Who is at greatest risk of dying after a broken hip?

Toby Smith is a Lecturer in Physiotherapy at the Faculty of Medicine and Health Sciences, University of East Anglia. His recent paper published in Age and Ageing has identified those people who are at greatest risk of dying following a broken hip. He tweets at @tobyosmith.

Hip fracture is a major challenge for health services worldwide, and can be catastrophic for the individual who experiences it, in addition to their friends, family and carers. The consequences of a broken hip can range from physical disability through reduced mobility and loss of independence, to death. It has been estimated that approximately 25% to 40% of people following a hip fracture die within the first 12 months after their injury. This has been, in part, attributed to the fact that many of these people are older and have numerous medical conditions which place them at greater risk of death irrespective of their hip fracture.

Given this high risk and the large number of people who experience a hip fracture annually, our team aimed to identify characteristics which could predict who would be at greatest risk of dying following a hip fracture.

Commissioning hip fracture care – the NICE way

Dr Karthik Kayan is onsultant orthogeriatrician at Stockport NHS Foundation NHS Trust.

Prof Opinder Sahota is consultant in elderly medicine at Nottingham University Hospitals NHS Trust and Joint Chairman of the Falls and Bones SIG at the BGS.

It is well known in geriatric medicine circles that hip fractures are the most common osteoporotic fracture affecting predominantly older people.

Currently, the incidence of hip fracture emergency admission is around 70,000 in the UK and will continue to increase as the population ages. The projected incidence for hip fracture in the UK is 101,000 by 2020. The crippling effects of hip fracture are significant for the patient as independence is affected and a number of them die within a year of sustaining a fracture. The cost of managing osteoporotic fractures is £1.7 billion and over 90 per cent of this is due to health and social care costs associated with the fracture.

New recruits needed to help build services for frail older people undergoing operations

Dr Jugdeep Dhesi is Chair of the BGS Peri-operative Care of Older People Ungergoing Surgery SIG (POPS) and is consultant physician and clinical lead for the POPS service at Guy’s and St Thomas’ Hospitals.

The number of frail older people undergoing elective surgical procedures is rapidly increasing. In fact the number of older people undergoing operations, as a proportion of all those having surgery, is increasing more rapidly than is the proportion of frail older people across the population as a whole.

There are a number of reasons for this. Advances in surgical technique and improvements in anaesthetic management have made it possible to operate safely on patients who would have been considered too frail for surgery in the past. At the same time patients and doctors now expect that they will be able to receive operations much later in life.  

National Hip Fracture Database Reports on Developments in Acute and Post-Acute Care

Dr Helen Wilson, is co chair of the National Hip Fracture Database (NHFD), a joint endeavour of the BGS and the British Orthopaedic Association to improve the care of patients with fragility fractures.

Hip fracture, which usually results from the combination of a fall and pre existing osteoporosis, is the most common serious injury of older people, with around 76,000 cases occurring per year across the UK. Many patients are already frail. Mortality is high, residual disability common, and care costly. Although there is good evidence on best practice in surgical, medical and rehabilitation care following hip fracture, such care and its outcomes – in terms of return home and also of mortality – continue to vary.

The NHFD has published a supplement to its 2012 National Report which demonstrates continuing improvements in acute care but  highlights variations in post-acute care and overall length of NHS stay.

Geriatricians’ Corner:- Ortho-geriatrics…..A tale of two specialities

Much akin to Charles Dickens’ famous tale of two cities, the orthopaedic bastille has been stormed with the publications of the Blue book and BOAST 1 guidelines. Supported by heavy artillery in the form of the new HRG tariff for hip fractures, the revolution has well and truly begun. Ortho-geriatric services across UK have been transformed and this has catapulted this emerging sub-speciality onto the map. As a trainee, the changes have been marked, radical and at times near miraculous. Orthopaedic junior doctors are actually taking time to document AMTS scores (Abbreviated Mini-Mental Test Score) in the admission clerk-in whilst Ortho-geriatricians are culturing a knack of looking at post-op wounds and prescribing post-op venous thrombo-prophylaxis.