Pils K, Vavrovsky G, Meisner W, Schreiber W, Böhmer F
Institut für Physikalische Medizin und Rehabilitation, Sophienspital, Wien.
Wien Klin Wochenschr. 2000 May 5;112(9):413-9.
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.
老年人因跌倒导致的髋部骨折可能会使原本有意义的生活质量大幅下降。焦虑、孤独、抑郁以及对帮助的迫切需求都会对手术和成功康复造成不利影响。因此，评估以出院评估为指导的综合病例管理的影响很有意义，该评估包括医疗和社会标准。在维也纳一家社区医院和红十字会研究部门进行的一项前瞻性开放性研究中，124名经过精心挑选的患者（117名女性，7名男性，平均年龄81.8±7.0岁）在六个月的时间里于出院前一周由多专业团队进行评估。患有精神疾病、痴呆、致残性神经疾病和明显手术并发症的患者被排除在外。34名患者（平均年龄83.7±7.6岁）被视为干预组。90名基本独立的患者（平均年龄81.1±6.6岁）被视为对照组。维也纳社区的一名专业护士负责干预组患者、康复单元和社会服务部门之间的联系，负责出院检查清单和反馈问卷（出院后2周、6周和12周）。所有患者在出院后12周都被要求进行检查，以调查日常生活活动（ADL）或所需护理方面的需求和重大变化。在对照组中，几乎所有患者都恢复到了受伤前的水平，而在干预组中，观察到有五分之一的退出率，并且对社会服务护理的总体需求更高。然而，考虑到该组患者年龄更大、健康状况和活动能力受损更严重，即便如此，这组患者显然也从这种病例管理策略中受益。总之，手术和康复需要进行全面的出院评估，随后建立一个综合社会服务措施网络，以成功治疗跌倒相关髋部骨折后的高危老年患者。
