Hip fractures: Inventarisation of Prognostic Factors and their Contribution towards Rehabilitation in older persons

Hip fracture is a major cause for mortality and morbidity in elderly persons
with an incidence of 17,000 in 2016. Beacuse of the incrasing age it is
expected that the number of hip fracture patients will increase. They form a
frail population. Patients with hip fracture have a mean age of 82 years,
almost 75% of their patients are women, nearly 70% has at least two chronic
illnesses , and they experience on average 3 complications 25% mortality rate
and only 40-60% chance of complete functional recovery in the first year after
fracture.

After the acute hospital phase, patients that had a previous independent living
situation are either discharged home or to an inpatient geriatric
rehabilitation(GR) in post-acute GR wards where they treated by a
multidisciplinary team consisting of an elderly care physician , physical
therapist, occupational therapist, psychologist and skilled nurse. Currently
there are no clear guidelines determining type, quality, or intensity during
rehabilitation admission. Also, the effect of quality and intensity as well as
important (age related) characteristic on functional outcome and quality of
life are unknown.

Other factors that are related to the success of geriatric rehabilitation after
a hip fracture include coping behaviour and psychosocial factors such as
depression and fear of falling and the way therapist can handle these personal
factors. The presence of an informal caregivers is probably an important
success factor in rehabilitation after hip fracture.

In this study we aim to investigate prognostic factors by adding extra
questionnaires for patients and their caregivers, observation list and the use
of an accelerometer. These variables can provide information about the
successful as well as non-successful rehabilitation process and explore
effective treatment programmes with the purpose of developing good
care-pathways. In order to develop these care-pathways, it is important to
gather information about patient-related factors, healthcare use during and
after admission to post-acute GR wards as well as caregiver burden and quality
of life

A mixed-method approach with a large inception cohort and qualitative
data-collection from surgeons/orthopaedic surgeons , elderly care physicians,
physical therapists, patients and primary care givers

In the post- operative fase the patient and care giver will be given
information about the study.
The patient has 24-48 hours to think about the study. After this period the
researcher will supply verbal information and if agreed the informed consent
will be signed. There are questionnaire during the post- operative phase for
both patients and care givers The is time consuming for the patient and his/her
caregiver.

During the follow upt there are no additional check ups beside the regular
outpatient check-ups causing no additional burden to the patient. The burden
of participating is time investment due to the additional questionnaires
that must be filled in combination with the usual care given. The out patient
check will therefore be extende by 30 minutes.

During the 3 month control the patient will be fitted for an accelerometer for
7 days. Previous studies show that the burden is minimal.
For the patients in the follow up fase who cannot come to the outpatient
check-up the researcher will conducted the investigation at their home or in
the nursing home. This too is a burden of time investing for the patient and
his/her caregiver.