| Hip fracture management: tailoring care for the older patient. | |
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MedLine Citation:
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PMID: 22618926 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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Hip fracture is a potentially devastating condition for older adults. Hip fracture leads to pain and immobilization with complications ranging from delirium to functional loss and death. Although a mainstay of treatment is orthopedic repair, a multidisciplinary comanagement approach, including medical specialists and rehabilitation, may maximize patient recovery. Using the case of Mr W, an older man who sustained a fall and hip fracture, we present evidence-based components of care both in the hospital and outpatient settings. Preoperatively, clinicians should correct medical abnormalities and consider the appropriateness, timing, and type of surgical repair in the context of the patient's life expectancy and goals of care. Perioperative care should include prophylaxis with antibiotics, chemoprophylaxis for venous thromboembolism, and correction of major clinical abnormalities prior to surgery. Pain control, delirium, and pressure ulcer prevention are important inpatient care elements. Multidisciplinary models incorporating these care elements can decrease complications during inpatient stay. Rehabilitation strategies should be tailored to patient needs; early mobilization followed by rehabilitation exercises in institutional, home, and group settings should be considered to maximize restoration of locomotive abilities. Attention to care transitions is necessary and treatment for osteoporosis should be considered. The road to recovery for hip fracture patients is long and most patients may not regain their prefracture functional status. Understanding and anticipating issues that may arise in the older patient with hip fracture, while delivering evidence-based care components, is necessary to maximize patient recovery. |
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Authors:
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William W Hung; Kenneth A Egol; Joseph D Zuckerman; Albert L Siu |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 307 ISSN: 1538-3598 ISO Abbreviation: JAMA Publication Date: 2012 May |
Date Detail:
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Created Date: 2012-05-23 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: United States |
Other Details:
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Languages: eng Pagination: 2185-94 Citation Subset: AIM; IM |
Affiliation:
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Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA. william.hung@mssm.edu |
Export Citation:
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Descriptor/Qualifier:
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| Grant Support | |
ID/Acronym/Agency:
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P30-AG028741/AG/NIA NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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