Bradeanu Andrei Vlad, Bounegru Iulian, Pascu Loredana Sabina, Ciubara Anamaria
Department of Orthopedy and Traumatology, Saint Apostle Andrew Emergency County Clinical Hospital, Galati, Romania.
Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galati, Romania.
Discoveries (Craiova). 2024 Jun 30;12(2):e188. doi: 10.15190/d.2024.7. eCollection 2024 Apr-Jun.
Hip fractures are a serious global health concern with a substantial impact on senior patients' mobility, quality of life, and morbidity. Patients with psychiatric pathology may experience heightened levels of distress, making pain management more challenging. The presence of multiple comorbidities may complicate the therapeutic management of hip fractures. Treatment plans must be carefully tailored to accommodate each individual's unique medical history and current health status. We looked for improving pain evaluation and management in patients with dementia and choosing the best treatment according to age and comorbidities. This study highlights the mortality rate in surgically and non-surgically treated patients and possible correlations with other factors. We conducted a prospective study on 184 patients over 60 years old, with dementia and hip fractures, between 2018 and 2020 in Romania, within the Galati County Clinical Hospital. We applied the Charlson Comorbidity Index, ACE III test, EQ5D5L, and Harris test scores to assess the comorbidities, respectively, pain levels, mobilization in daily life activities, self-care and severity of dementia to exert the optimal treatment for patients with dementia and hip fracture. Our study pointed out that pain was frequently excruciating in non-operated patients compared to those who were operated. Most non-operated patients were immobilized in bed, they required careful and permanent care, while most of the operated patients experienced lower pain levels. While some risk factors of morbidity and mortality, such as comorbidities, severity of dementia, high age, and previous living situations are not preventable, delayed surgery, and general anesthesia risks may be prevented. Despite the treatment, mortality was high both at 6 months and 2 years, with increased survival rate in surgical treated patients. Our study addresses issues such as the importance of mental state evaluation in elderly patients in therapeutic decisions, the surgical intervention and the particularities in pre- and postoperative pain control in patients with dementia, topics that are insufficiently established in the current practical guidelines.
髋部骨折是一个严重的全球健康问题，对老年患者的行动能力、生活质量和发病率有重大影响。患有精神疾病的患者可能会有更高程度的痛苦，这使得疼痛管理更具挑战性。多种合并症的存在可能会使髋部骨折的治疗管理变得复杂。治疗方案必须根据每个人独特的病史和当前健康状况进行精心调整。我们寻求改善痴呆症患者的疼痛评估和管理，并根据年龄和合并症选择最佳治疗方法。本研究强调了手术和非手术治疗患者的死亡率以及与其他因素可能存在的相关性。2018年至2020年期间，我们在罗马尼亚加拉茨县临床医院对184名60岁以上患有痴呆症和髋部骨折的患者进行了一项前瞻性研究。我们分别应用查尔森合并症指数、ACE III测试、EQ5D5L和哈里斯测试评分来评估合并症、疼痛程度、日常生活活动中的活动能力、自我护理以及痴呆症的严重程度，以便为患有痴呆症和髋部骨折的患者实施最佳治疗。我们的研究指出，与接受手术的患者相比，未接受手术的患者疼痛常常极为剧烈。大多数未接受手术的患者卧床不起，需要精心且持续的护理，而大多数接受手术的患者疼痛程度较低。虽然一些发病和死亡的风险因素，如合并症、痴呆症严重程度、高龄和以前的生活状况无法预防，但可以预防手术延迟和全身麻醉风险。尽管进行了治疗，但6个月和2年时的死亡率都很高，手术治疗患者的生存率有所提高。我们的研究涉及了一些问题，如老年患者精神状态评估在治疗决策中的重要性、手术干预以及痴呆症患者术前和术后疼痛控制的特殊性，这些主题在当前的实用指南中尚未充分确立。
