A two-year multicenter point prevalence study of older patients with hip fractures admitted to rehabilitation units in Italy

Key summary points

AbstractSection Aim

To study the characteristics of older patients with hip fracture admitted to rehabilitation units in Italy with a specific focus on geriatric syndromes and the rehabilitation process.

AbstractSection Findings

Of 615 patients included almost half of the patients lived alone before the hip fracture. Most of the falls happened at home. Clinicians identified geriatric syndromes including delirium, dementia, and depression in a significant number of patients. We found a relatively low involvement of the multiprofessional team in the rehabilitation process.

AbstractSection Message

This two-year multicenter point prevalence study allowed the collection of data on a relatively large sample of older patients with hip fracture showing the possible current limitations in the management of geriatric syndromes in this frail population

Abstract

Purpose

To date in Italy we do not have sufficient information on the rehabilitation process of older patients with hip fractures especially in the context of dementia. The main aims of the study were to gather information on the characteristics of older patients with hip fracture admitted to rehabilitation units with a specific focus on geriatric syndromes and the rehabilitation process.

Methods

A national multi-center “point prevalence study” was conducted in Italy over two index days in 2017 and 2018. All patients aged 70 years and older hospitalized on the index day in Rehabilitation Units after a hip fracture were eligible.

Results

A total of 615 patients were included. Most of the hospitals involved were from northern Italy, to a lesser extent from central and from southern Italy. The mean age was 83.08 ± 7.9 years. Almost half of the patients lived alone before the hip fracture. Most of the falls happened at home and while walking. The prevalence of delirium, dementia and malnutrition was 9.1%, 36.6%, and 19.3%, respectively. Antidepressants were prescribed in 27% of the population. The multidisciplinary team was activated as follows: occupational therapist in 18.9% of the cases, psychologists in 14.5%, social workers in 15.3%, and speech therapists in 6.5%.

Conclusion

The study allowed the collection of data on a relatively large sample of older patients with hip fracture showing the possible current limitations in the correct management of geriatric syndromes in this frail population. Future multicenter longitudinal studies are required to further study this population.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis Int 17(12):1726–1733

    CAS  Article  Google Scholar 

  2. 2.

    Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporosis Int 7(5):407–413

    CAS  Article  Google Scholar 

  3. 3.

    Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporosis 8:136

    CAS  Article  Google Scholar 

  4. 4.

    Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, Sherrington C (2016) A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 16:158

    PubMed  PubMed Central  Article  Google Scholar 

  5. 5.

    Resnick B, Beaupre L, McGilton KS, Galik E, Liu W, Neuman MD, Gruber-Baldini AL, Orwig D, Magaziner J (2016) Rehabilitation interventions for older individuals with cognitive impairment post-hip fracture: a systematic review. J Am Med Dir Asso 17(3):200–205

    Article  Google Scholar 

  6. 6.

    Olofsson B, Persson M, Bellelli G, Morandi A, Gustafson Y, Stenvall M (2018) Development of dementia in patients with femoral neck fracture who experience postoperative delirium—a three-year follow-up study. Int J Geriatr Psychiatry 33(4):623–632

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Aliberti S, Bellelli G, Belotti M, Morandi A, Messinesi G, Annoni G, Pesci A (2015) Delirium symptoms during hospitalization predict long-term mortality in patients with severe pneumonia. Aging Clin Exp Res 27(4):523–531

    PubMed  Article  Google Scholar 

  8. 8.

    Bellelli G, Mazzola P, Morandi A, Bruni A, Carnevali L, Corsi M, Zatti G, Zambon A, Corrao G, Olofsson B et al (2014) Duration of postoperative delirium is an independent predictor of 6-month mortality in older adults after hip fracture. J Am Geriatr Soc 62(7):1335–1340

    PubMed  Article  Google Scholar 

  9. 9.

    Morghen S, Gentile S, Ricci E, Guerini F, Bellelli G, Trabucchi M (2011) Rehabilitation of older adults with hip fracture: cognitive function and walking abilities. J Am Geriatr Soc 59(8):1497–1502

    PubMed  Article  Google Scholar 

  10. 10.

    Seitz DP, Gill SS, Austin PC, Bell CM, Anderson GM, Gruneir A, Rochon PA (2016) Rehabilitation of older adults with dementia after hip fracture. J Am Geriatr Soc 64(1):47–54

    PubMed  Article  Google Scholar 

  11. 11.

    Lee SY, Beom J, Kim BR, Lim SK, Lim JY (2018) Comparative effectiveness of fragility fracture integrated rehabilitation management for elderly individuals after hip fracture surgery: a study protocol for a multicenter randomized controlled trial. Medicine 97(20):e10763

    PubMed  PubMed Central  Article  Google Scholar 

  12. 12.

    Pioli G, Barone A, Mussi C, Tafaro L, Bellelli G, Falaschi P, Trabucchi M, Paolisso G (2014) The management of hip fracture in the older population. Joint position statement by Gruppo Italiano Ortogeriatria (GIOG). Aging Clin Exp Res 26(5):547–553

    PubMed  Article  Google Scholar 

  13. 13.

    Conley RB, Adib G, Adler RA, Akesson KE, Alexander IM, Amenta KC, Blank RD, Brox WT, Carmody EE, Chapman-Novakofski K et al (2020) Secondary fracture prevention: consensus clinical recommendations from a multistakeholder coalition. J Bone Min Res 35(1):36–52

    Article  Google Scholar 

  14. 14.

    Ouellet JA, Ouellet GM, Romegialli AM, Hirsch M, Berardi L, Ramsey CM, Cooney LM Jr, Walke LM (2019) Functional outcomes after hip fracture in independent community-dwelling patients. J Am Geriatr Soc 67(7):1386–1392

    PubMed  PubMed Central  Article  Google Scholar 

  15. 15.

    Davis DH, Muniz Terrera G, Keage H, Rahkonen T, Oinas M, Matthews FE, Cunningham C, Polvikoski T, Sulkava R, MacLullich AM et al (2012) Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain 135(Pt 9):2809–2816

    PubMed  PubMed Central  Article  Google Scholar 

  16. 16.

    Davis DH, Muniz-Terrera G, Keage HA, Stephan BC, Fleming J, Ince PG, Matthews FE, Cunningham C, Ely EW, MacLullich AM et al (2017) Association of delirium with cognitive decline in late life: a neuropathologic study of 3 population-based cohort studies. JAMA Psychiatry 74(3):244–251

    PubMed  PubMed Central  Article  Google Scholar 

  17. 17.

    Morandi A, Davis D, Fick DM, Turco R, Boustani M, Lucchi E, Guerini F, Morghen S, Torpilliesi T, Gentile S et al (2014) Delirium superimposed on dementia strongly predicts worse outcomes in older rehabilitation inpatients. J Am Med Dir Assoc 15(5):349–354

    PubMed  PubMed Central  Article  Google Scholar 

  18. 18.

    Kiely DK, Bergmann MA, Murphy KM, Jones RN, Orav EJ, Marcantonio ER (2003) Delirium among newly admitted postacute facility patients: prevalence, symptoms, and severity. J Gerontol Ser A 58(5):M441–445

    Article  Google Scholar 

  19. 19.

    Weng CF, Lin KP, Lu FP, Chen JH, Wen CJ, Peng JH, Tseng AH, Chan DC (2019) Effects of depression, dementia and delirium on activities of daily living in elderly patients after discharge. BMC Geriatr 19(1):261

    PubMed  PubMed Central  Article  Google Scholar 

  20. 20.

    Givens JL, Sanft TB, Marcantonio ER (2008) Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium. J Am Geriatr Soc 56(6):1075–1079

    PubMed  Article  Google Scholar 

  21. 21.

    Bellelli G, Morandi A, Trabucchi M, Caironi G, Coen D, Fraticelli C, Paolillo C, Prevaldi C, Riccardi A, Cervellin G et al (2018) Italian intersociety consensus on prevention, diagnosis, and treatment of delirium in hospitalized older persons. Intern Emerg Med 13(1):113–121

    PubMed  PubMed Central  Article  Google Scholar 

  22. 22.

    Network SIG. Risk Reduction and management of delirium. https://www.sign.ac.uk/sign-157-delirium.html.

  23. 23.

    Pozzi C, Lucchi E, Lanzoni A, Gentile S, Trabucchi M, Bellelli G, Morandi A (2017) Preliminary evidence of a positive effect of occupational therapy in patients with delirium superimposed on dementia. J Am Med Dir Assoc 18(12):1091–1092

    PubMed  Article  Google Scholar 

  24. 24.

    Alvarez EA, Garrido MA, Tobar EA, Prieto SA, Vergara SO, Briceno CD, Gonzalez FJ (2017) Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit. A pilot randomized clinical trial. J Crit Care 40:265

    PubMed  Article  Google Scholar 

  25. 25.

    Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D et al (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373(9678):1874–1882

    PubMed  Article  Google Scholar 

  26. 26.

    Love AL, Cornwell PL, Whitehouse SL (2013) Oropharyngeal dysphagia in an elderly post-operative hip fracture population: a prospective cohort study. Age Ageing 42(6):782–785

    PubMed  Article  Google Scholar 

  27. 27.

    Michel A, Verin E, Gbaguidi X, Druesne L, Roca F, Chassagne P (2018) Oropharyngeal dysphagia in community-dwelling older patients with dementia: prevalence and relationship with geriatric parameters. J Am Med Dir Assoc 19(9):770–774

    PubMed  Article  Google Scholar 

  28. 28.

    Malafarina V, Reginster JY, Cabrerizo S, Bruyere O, Kanis JA, Martinez JA, Zulet MA (2018) Nutritional status and nutritional treatment are related to outcomes and mortality in older adults with hip fracture. Nutrients 10(5):555

    PubMed Central  Article  Google Scholar 

  29. 29.

    Morandi A, Mazzone A, Bernardini B, Suardi T, Prina R, Pozzi C, Gentile S, Trabucchi M, Bellelli G (2019) Association between delirium, adverse clinical events and functional outcomes in older patients admitted to rehabilitation settings after a hip fracture: a multicenter retrospective cohort study. Geriatr Gerontol Int 19(5):404–408

    PubMed  Article  Google Scholar 

  30. 30.

    Mazzola P, Floris P, Picone D, Anzuini A, Tsiantouli E, Haas J, Bellelli G, De Filippi F, Annoni G (2018) Functional and clinical outcomes of patients aged younger and older than 85 years after rehabilitation post-hip fracture surgery in a co-managed orthogeriatric unit. Geriatr Gerontol Int 18(8):1194–1199

    PubMed  Article  Google Scholar 

  31. 31.

    Sheehan KJ, Fitzgerald L, Hatherley S, Potter C, Ayis S, Martin FC, Gregson CL, Cameron ID, Beaupre LA, Wyatt D et al (2019) Inequity in rehabilitation interventions after hip fracture: a systematic review. Age Ageing 48(4):489–497

    CAS  PubMed  Article  Google Scholar 

  32. 32.

    Naglie G, Tansey C, Kirkland JL, Ogilvie-Harris DJ, Detsky AS, Etchells E, Tomlinson G, O'Rourke K, Goldlist B (2002) Interdisciplinary inpatient care for elderly people with hip fracture: a randomized controlled trial. CMAJ 167(1):25–32

    PubMed  PubMed Central  Google Scholar 

  33. 33.

    Karlsson A, Berggren M, Gustafson Y, Olofsson B, Lindelof N, Stenvall M (2016) Effects of geriatric interdisciplinary home rehabilitation on walking ability and length of hospital stay after hip fracture: a randomized controlled trial. J Am Med Dir Assoc 17(5):464 (e469-464 e415)

    PubMed  Article  Google Scholar 

  34. 34.

    Prestmo A, Hagen G, Sletvold O, Helbostad JL, Thingstad P, Taraldsen K, Lydersen S, Halsteinli V, Saltnes T, Lamb SE et al (2015) Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet 385(9978):1623–1633

    PubMed  Article  Google Scholar 

  35. 35.

    Lee SY, Jung SH, Lee SU, Ha YC, Lim JY (2019) Is occupational therapy after hip fracture surgery effective in improving function?: A systematic review and meta-analysis of randomized controlled studies. Am J Phys Med Rehabil 98(4):292–298

    CAS  PubMed  Article  Google Scholar 

Download references

Funding

No funding was received.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Alessandro Morandi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the Ethical Committee of the Azienda Sanitaria of Cremona.

Informed consent

Patients were excluded if they refused to sign an informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Guerzoni, V., Lanzoni, A., Pozzi, C. et al. A two-year multicenter point prevalence study of older patients with hip fractures admitted to rehabilitation units in Italy. Eur Geriatr Med 11, 573–580 (2020). https://doi.org/10.1007/s41999-020-00363-6

Download citation

Keywords

  • Fragility fractures
  • Hip fractures
  • Elderly
  • Dementia
  • Delirium
  • Geriatric syndromes