老年髋部骨折患者：三组不同需求的患者。
Older hip fracture patients: three groups with different needs.
机构信息
Department of Medicine, Diakonhjemmet Hospital, PB 23 Vinderen, 0319 Oslo, Norway.
出版信息
BMC Geriatr. 2010 Sep 18;10:65. doi: 10.1186/1471-2318-10-65.
BACKGROUND
Norway, and particularly Oslo, has the highest reported incidence of hip fractures in the world. It is increasingly common to care for older hip fracture patients in orthogeriatric units where orthopaedic care is combined with interdisciplinary geriatric care. The characteristics and needs of older hip fracture patients are poorly described. The aim of this paper is to describe the characteristics of these patients in order to better understand their need for care and rehabilitation.
METHODS
This is an observational study based on a quality register for all patients 65+ years in an orthogeriatric unit who are operated for a hip fracture. The unit covers 250,000 inhabitants in Oslo. Patient data were collected in the aim of quality control. The quality database includes demographic, medical, and functional data collected from routine assessment by the interdisciplinary team.
RESULTS
From January 2007 to September 2009, 1010 patients, included 241 (24%) from long-term care institutions, were enrolled in the database. Mean age was 85.1 years (SD 7.1), 76% were female, and 83% had experienced an indoor fall. Chronic diseases were registered in 88%, and 38% of the community-dwelling patients had pre-fracture cognitive impairment defined as IQCODE-SF > 3.6. Complications were observed in 51% of the patients, of which the most common were a need for blood transfusion, delirium, and urinary tract infections. Post-operative orthopaedic infections were rare (3.1%). Patients from long-term care were older, (87 vs. 84 years, p < 0.001), more had American Society of Anaesthesiologists (ASA) score >/= 3 (67% vs. 48%, p < 0.001) and a higher number of chronic medical conditions (mean 2.2 vs. 1.6, p < 0.001). Among community-dwelling patients, those who had fallen indoors were older, more often female, had ASA score >/= 3, chronic medical conditions, impairment in pre-fracture ADL and cognitive function, and more complications during hospital stay.
CONCLUSIONS
Older hip fracture patients in this orthogeriatric unit may be divided into three groups; patients who are relatively fit and have experienced outdoors falls (17%), frail community-dwelling patients who have fallen indoors (59%), and patients from long-term care institutions (24%). Different caring pathways are needed for these groups.
背景
挪威，尤其是奥斯陆，是世界上报告的髋部骨折发生率最高的地区。在矫形-老年病学病房中，护理老年髋部骨折患者的情况越来越常见，在那里，矫形护理与跨学科老年护理相结合。髋部骨折老年患者的特征和需求描述不足。本文的目的是描述这些患者的特征，以便更好地了解他们对护理和康复的需求。
方法
这是一项基于矫形-老年病学病房所有 65 岁以上接受髋关节骨折手术的患者质量登记的观察性研究。该病房覆盖了奥斯陆 25 万居民。患者数据是为质量控制而收集的。质量数据库包括从跨学科团队的常规评估中收集的人口统计学、医学和功能数据。
结果
从 2007 年 1 月至 2009 年 9 月，1010 名患者，其中 241 名（24%）来自长期护理机构，被纳入数据库。平均年龄为 85.1 岁（标准差 7.1），76%为女性，83%曾发生室内跌倒。88%的患者有慢性疾病，38%的社区居住患者有骨折前认知障碍，定义为 IQCODE-SF > 3.6。51%的患者出现并发症，其中最常见的是需要输血、谵妄和尿路感染。术后骨科感染罕见（3.1%）。长期护理机构的患者年龄更大（87 岁 vs. 84 岁，p < 0.001），更多的美国麻醉医师协会（ASA）评分≥3（67% vs. 48%，p < 0.001）和更多的慢性疾病（平均 2.2 种 vs. 1.6 种，p < 0.001）。在社区居住的患者中，室内跌倒的患者年龄更大，更多为女性，ASA 评分≥3，患有慢性疾病，骨折前日常生活活动和认知功能受损，住院期间并发症更多。
结论
该矫形-老年病学病房的老年髋部骨折患者可分为三组；相对健康、发生室外跌倒的患者（17%）、虚弱的社区居住、发生室内跌倒的患者（59%）和来自长期护理机构的患者（24%）。这些组需要不同的护理途径。
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