Hip Fracture
Conditions
Keywords
Elderly, Hip fracture, Intervention program
Brief summary
Hip fracture in the elderly is associated with excess mortality of 5 to 20%, and mobility problems that usually results in costly hospital stays and lengthy rehabilitation procedures. The purpose of this study is to compare the costs and effectiveness of three care models- acute/sub-acute, comprehensive, and routine care models for hip fractured elders in Taiwan.
Detailed description
Hip fracture in the elderly is associated with excess mortality of 5 to 20%, and mobility problems that usually results in costly hospital stays and lengthy rehabilitation procedures. With this increase in the aging population, hip fracture represents a major and a fast growing health care problem in Taiwan. Currently, the incidence rate of hip fractures is 10 times of the incidence rate for the general population. Despite the use of advanced treatment, the one-year mortality rate (15.4%) remains significant, and many of the patients never recover completely in terms of activities of daily living functions. Many studies in the United States have proved that elderly patients with hip fracture can benefit from post-operative rehabilitation, early discharge planning programs, or transitional care programs. However, little is known about what intervention should be attempted for these patients and their families in Taiwan. The purpose of this study is to compare the costs and effectiveness of three care models- acute/sub-acute, comprehensive, and routine care models for hip fractured elders in Taiwan.
Interventions
OTHERComprehensive care
Comprehensive care consisted of subacute care plus health-maintenance interventions to manage depressive symptoms, manage malnutrition, and prevent falls.
OTHERSubacute care
Subacute care included geriatric consultation, continuous rehabilitation, and discharge planning.
Sponsors
National Health Research Institutes, Taiwan
Chang Gung Memorial Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 60 years or older * Admitted to hospital for an accidental single-side hip fracture * Receiving hip arthroplasty or internal fixation * Able to perform full range of motion against gravity and against some or full resistance, and have a pre-fracture Chinese Barthel Index (CBI) score \>70 * Living in northern Taiwan
Exclusion criteria
* Severely cognitively impaired and completely unable to follow orders (determined by a Chinese Mini-Mental State Examination \[MMSE\] score \<10), or * Terminally ill
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Self-care ability | 1, 3, 6, 12 months after hospital discharge | Measured by the Chinese Barthel Index (CBI) as ability to perform activities of daily living (ADLs), with scores ranging from 0 to 100. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Depressive symptoms | 1, 3, 6, 12 months after hospital discharge | Depressive symptoms were assessed using the Chinese version of the Geriatric Depression Scale, short form (GDS-s). Patients with a score ≥ 5 were categorized as at risk for clinical depression. |
| Nutritional status | 1, 3, 6, 12 months after hospital discharge | Nutritional status was assessed using the Mini Nutritional Assessment (MNA). MNA scores categorize each person as well-nourished (≥24 points), at risk of malnutrition (17-23.5 points), and malnourished (\<17 points). |
Countries
Taiwan
Outcome results
None listed