Proactive Geriatric Assessment to Improve Outcomes of Fragility hip Fracture Patients

Abstract Description

Authors (including presenting author) :

Chan FC (1)(3), Chiu KCP (1)(4), Ng KH (2)(2),Luk KHJ (1)(3), Chan HWF(1)(3)

Affiliation :

(1)Department of Medicine and Geriatrics, (2)Department of Orthopaedics and Traumatology, (3) TWGHs Fung Yiu King Hospital, (4) Queen Mary Hospital

Introduction :

Fragility hip fracture is like a geriatric syndrome rather than a single orthopaedic illness. The mean age of hip fracture patients is around 84 years and they are prone to peri-operative complications. Proactive geriatrician assessment to all fragility hip fracture patients help to identify the problems earlier and thus improve patient’s outcomes.

Objectives :

To optimize patient’s chronic diseases control and prevent complications To assess and manage the etiology of falls and optimize bone health To facilitate the rehabilitation progress and discharge planning To provide 365-day physiotherapy, in extended care setting

Methodology :

Fragility hip fracture patients with age 65 years or above transferred to extended care setting for further care were studied. A “pre-test” vs “post-test” design was employed. Pre-implementation patients with hip fracture were enrolled as historical control group (from 1 Oct 2016 to 31 March 2017). Patients after the implementation of the program as the study group ( from 1 Oct 2017 to 31 March 2018). Outcome measures were categorized as (1) length of stay, (2) mortality (3) use of anti-osteoporosis medications and (4) patients needed unplanned transferal to acute care.

Result & Outcome :

There were 203 patients in the control group and 244 patients in the study group. The mean age were 82 years in both groups. When compare with control group, the total hospital length of stay showed slightly shortened in the study group (32.4 days vs 31.2 days), mortality is lower in the study group ( 3% vs 1.2%), the use of osteoporosis medications is increased in the study group ( 4.9% vs 46.7%) and the needed for unplanned acute care transferal also reduced in the study group ( 14.8% vs 11.5%).