Holmes J, House A
Division of Psychiatry and Behavioural Sciences, University of Leeds.
Psychol Med. 2000 Jul;30(4):921-9. doi: 10.1017/s0033291799002548.
Hip fracture is common in the elderly. Previous studies suggest that psychiatric illness is common and predicts poor outcome, but have methodological weaknesses. Further studies are required to address this important issue.
We prospectively recruited 731 elderly participants with hip fracture in two Leeds hospitals. Psychiatric diagnosis was made within 5 days of surgery using the Geriatric Mental State schedule and other standardized instruments, and data on confounding factors was collected. Main study outcomes were length of hospital stay, and mortality over 6 months after fracture.
Fifty-five per cent of participants had cognitive impairment (dementia in 40% and delirium in 15%), 13% had a depressive disorder, 2% had alcohol misuse and 2% had other psychiatric diagnoses. Participants were likely to remain in hospital longer if they suffered from dementia, delirium or depression. The relative risks of mortality over 6 months after hip fracture were increased in dementia and delirium, but not in depression.
Psychiatric illness is common after hip fracture, and has significant effects on important outcomes. This suggests a need for randomized, controlled trials of psychiatric interventions in the elderly hip fracture population.
髋部骨折在老年人中很常见。先前的研究表明，精神疾病很常见且预示着预后不良，但存在方法学上的缺陷。需要进一步的研究来解决这个重要问题。
我们在利兹的两家医院前瞻性招募了731名髋部骨折的老年参与者。在手术后5天内使用老年精神状态检查表和其他标准化工具进行精神疾病诊断，并收集混杂因素的数据。主要研究结局为住院时间和骨折后6个月内的死亡率。
55%的参与者有认知障碍（40%为痴呆，15%为谵妄），13%有抑郁症，2%有酒精滥用问题，2%有其他精神疾病诊断。患有痴呆、谵妄或抑郁症的参与者住院时间可能更长。髋部骨折后6个月内痴呆和谵妄患者的死亡相对风险增加，但抑郁症患者未增加。
髋部骨折后精神疾病很常见，且对重要结局有显著影响。这表明有必要对老年髋部骨折人群进行精神疾病干预的随机对照试验。
