Hip Fracture Intervention Trial

Intervention group receives one or more of the following treatments, depending on their condition, the outcome of the assessments and the recommendations from the geriatricians and the multidiciplinary team: 1. Progressive resistance training (all participants) ; 2 x 1 hour session per week for 12 months in small groups of maximum 4 participants supervised by exercise physiologist. High intensity progressive resistance training on pneumatic resistance machines. Volume: 3 sets of 8 repetitions on 7 machines: leg press, standing hip extension and abduction, knee extension, knee flexion, triceps, chest press, seated row Intensity: 80% of most recent one repetition maximum (1RM) or rating less than 15 on Borg's scale of perceived exertion. 2. Balance training: Progressing through eight different exercises, each with progressive levels of difficulty, until mastered: Sitting balance, Single Leg Stand, Med-Lat Shift, Ant-Post Shift, Stepping over Objects, Tandem Walk, Toe Walk, Heel Walk. Wobble board practice. 2 x 15 minutes session per week for 12 months in small groups of maximum 4 participants supervised by exercise physiologist. 3. Home assessment and modification (all participants): Administered by research assistant in consultation with interdisciplinary team. A comprensive assessment of the residence & its access was conducted by research staff looking for any hazard, falls risk & obstacles to independence to address. After discussion with the interdisciplinary team an individualized plan was drawn & implemented by research staff. This was followed up by the research staff at monthly visits. 4. Nutritional supplementation and support for nutrition-related Instrumental Activities of Daily Living (IADLs): Administered face to face by research staff and/or dietician Provision of nutritional supplement and/or dietary advice to increase energy (400-600 kcal) / protein (20 gm) intake, Nutritional supplements used: Resource and 2cal. Dietary advice: encouraged to consume increased Protein and calorie rich foods and snacks throughout day, preferred sources: Meat, Fish, Meat and cheese pizza, Meat Pies, Whole Milk, Whole Mild Yogurt, Hard Cheese, Whole Mild Custard, Whole Milk Ice Cream, Milkshakes, smoothies, Liquid supplements (2 cal if possible), High protein bars, Muffins, Dried fruit, Nuts, Peanut butter, Nutella sandwiches, Butter, margarine, mayonnaise on all breads, Add sugar, honey, syrup, cream to cereals and porridge, Cook with olive or canola oil, Add evaporated milk, cream, cheese or dry milk powder to soups, casseroles, Omlettes with cheese, ham. Chocolate candy, hot cocoa, Milo made with whole milk Cheese and crackers, cheese and peanut butter snacks Supplements:1 to 3 times a day in between meals, as well as after exercise training sessions for both supplements & increase in calories. Reviewed monthly. 5. Calcium and Vitamin D deficiency: Vitamin D supplementation when 25-OH Vitamin D level <40 ng/ml: 12 months of Vit D orally (Osteolyn 1000 IU/day) Calcium supplementation when Calcium intake <1200 mg/day in diet: Caltrate 600 mg 2 x day for 12 months. 6. Depression treatment: - Resistance training 2 days a week, Frequency-3 sets of 8 reps on 7 machines Intensity-80% of most recent one repetition maximum (1 RM) or rating less than 15 on Borg's perceived exertion scale. - Pleasurable events scheduled as appropriate - Problem solving as needed - Optimise medical condition by geriatrician and reviewed monthly - Antidepressant: Cipramil if determined by geriatrician review and repeat gds scale at one month that prt and cbt were not sufficient 7. Visual impairment support/referral: - Cataract extraction referral at time of initial assessment by ophtalmologist - New prescription for read/distance glasses at time of initial assessment by ophtalmologist - Elimination of bifocals as part of new glasses prescription - New glaucoma medications - Home modifications at initial visit & followed up monthly by research staff - Referral to Blind Society services/resources - Provision of support for ADL’s unable to be done due to visual impairment as needed 8. Treatment for dementia and familiy education: - Optimise medical condition - Minimise drugs by geriatrician in collaboration with general practitioner - Commence donepezil if determined needed by geriatrician review - Family/caregiver support and counseling; - Referral to Alzheimers Association 9. Hip protectors (all participants): Hip protectors are shields worn over the hip bone to assist in preventing hip fracture in the event of a fall. The soft silicone shields that absorb the force of an impact caused by a fall onto the hip are held in place by specially designed underwear. When to wear: Put on in the morning when dressing and take off at night when going to bed. How to wear: 1)place the shields in the inside pockets of the pants: -hollow side faces in, towards the hip -rounded side faces out, away from the hip 2) put on as normal underpants so that the pants are well adjusted with the shields at hip height 10. Social support network optimisation: Individual packages varying according to the individual’s needs, for the 12 months of the study participation & reviewed at monthly visits. One or more of the following involved: - Practical care such as services to help with self care, meals, medications, cleaning & shopping - Social and emotional support through regular planned visits and phone calls - Information and advice relevant to the rehabilitation process and/or availability of appropriate programs or services - Monthly visit by research staff 11 Self-efficacy education/training: Self-efficacy as needed one or more of the following administered face to face by research staff and reviewed at monthly visits and administered by group education sessions - Use of confidence stepladder - Exploring barriers and overcoming obstacles - Breaking down skills, practice, reframing negative statements 12. Management of polypharmacy: management of polypharmacy - Medication review by geriatrician - Consultation with General Practitioner - Education of patient/caregiver - Completion of medical record card from pharmacy 13. Pharmacological treatment of osteoporosis (all participants: - 12 months of Vit D orally (Osteolyn 1000 IU/day) or calcium and Vit D (Caltrate 600 mg 2 x day plus Osteolyn) - 12 months Biophosphonates Fosamax - Provision of educational materials The overall period duration of this intervention 12 months with yearly follow-up for 4 years (at 2, 3, 4 and 5 years post hip fracture). The intervention group is being monitored closely throughout the 12 months. For both groups, the assessments are done at 3 timepoints: baseline, 4 months and 12 months. Update description of intervention(s) / exposure: Participants are also called yearly for the next 4 years following the 12 month assessment to ascertain functional and residency status.