Department of Geriatric Medicine, Geriatric Service, Hospital Universitario La Paz, Paseo La Castellana 261, 28046, Madrid, Spain.
La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain.
Eur Geriatr Med. 2021 Oct;12(5):1021-1029. doi: 10.1007/s41999-021-00503-6. Epub 2021 May 10.
One in four hip fracture patients comes from an aged care facility. This study aimed to compare the characteristics of these subjects with their community-dwelling counterparts at baseline, during hospitalization and 1-month post-fracture.
We analyzed data from a cohort of older adults admitted with hip fractures to 75 Spanish hospitals, collected prospectively in the Spanish National Hip Fracture Registry between 2016 and 2018. We classified participants according to pre-fracture residence: community dwellers vs. aged care facilities residents. We collected demographic records at baseline, along with variables relating to in-hospital evolution and discharge to geriatric rehabilitation units. Patients or relatives were interviewed at 1-month follow-up.
Out of 18,262 patients, 4,422 (24.2%) lived in aged care facilities. Aged care facilities residents were older (median age: 89 vs. 86 years), less mobile (inability to walk independently: 20.8% vs. 9.4%) and had more cognitive impairment (Pfeiffer's SPMSQ > 3, 75.3% vs. 34.8%). They were more likely to receive conservative treatment (5.4% vs. 2.0%) and less likely to be mobilized early (58.2% vs. 63.0%). At discharge, they received less vitamin D supplements (68.5% vs. 72.4%), less anti-osteoporotic medication (29.3% vs. 44.3%), and were referred to geriatric rehabilitation units less frequently (5.4% vs. 27.5%). One-month post-fracture, 45% of aged care facilities residents compared to 28% of community dwellers experienced a severe gait decline. Aged care facilities residents had a higher one-month mortality (10.6% vs. 6.8%).
Hip fracture patients from aged care facilities are more vulnerable than their community-dwelling peers and are managed differently both during hospitalization and at discharge. Gait decline is disproportionately higher among those admitted from aged care.
四分之一的髋部骨折患者来自养老院。本研究旨在比较这些患者与社区居住的髋部骨折患者在基线、住院期间和骨折后 1 个月的特征。
我们分析了 2016 年至 2018 年期间在西班牙国家髋部骨折登记处前瞻性收集的 75 家西班牙医院收治的老年髋部骨折患者队列的数据。我们根据骨折前的居住地对参与者进行分类：社区居住者与养老院居住者。我们在基线时收集人口统计学记录，以及与住院期间进展和出院到老年康复单位相关的变量。在 1 个月的随访时对患者或家属进行了访谈。
在 18262 名患者中，4422 名（24.2%）居住在养老院。养老院居住者年龄更大（中位数年龄：89 岁 vs. 86 岁），移动能力更差（不能独立行走：20.8% vs. 9.4%），认知障碍更严重（Pfeiffer 的 SPMSQ>3，75.3% vs. 34.8%）。他们更有可能接受保守治疗（5.4% vs. 2.0%），早期活动的可能性较小（58.2% vs. 63.0%）。出院时，他们接受维生素 D 补充剂的比例较低（68.5% vs. 72.4%），接受抗骨质疏松药物的比例较低（29.3% vs. 44.3%），较少被转诊到老年康复单位（5.4% vs. 27.5%）。骨折后 1 个月，45%的养老院居住者与 28%的社区居住者相比，出现严重步态下降。养老院居住者 1 个月死亡率更高（10.6% vs. 6.8%）。
来自养老院的髋部骨折患者比社区居住的同龄人更脆弱，在住院期间和出院时的治疗方式也不同。从养老院入院的患者步态下降更为明显。
