Assessment of older acute hip fracture patients: from the view of geriatricians

Introduction: Hip fractures are important causes of disability and mortality in older adults. The orthogeriatric assessment proved beneficial while it is limited in many developing countries.

Objectives: Herein, we aimed to report the results derived from the first two orthogeriatric assessment centers in Turkey.

Methods: 103 older adults underwent geriatric assessment in the study period (November 2018-September 2020). We noted demographics, geriatric syndromes identified by a comprehensive geriatric assessment, laboratory parameters on admission, and mortality in the hospital. Descriptive statistics were generated for all study variables. Numerical variables were given as mean±standard deviation, and relative frequencies were given for categorical (qualitative) variables. Also, continuous data were given as a median, interquartile range (IQR) as appropriate.

Results: Mean age was 81.2±7.8 (range: 63-95), and 65% were female. While 58.3% of the patients were widowed, 4.9% were single. 22.3% were living alone. 35% were uneducated. 8.7% were smokers, 3.9% had reported using alcohol regularly. The mean time to preoperative evaluation of hip fracture patients by the geriatrician was 3.99±3.80 [median=3; interquartile range (IQR)=3] days. 79.7% were either frail or prefrail (58.3%, frail; 21.4%, prefrail) before admission to the hospital. Before the hospitalization, 50.5% were undernourished [10.7%, malnutrition (MN); 39.8%, malnutrition risk (MNR)]. This rate became 73.8% during the early days of hospitalization (median=3 days, IQR=3) (28.2%, MN; 45.6%, MNR, respectively). 54.4% of the patients had a previous complaint of urinary incontinence before admission to the hospital; the most common (46.4%) incontinence type was urge incontinence. 44.7% of the patients reported having difficulty in falling asleep and/or maintaining sleep. 23.3% of the patients had positive screening test (Patient Health Questionnaire, PHQ-2) for depression. Delirium was screened positive in 28.2% of the patients on admission. 25.2% had reported severe pain before operation. 90% had at least one chronic disease, and 53.4% had polypharmacy. 37.9% of the patients had orthostatism symptoms before admission to the hospital. Most of the patients had some degree of dependency before admission. The scores of activities of daily living and instrumental activities of daily living were as follows: median=6, IQR=2, and median=3, IQR=8, respectively. 50.5% of the patients had a fear of falling, and the prevalence of falls in the last year was 36.9%. Among them, 21.4% had recurrent falls, and 15.5% had a history of one fall before the fall that caused the hip fracture. Hip fractures occurred due to falling at home in 77.7% of the patients, falling outside in 16.5%, and falling in a nursing home in 1.9%. 22.3% of the patients reported a previous fragility fracture, and 17.3% of the patients who reported a previous fragility fracture had recurrent fractures. Only 21.7% of the patients with fragility fractures had received treatment for osteoporosis. 36% of the patients used vitamin D, and 20.4% used calcium before the hip fracture. The values of c-reactive protein, hemoglobin, albumin, creatinine, and CKD-EPI at admission were as follows: median=40.5 mg/L, IQR=95.3; 11.2±1.96 g/dL; 3.5±0.5 g/dL; median=0.84 mg/dL, IQR=0.54; and median=68.8, IQR=38.5. Spinal anesthesia was applied in 76% of the patients. 7.1% of the patients died before surgery, and 4.3% died after operation during hospitalization.

Conclusions: Our patients were older, mostly female, frail, and malnourished. Most of them were previously osteoporotic, but there was a lack of treatment for osteoporosis. In order to prevent fractures in the future, awareness of osteoporosis should be increased. A comprehensive orthogeriatric approach should be incorporated into these risky hip fracture patients to handle harmful consequences.