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 (β = 9.38, p = 0.002), vitality (β = 9.40, p < 0.001), mental health (β = 8.16, p = 0.004), physical function (β = 16.01, p < 0.001), and role physical (β = 22.66, p < 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

Preoperative cardiac risk assessment in geriatric patients with hip fractures: an orthopedic surgeons’ perspective

Hip fracture is one of the most common orthopedic conditions and is associated with significant morbidity and mortality. With a progressively aging population, the annual incidence of hip fracture is expected to increase substantially. Emerging evidence suggests that early surgery (<24 h) minimizes complications secondary to immobilization, including orthostatic pneumonia and venous thromboembolism. Delayed surgical repair (>48 h) has been consistently demonstrated to be associated with an increased risk of 30-day and 1-year mortality. Nonetheless, early surgery necessitates a shorter time for preoperative medical preparation, in particular cardiac assessment. Patients who undergo emergent orthopedic surgery are therefore at greater risk of perioperative cardiac events than those who undergo elective surgery. In addition, the prompt triage system for preoperative cardiac assessment not only identifies patients at high risk of perioperative cardiac complications but also reduces unnecessary cardiac consultations for low-risk patients. We review the current recommendations for preoperative cardiac assessment adapted for patients with hip fracture and describe our current triage system for preoperative cardiac consultation

The Comparative Risk of Delirium with Different Opioids:A Systematic Review

There is substantial evidence that the use of opioids increases the risk of adverse outcomes such as delirium, but whether this risk differs between the various opioids remains controversial. In this systematic review, we evaluate and discuss possible differences in the risk of delirium from the use of various types of opioids in older patients. We performed a search in MEDLINE by combining search terms on delirium and opioids. A specific search filter for use in geriatric medicine was used. Quality was scored according to the quality assessment for cohort studies of the Dutch Cochrane Institute. Six studies were included, all performed in surgical departments and all observational. No study was rated high quality, one was rated moderate quality, and five were rated low quality. Information about dose, route, and timing of administration of the opioid was frequently missing. Pain and other important risk factors of delirium were often not taken into account. Use of tramadol or meperidine was associated with an increased risk of delirium, whereas the use of morphine, fentanyl, oxycodone, and codeine were not, when compared with no opioid. Meperidine was also associated with an increased risk of delirium compared with other opioids, whereas tramadol was not. The risk of delirium appeared to be lower with hydromorphone or fentanyl, compared with other opioids. Numbers used for comparisons were small. Some data suggest that meperidine may lead to a higher perioperative risk for delirium; however, high-quality studies that compare different opioids are lacking. Further comparative research is neede

Rates, variability, and associated factors of polypharmacy in nursing home patients

Yichayaou Beloosesky,1,3 Olga Nenaydenko,2 Revital Feige Gross Nevo,1,3 Abraham Adunsky,2,3 Avraham Weiss1,3 1Department of Geriatrics, Rabin Medical Center, Beilinson Hospital, Petah Tikva, 2Department of Geriatric Rehabilitation, Sheba Medical Center, Tel Hashomer, 3Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel Objectives: To determine the rate and variability of polypharmacy in nursing home (NH) residents and investigate its relationship to age, sex, functional status, length of stay, and comorbidities. Methods: We conducted a cross sectional, multicenter study that included six nursing homes. Demographic, clinical characteristics, Charlson comorbidity index (CCI), the number and classes of chronic medications, rate of polypharmacy &gt;5 drugs (per day) and polypharmacy &gt;7 drugs (per day) were recorded. Results: Nine hundred and ninety-three residents were included; 750 (75.5%) fully dependent residents and 243 (24.5%) mobile demented residents requiring institutional care. The mean age was 85.04&plusmn;7.55 (65&ndash;108) years. The mean rates of polypharmacy &gt;5 drugs and polypharmacy &gt;7 drugs were 42.6% and 18.6%, respectively. Differences in polypharmacy &gt;5 drugs and polypharmacy &gt;7 drugs were observed in NHs 24.7%&ndash;56% and 4.9%&ndash;30.4%, respectively (P&lt;0.001). Mean number of chronic drugs per resident was 5.14&plusmn;2.60 from 3.81&plusmn;2.24 to 5.95&plusmn;2.73 (P&lt;0.001). No differences in polypharmacy were found between sex and fully dependent versus mobile demented residents. The most common medications taken were for gastrointestinal, neurological, and cardiovascular disorders. Regression analysis revealed four independent variables for polypharmacy &gt;5 drugs: groups aged 75&ndash;84 and &gt;85 relative to 65&ndash;74, odds ratio (OR) 0.46 (95% confidence interval [CI] 0.27&ndash;0.78) P=0.004, OR 0.35 (95% confidence interval 0.19&ndash;0.53), respectively, P&lt;0.001; length of stay &gt;2 years, OR 0.51 (95% CI 0.36&ndash;0.73) P&lt;0.001; CCI, OR 1.58 (95% CI 1.42&ndash;1.75) P&lt;0.001; and feeding tube versus normal feeding, OR 0.27 (95% CI 0.12&ndash;0.60) P=0.001. Conclusion: Rates of polypharmacy in NHs are high with significant variability. Variability rates of polypharmacy, distinct residents&#39; characteristics, and excessive use of certain drug groups may indicate that a decrease in medication is potentially feasible. Keywords: polypharmacy, nursing homes, variability, dementia, dependent, resident