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Are the Extremely Elderly Really At Greater Risk of Hip Fracture?

Posted on: 09/11/2008
It makes sense that the older we get, the greater our risk of hip fracture. But how does risk compare before age 90 and after age 95? The Scottish Hip Fracture Audit was used to find out. This audit is a national, multicenter study of patients over age 50 who are admitted to the hospital with a hip fracture.

Two groups of adults were compared. Patients in the comparison (control) group were between 75 and 89 years old. The extremely elderly group was 95 years old or older. The oldest member of this study group was 106. There were many more women in both groups than men. The ratio of females-to-males in the younger (control) group was 4:1. The ratio was 8:1 in the study group.

Everyone had suffered a hip fracture that was treated surgically. All were able to walk without help before the fracture. Except for age, the two groups were very similar. This made it possible to study just the effect of age on outcomes.

Results were measured and compared using four variables. These measures included death rate, length of hospital stay, living arrangements, and mobility. Type of fracture was also observed and recorded.

The authors report no difference in the total length of hospital stay between the two groups. That included the acute and rehab phases of care. There was a higher mortality (death) rate in the older group. This was true for both the 30-day and 120-day post-fracture rechecks performed by telephone.

Fewer of the extremely elderly patients living at home before the fracture were able to return home. About half of the surviving members of the study group returned home after hospitalization. This was compared to 77 per cent (about three-fourths) of the control group.

Likewise, only two per cent of the elderly adults who were able to walk unassisted (no cane or walker) could recover their former level of mobility. Twenty-two per cent (22%) of the control group was able to regain their mobility independence.

The findings of this study are important because more and more adults are living well into their 90s and 100s. It's assumed that the number of hip fractures will continue to increase as the size of this age group increases. Although the results of this study are from Scotland, there's no reason to think the information doesn't apply to elderly adults worldwide.

The authors suggest that age is linked with hip fractures because of the comorbidities present in elderly adults. Comorbidity refers to coexisting medical problems in this age group, which is a strong predictor of death after hip fracture.

In this study, the extremely elderly group were twice as likely to die within 30-days of the fracture compared to the younger group. The same was true at the end of 120 days (four months postfracture). In fact, only half the patients in the over 90 age group who were admitted to the hospital for a hip fracture returned home. Twenty-five per cent ended up in long-term care facilities. The other 25 per cent died.

And the researchers compared these figures with adults the same ages who did not have a fracture. Survival outcomes showed that death rate was higher in the fracture group compared with extremely elderly in the general population. This helped confirm age as an independent variable linked with higher mortality after hip fracture.

All of these statistics point to increasing medical costs for aging adults. More efforts are being made to help elderly patients prevent fractures but also return home after a hip fracture. Patients with a hip fracture who come to the hospital from a skilled nursing facility or other institution are very, very unlikely to regain an independent living status.

In summary, older age is a way to predict poor prognosis for recovery after a hip fracture. Hip fracture can bring on disability and loss of independence in extremely elderly adults who were living at home independently before the fracture. Severe medical problems increase the risk of death and loss of independence.

G. Holt, MBChB, MRCS, et al. Outcome After Surgery for the Treatment of Hip Fracture in the Extremely Elderly. In Journal of Bone and Joint Surgery. September 2008. Vol. 90. No. 9. Pp. 1899-1905.

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