-225.pdfPeer Reviewe

Orthogeriatric management: Improvements in outcomes during hospital admission due to hip fracture

Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery

Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients : A Systematic Overview. The SENATOR project ONTOP Series

The research leading to these results has received funding from the European Union Seventh Framework program (FP7/2007-2013) under grant agreement n° 305930 (SENATOR). The funders had no role in the study design, data collection and analysis, the decision to publish, or the preparation of the manuscript.Peer reviewedPublisher PD

A Nurse-Led Delirium Prevention Program for Hospitalized Older Adults

Background: Delirium, an acute decline in cognition and attention, is a common and severe problem for hospitalized older adults, with incidence rates ranging from 11% to 56%, and 1.5 to 4.0-fold increased risk of death. Despite its multifaceted nature, delirium is preventable in 30% to 40% cases. A California academic community hospital experienced a higher incidence of delirium (30% to 40%) in adult non-critical care units as compared to delirium rates (11% to 29%) in similar hospital settings. The higher rates of delirium were believed to be due to fragmented, inconsistent, and non-individualized delirium care. Purpose/Objectives: The purpose of this evidence-based, quality improvement project was to determine whether a nurse-led Delirium Prevention Bundle (DPB) when compared to usual care, reduces delirium incidence in hospitalized geriatric patients. Method: The project was a two-group, pre-post design using the nurse-led DPB educational intervention for nurses. The project was implemented in two stages: 1) an educational session for nurses on completing the DPB including the Delirium Risk Factor Identification (DRFI) tool, targeted delirium prevention strategies (based on the Hospital Elder Life Program), and nursing documentation; and 2) the DPB implementation on a 26-bed geriatric unit at a 250-bed academic community medical center. Baseline data on delirium incidence rates were collected on eligible patients on the geriatric unit for one month before the intervention and prospectively on patients who were eligible following the educational intervention. Demographic data on eligible patients and unit nursing staff as well as nurse knowledge of delirium and adherence to the DPB were collected. Statistical analyses included descriptive statistics, t-tests, and chi-square test. Results: implementation of nursing education of the DPB, the addition of the DRFI tool, and documentation template in the hospital Electronic Health Record, was effective in reducing delirium incidence rate from 16% to 14% (p =&lt;.001) and improving documentation compliance from &lt;1% to 17%. Nurse delirium knowledge was also improved significantly (pre-test mean 80.0, post-test mean 94.3, p=.029). Conclusion: Nursing education utilizing the DPB is an effective approach in increasing nurse awareness of preventive care for delirium and decreasing incident delirium in this population

Early Delirium Assessment for Hospitalized Older People in Indonesia: a Systematic Review

Background: Due to the increasing risk of getting co-morbidity and frailty, older people tend to be prone to hospitalization. Hospitalization in older people brings many adverse effects. Moreover, when these elderly get delirium, the mortality and morbidity will increase. The risk of getting deterioration and worsening condition because of delirium would also increase. In fact, delirium assessment is not a high priority in taking care older people during hospitalization because the focus of care is treating the disease.Delirium screening as an early recognition of delirium in the hospitalized elderly inIndonesia remains unreported and even do not well evaluated. Therefore, delirium as a preventable problem or causing problems remains unrecognized.Purpose: This paper aims to review the current evidence of early assessment of delirium in hospitalized older people.Methods: A systematic review was conducted from four databases yielding to 4 articles which met the inclusion and exclusion criteria.Results: There are four focuses on the result, namely delirium screening tools, patient characteristics, identified early delirium assessment, and outcomes affected by early delirium assessment. Confusion Assessment Method (CAM) was used as the delirium screening tool in the hospital. Establishing the care team involving many disciplines will give a better way to improve the integrated care and collaborative care.Conclusion: Performing CAM integrated into comprehensive geriatric assessment can be the most important thing to be undertaken when looking after the hospitalized elderly

Time from admission to surgery in Polish patients with hip fractures : temporal trends in the last decade and association with duration of hospitalization and in-hospital mortality

Introduction: Hip fracture is an important cause of morbidity and mortality among elderly patients worldwide. It poses a particular challenge for healthcare systems with limited financial and human resources. Objectives: The aim of the study was to assess factors associated with the length of hospital stay and in-hospital mortality, focusing on the time from admission to surgery. The secondary goal was to assess temporal trends in the intervals of admission to surgery between 2010 and 2011 and in 2019. Patients and methods: This was a cross-sectional study enrolling patients aged 65 years or older who underwent surgery for hip fracture between January 2010 and October 2011 in 12 Polish hospitals. Demographic and clinical data, dates of hospital admission and surgery as well as information about in-hospital death were gathered. We additionally searched the databases of the same 12 hospitals for patients hospitalized due to hip fracture between January and June 2019 and recorded the dates of admission and surgery. Results: We included 381 patients who underwent surgery in 2010 and 2011 and 761 patients hospitalized in 2019. In a multivariable analysis, including age, sex, and diagnosis of dementia, we observed association between time from admission to surgery and higher in-hospital mortality and longer hospital stay. There was a decrease in proportion of patients undergoing surgery within 2 days from admission (52.8% vs 44.3%; P = 0.007) between 2010 to 2011 and in 2019. Conclusions: In-hospital mortality and length of hospitalization were associated with time from admission to surgery in patients undergoing surgery for hip fracture. We observed an alarming trend towards an increase in the admission–surgery interval