Boukemis Rabah, Jackson Robert, Shaver Erin, Chafin Ransom, Fitzpatrick Chris, Franks Adam M, Wellman Courtney D
Department of Family and Community Health, Division of Physical Medicine and Rehabilitation, Marshall University Joan C. Edwards School of Medicine, USA.
Department of Family and Community Health, Marshall University Joan C. Edwards School of Medicine, USA.
J Family Med Prim Care. 2025 Jun;14(6):2395-2401. doi: 10.4103/jfmpc.jfmpc_614_24. Epub 2025 Jun 30.
The US population ≥65 years old is rapidly growing. Geriatric disorders including hip fractures are becoming more numerous and the medical cost is significant. Hip fractures increase the risk of mortality in geriatric patients, but with improvements in medical care, this risk is declining over time. One important factor in the recovery and rehabilitation of hip fracture patients is pain management. Understanding the impact of opiate prescribing practices on outcomes in the rehabilitation setting can guide recommendations for the future.
Patients ≥65 years old with hip fracture undergoing rehabilitation were retrospectively reviewed within the electronic health record. Information regarding gender, age, height, weight, BMI, length of stay, type of fracture, weight-bearing status, and comorbidities such as coronary artery disease, heart failure, chronic obstructive pulmonary disease, dementia, diabetes, renal disease, and vitamin D deficiency were obtained. The patients' morphine milligram equivalents were calculated and averaged by length of stay. This information was analyzed with the GG score along with patient-specific information above to assess for a relationship using odds ratio and Wald confidence intervals.
Of the studied ≥65-year-old patients (n = 115), the amount of MME weakly positively correlated, with the change in GG score for MME/day ( = 0.01), mobility ( = 0.02) and self-care ( = 0.03) scores. Age >85 years old ( = 0.002) and BMI <25 ( = 0.046) correlated with lower MMEs/day. Negative correlation with GG improvement was seen for age ( = 0.002), dementia ( < 0.001), and avitaminosis D ( = 0.01). Age ( = 0.001), dementia ( < 0.001), and avitaminosis D ( = 0.03) also correlated negatively with mobility, while only dementia ( < 0.001) and avitaminosis D ( = 0.004) correlated negatively with an overall score. Weight-bearing status displayed the most consistent positive correlation with overall ( = 0.009) and mobility ( = 0.04) scoring. Isolated positive impacts were seen with 'unknown' fracture types on mobility ( = 0.04), femur fractures on self-care ( = 0.047), and pubic rami fractures on self-care ( = 0.04).
A weak but significant correlation was seen between treatment with opioids and change in rehabilitation scoring. Age, dementia, and avitaminosis D correlated negatively in this rural, geriatric population, consistent with previous findings, while weight-bearing status and type of fracture had more positive correlations with functional scoring.
美国65岁及以上的人口正在迅速增长。包括髋部骨折在内的老年疾病越来越多，医疗成本也很高。髋部骨折会增加老年患者的死亡风险，但随着医疗护理的改善，这种风险会随着时间的推移而下降。髋部骨折患者康复和恢复的一个重要因素是疼痛管理。了解阿片类药物处方做法对康复环境中治疗结果的影响可以为未来的建议提供指导。
对电子健康记录中65岁及以上接受康复治疗的髋部骨折患者进行回顾性研究。获取了有关性别、年龄、身高、体重、体重指数、住院时间、骨折类型、负重状态以及合并症（如冠状动脉疾病、心力衰竭、慢性阻塞性肺疾病、痴呆症、糖尿病、肾病和维生素D缺乏症）的信息。计算患者的吗啡毫克当量，并按住院时间进行平均。将这些信息与GG评分以及上述患者特定信息一起进行分析，以使用优势比和Wald置信区间评估两者之间的关系。
在研究的65岁及以上患者（n = 115）中，MME的量与MME/天（r = 0.01）、活动能力（r = 0.02）和自我护理（r = 0.03）评分的GG评分变化呈弱正相关。年龄>85岁（r = 0.002）和BMI<25（r = 0.046）与较低的MME/天相关。年龄（r = 0.002）、痴呆症（r < 0.001）和维生素D缺乏症（r = 0.01）与GG改善呈负相关。年龄（r = 0.001）、痴呆症（r < 0.001）和维生素D缺乏症（r = 0.03）也与活动能力呈负相关，而只有痴呆症（r < 0.001）和维生素D缺乏症（r = 0.004）与总体评分呈负相关。负重状态与总体评分（r = 0.009）和活动能力评分（r = 0.04）显示出最一致的正相关。“不明”骨折类型对活动能力有单独的积极影响（r = 0.04），股骨骨折对自我护理有积极影响（r = 0.047），耻骨支骨折对自我护理有积极影响（r = 0.04）。
阿片类药物治疗与康复评分变化之间存在微弱但显著的相关性。在这个农村老年人群中，年龄、痴呆症和维生素D缺乏症呈负相关，与先前的研究结果一致，而负重状态和骨折类型与功能评分有更多的正相关。
