[Improvement of rehabilitation outcomes of hip fractures: discharge assessment by patient care team, case management and wound healing].

Fall related hip fractures in elderly persons may substantially deteriorate a previously worthwhile life. Anxiety, isolation, depression and the immediate need for help jeopardize surgery and successful rehabilitation. It was therefore of interest to evaluate the impact of a comprehensive case management guided by a discharge assessment which included medical and social criteria. In a prospective, open study, conducted by a community hospital in Vienna and the Research Department of the Red Cross, 124 carefully selected patients (117 female, 7 male, mean age 81.8 +/- 7.0 years) over a period of six months were assessed one week before hospital discharge by a multiprofessional team. Patients were excluded for mental illness, dementia, disabling neurological diseases and noteworthy surgical complications. Thirty-four patients (mean age 83.7 +/- 7.6 years) were considered as intervention group. Ninety essentially independent patients (mean age 81.1 +/- 6.6 years) were considered as control group. A specialised nurse from the Community of Vienna was responsible for the link between the patients of the intervention group, the rehabilitation unit and the Social Services, for the discharge check lists and the feed back questionnaires (2, 6 and 12 weeks after discharge). All patients were asked for a check up 12 weeks after discharge in order to investigate needs and substantial changes in the ADL or required care. In the control group, nearly all patients reached the pre-traumatic level, whereas in the intervention group a drop out rate of 1/5th and a higher over all need of Social Services care was observed. However, in respect of the higher age, the more compromised health and activities, even this group of patients obviously profits by this case management strategy. In conclusion, surgery and rehabilitation need a thoroughly performed discharge assessment followed by a network of comprehensive Social Services measures to treat successfully high risk elderly patients after fall related hip fractures.