Hip fracture treatments – what happens to patients from residential care?

Maria Crotty PhD, FAFRM, Michelle Miller BSc, MNutDiet, Craig Whitehead BMBS(Hons), FRACP, Jegan Krisnan PhD, FRACS, Trevor Hearn PhD
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引用次数: 30

Abstract Hip fractures are a growing problem and new models of care have been called for. However, patients from residential care are rarely considered in these discussions. Hip fracture is a common serious problem for older people in residential care with profound effects on subsequent mobility and quality-of-life. There are no Australian data documenting differences in hospital treatments offered to patients from the community and residential care to inform discussions. In a prospective audit we describe the treatment and 4 month outcomes of patients with fractured hips who were admitted to Flinders Medical Centre in South Australia from the community and residential care between August 1998 and June 1999. Information was collected on prefracture health, types of surgical and rehabilitation treatments and dependency. Of the 215 older adults who were admitted during this time, 183 agreed to participate (119 from community and 64 from residential care). Surgical management of the fracture was not affected by admission accommodation. Those from residential care had short hospital stays, less rehabilitation and access to physiotherapy. Although 61% of those from residential care were classified as independently mobile prefracture, by 4 months this had declined to 32% of survivors. Strategies to improve outcomes in those from residential care include: early identification of those walking independently prefracture with assessment by rehabilitation teams. Inclusion of liaison with community therapists in the clinical pathway and in selected cases use of ‘rehabilitation at home’ services to provide physiotherapy services should be considered.

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髋部骨折治疗-住院护理的患者会发生什么?
髋部骨折是一个日益严重的问题,需要新的治疗模式。然而,在这些讨论中很少考虑到来自住宿护理的患者。髋部骨折是老年人在住院护理中常见的严重问题,对随后的行动能力和生活质量产生深远影响。澳大利亚没有数据记录向社区患者提供的医院治疗和住院治疗之间的差异,从而为讨论提供信息。在一项前瞻性审计中,我们描述了1998年8月至1999年6月期间从社区和寄宿护理中进入南澳大利亚弗林德斯医疗中心的髋部骨折患者的治疗和4个月的结果。收集了关于骨折前健康状况、手术和康复治疗类型以及依赖性的信息。在此期间入院的215名老年人中,有183人同意参加(119人来自社区,64人来自寄宿护理)。骨折的手术处理不受入院住宿的影响。那些住在养老院的人住院时间较短,康复和物理治疗的机会较少。虽然61%的住院护理者被归类为独立活动的骨折前患者,但4个月后,这一比例下降到32%。改善住院护理患者预后的策略包括:骨折前独立行走患者的早期识别,并由康复团队进行评估。应考虑在临床途径中包括与社区治疗师的联系,并在选定的情况下使用“在家康复”服务来提供物理治疗服务。
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