A Geriatric Multidisciplinary and Tailor-Made Hospital-At-Home Method in Nursing Home Residents With Hip Fracture
Open Access
- 1 July 2011
- journal article
- Published by SAGE Publications in Geriatric Orthopaedic Surgery & Rehabilitation
- Vol. 2 (4), 148-154
- https://doi.org/10.1177/2151458511421908
Abstract
Introduction: Nursing home residents represent a large proportion of patients hospitalized with hip fracture. Generally, residents do not achieve the same physical ability level as before their fracture and have an increased risk of death within few days after discharge. This study aims to compare 2 new approaches to geriatric intervention in residents with hip fracture. Materials and Methods: In nursing home residents aged 65 or older with hip fracture, 85 received a newly developed standardized rehabilitation intervention undertaken by the geriatric orthopedic team (GO team) from December 1, 2006 to November 30, 2007. This standardized method was compared with a further developed tailor-made intervention method performed by the GO team in 153 residents from February 1, 2008 to January 31, 2010. Both the interventions began at hospital admission and until 30 days after surgery. Outcomes were length of hospital stay (LOS), difference in physical ability, 90-day acute readmission, 30-day mortality, and 90-day mortality. Results: The tailor-made intervention method reduced the readmission rate (14% vs 26%) compared with the standardized intervention method (odds ratio [OR] = 0.47 [95% confidence interval [CI]: 0.23, 0.94]). Tailor-made intervention reduced 30-day mortality (8% vs 19%) compared with standardized intervention (OR = 0.42 [95% CI: 0.18, 0.97]). Improving 90-day survival could not be demonstrated (81% vs 73%; OR = 0.72 [95% CI: 0.37, 1.40]). Median LOS was 2 days in both the groups. A total of 7 follow-up visits were performed with tailor-made intervention versus 3 visits with standardized intervention. In both the groups, the physical ability decreased significantly within the first 30 postoperative days, with no difference between groups (β = 1.01 [95% CI: 0.82, 1.24]).Conclusion: A multidisciplinary and tailor-made geriatric intervention in nursing home residents has a positive effect on readmission rate and short-term mortality. Still, it is not obvious which part of the tailor-made intervention is most crucial.Keywords
This publication has 31 references indexed in Scilit:
- [The effect of geriatric intervention on rehabilitation of elderly patients with hip fracture].2009
- A Multifactorial Intervention Program Reduces the Duration of Delirium, Length of Hospitalization, and Mortality in Delirious PatientsJournal of the American Geriatrics Society, 2005
- Effectiveness of a multidisciplinary team approach to hip fracture management.2005
- The influence of outpatient comprehensive geriatric assessment on survival: a meta-analysisArchives of Gerontology and Geriatrics, 2004
- Effects of blood transfusion on clinical and functional outcomes in patients with hip fractureTransfusion, 2003
- [Intensive physical therapy after trochanteric femoral fracture. A randomized clinical trial].2002
- A Nurse‐Led Interdisciplinary Intervention Program for Delirium in Elderly Hip‐Fracture PatientsJournal of the American Geriatrics Society, 2001
- The added effectiveness of early geriatrician involvement on acute orthopaedic wards to orthogeriatric rehabilitation.1996
- Prospective randomised study of an orthopaedic geriatric inpatient service.BMJ, 1988
- Effectiveness of geriatric rehabilitative care after fractures of the proximal femur in elderly women: a randomised clinical trial.BMJ, 1988