Hip fracture care varies according to patients’ place of residence
MedWire News: Care home residents admitted to hospital with hip fracture are less likely to receive a comprehensive risk assessment for falls and osteoporosis than patients admitted from their own homes, UK researchers report.
Post-hip fracture care home residents also have fewer opportunities for rehabilitation, say Elizabeth Burleigh (Victoria Infirmary, Glasgow) and colleagues.
The researchers explain that previous studies have shown that care home patients have shorter hospital stays after hip fracture than patients admitted from their own home.
To investigate whether this phenomenon is associated with a difference in access to comprehensive rehabilitation, Burleigh and team studied data from the latest Scottish Hip Fracture Audit, published in 2009.
In total, 2274 patients were admitted to Scottish hospitals with a hip fracture between April and September 2008. Of these, 1789 (79%) lived in their own home and 485 (21%) lived in care homes.
The proportion of care home residents discharged via a rehabilitation unit was significantly lower than the proportion of patients living at home, at 18% versus 55%, observes the team.
However: "This may reflect their limited rehabilitation potential given the high prevalence of dementia (80%) in this group," they say.
At 120 days post-fracture, 56% of own-home patients who walked unaccompanied with no aids prior to fracture had returned to this mobility, compared with only 22% of care home residents, a difference that was statistically significant.
When aspects of a comprehensive falls assessment were analyzed, the team found that cognition and postural blood pressures were infrequently measured, especially in care home residents and inpatients on acute orthopedics wards (versus rehabilitation wards).
In addition, care home residents were significantly less likely to be seen by physiotherapists or occupational therapists in both acute orthopedics and rehabilitation settings, or have nursing care plans and nutritional assessments performed.
"Our data showed that many of the observed differences in practice were more marked in orthopedics versus rehabilitation wards," note Burleigh et al in the journal Age and Ageing.
"Earlier involvement of geriatricians may ensure all patients receive a comprehensive assessment of risk and rehabilitation potential," they conclude.
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By Laura Dean