Why Do Elderly People Die Soon After Breaking A Hip
Hip fractures can be associated with several contributing factors that cause death. The range of these falls stems from a variety of causes, such as neurological deficits, cardiovascular problems, or pulmonary conditions, which accompany post-operative complications, such as infections and pulmonary embolisms.
Dementia As A Spectrum
Dementia is a progressive syndrome, with a median life expectancy of 4.5 years following diagnosis. Dementia most commonly results from Alzheimer disease , vascular disease , Lewy body dementia , and Parkinson disease . Clinical presentations differ based on etiology. For example, Lewy body dementia is characterized by parkinsonism, fluctuations in cognition, visual hallucinations, disturbances in consciousness, sensitivity to neuroleptic medications, and frequent falls. Many of these features may increase hip fracture risk. It is likely that hip fracture incidence differs based on etiology of dementia. For example, in a study of 192 African Americans with dementia, 8.1% of those with Alzheimer disease had a history of hip fracture versus 1.3% of those with vascular dementia. This paper will review literature addressing cognitive impairment, dementia, and specific etiologies of dementia. Where etiologies are identified , we specify the cause of dementia.
Epidemiology Of Delirium And Post
Delirium is a complex neuropsychiatric syndrome with an acute onset and fluctuating course. It is common in all medical settings, occurs in about 15%-20% of all general admissions to hospital , with higher frequency in elderly people and in those with pre-existing cognitive impairment . Delirium is underidentified in clinical practice as non detection rates of 33%-66% are reported . Nurses and physicians have been shown to consistently underdiagnose delirium . Incidence rates of delirium in medical inpatients range between 5% and 10% with one study reporting a rate of over 50% in a mixed group of medical and surgical patients over the age of 60. Both the prevalence and the incidence of delirium are particularly high in surgical inpatients, especially in people undergoing cardiothoracic and emergency orthopaedic procedures, cataract removal, or those in intensive care units. Rates in cancer units have also been described, with prevalence and incidence rates of 42% and 45%, respectively , , , , .
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Older Adult Mortality Following Broken Hip Surgery
A broken bone or joint may not sound all that dangerous, but when you are advanced in age, you can pay a heavy price for broken hip surgery. You could be on your way to serious disability -or worse. For many, the best-case scenario still involves some decline in independence and overall outlook on life.
A meta-study published in 2010 that involved more than half a million women and over 150,000 men over 50, researchers from both Belgium and America found the potential for death in both genders three months after broken hip surgery to be five to eight times higher.
The causes of death after hip fracture surgery included pneumonia, accelerated dementia, pulmonary embolism, infection, and heart failure.
How Common Is A Hip Fracture
Hip fracture is a very common injury mainly affecting older people. It is one of the most common reasons for being admitted to a bone treatment ward in a hospital. Over 70,000 hip fractures are currently treated each year in the UK.
About 7-8 in 10 people who fracture a hip are women. The average age of someone who fractures their hip is over 80 years.
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What Are The Symptoms Of A Hip Fracture
The following are the most common symptoms of a hip fracture:
- Hip pain or pain that you can feel in your knee
- Low back pain
- Inability to stand or walk
- Bruising and swelling
- Foot turned out at an odd angle, making your leg look shorter
The symptoms of hip fracture may seem like other medical conditions. Always see your healthcare provider for a diagnosis.
Risk Factors For Hip Fractures
Age is a key risk factor, with hip fractures more likely to occur in those aged 65 or older. Theyre primarily a result of a fall, or when the hip collides with a solid object such as a kitchen bench. However, they can also occur when there has been little or no trauma, such as standing up.
Cognitive impairment such as dementia is a common factor that increases the risk of falling. Frailty, poor vision, the use of a combination of medications, and trip hazards in the home also increase the likelihood of falls. Osteoporosis, a disease characterised by low bone mass and degradation of bone tissue, is another significant risk factor for hip fractures.
Osteoporosis and osteopenia are reported to affect more than one million Australians aged 65 and older. Worldwide, one in three women and one in five men experience a fracture caused by such bone fragility, with a fracture occurring every three seconds. Compared to a fracture of any other bone, a hip fracture results in the most serious of all consequences.
Read more:Why older people get osteoporosis and have falls
While the reasons remain unclear, hip fractures also disproportionately affect those at the disadvantaged end of the social scale.
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Rehabilitation For People With Dementia Following A Hip Fracture Operation
Background
Hip fracture is an injury primarily of elderly people, which is usually caused by a fall. It can affect a person’s ability to walk, perform activities of daily living, and remain independent. Hip fracture is more common in people with dementia, and these individuals can find it more difficult to recover because they are at greater risk of becoming more confused and developing additional complications such as pressure sores and chest infections after surgery. They may also find it more difficult to express pain and discomfort.
Review question
We wanted to learn whether different ways of treating people with dementia following hip fracture might affect how well they recover and what the associated costs of their recovery might be. This is an update of a previous Cochrane Review.
Study characteristics
We searched for randomised controlled trials that compared any model of enhanced care and rehabilitation for people with dementia after hip fracture versus the usual care provided in the trial setting. The latest search was performed on 16 October 2019.
Key findings
Quality of the evidence
There may be some benefits from the care models studied, but the currently available research is insufficient to determine the best ways to care for people with dementia after a hip fracture operation.
Clinical Features Of Post
Clinical features of delirium can be summarized as impairment of consciousness, thinking, memory, psychomotor behaviour, perception, and emotion . Impairment of consciousness characteristically fluctuates often, with a deterioration in the evening when environmental stimulation is least. Awareness is impaired and alertness to the environment can either be falsely increased or lowered. Very minor degrees of impaired consciousness can occur, such as difficulty in estimating the passage of time .
Disordered attention is another key clinical feature of delirium. At interview, the patient appears to have impaired concentration and distractibility. Simple tests of concentration include: serial 7s where the patient counts backwards in sevens from 100 spelling the word “world” backwards saying the months of the year backwards, or counting down from 20 to 1. The interpretation of these assessments should take into account the patients age and educational attainment.
The sleep/wake cycle is almost always disturbed, with marked periods of drowsiness, sleeping during the day, and insomnia at night. Excessive dreaming with persistence of the experience into wakefulness is common – experiences which have also been described in Lewy body dementia where there is a profound cholinergic deficit, and the associated dopaminergic deficit may underlie the delirium-like states that are a characteristic feature of that condition .
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What Should I Do If I Am Concerned That I Have A Hip Fracture
If you think that you may have broken your hip, you need to go to hospital as soon as possible. In most cases, this will mean calling 999/112/911 for an ambulance, as it is unlikely that you can be comfortably moved without a stretcher. Whilst waiting for the ambulance to arrive, do not try to move. You should also try to keep warm covering up with a blanket may be helpful.
Do not eat or drink anything while you are waiting for the ambulance to arrive. When the ambulance arrives, you may be given some pain relief for the journey, sometimes as a painkilling gas to breathe. You will be carried on a stretcher to the ambulance and taken to hospital.
Why Is This Important
Inflammation is a natural process that kicks into action in the body when it experiences damage or infection.
Its a defence mechanism orchestrated by immune cells that rally into action to keep us healthy.
However, there is growing evidence linking the immune system to diseases like Alzheimers.
Between 2009 and 2014 our funding helped in the discovery of over 20 risk genes for Alzheimers, many of which were found to play a role in controlling inflammation.
As the focus draws in on the immune system in Alzheimers, researchers are trying to work out what could trigger inflammation in the brain in people with dementia and how this might contribute to the progression of their disease.
This knowledge will arm researchers will the ability to develop interventions or approaches to reduce the risk of brain inflammation in people with dementia, as well as identifying key molecules involved in the process that could be targeted in the search for new treatments.
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Lifestyle Changes To Improve Vascular Dementia Symptoms
A diagnosis of dementia is scary. But its important to remember that many people with dementia can lead healthy, fulfilling lives for years after the diagnosis. Dont give up on life! As much as possible, continue to look after your physical and emotional health, do the things you love to do, and spend time with family and friends.
The same strategies used to keep your brain healthy as you age and prevent the onset of dementia can also be used to improve symptoms.
Find new ways to get moving. Research suggests that even a leisurely 30-minute walk every day may reduce the risk of vascular dementia and help slow its progression. Regular exercise can also help control your weight, relieve stress, and boost your overall health and happiness.
Create a network of support. Seeking help and encouragement from friends, family, health care experts, and support groups can improve your outlook and your health. And its never to late to make new friends and expand your network.
Eat for heart health. Heart disease and stroke share many of the same risk factors, such as high LDL cholesterol , low HDL cholesterol , and high blood pressure. Adopting a heart-healthy diet may help to improve or slow down your dementia symptoms.
Make it a point to have more fun.Laughing, playing, and enjoying yourself are great ways to reduce stress and worry. Joy can energize you and inspire lifestyle changes that may prevent further strokes and compensate for memory and cognitive losses.
How Is A Hip Fracture Treated
A fracture of your hip is generally treated with surgery. Your surgeon may use metal devices to strengthen and stabilize your joint. In some cases, they may do a partial or total hip replacement. The type of surgical repair will depend on the type of hip fracture. Your surgeon will determine the best procedure for you, based on your situation. The goal of treatment is to provide relief from pain and enable you to resume your normal activity level. Hip surgery usually requires an in-hospital stay. While in the hospital, you start doing physical therapy exercises to regain strength and range of motion in your hip. Physical therapy will continue at home or on admission to a rehabilitation facility.
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Seek Treatment At Crystal Run Healthcare
Our orthopedic surgeons specialize in the latest minimally invasive techniques that lead to less pain, scarring, and hip surgery complications. A faster recovery and more favorable outcome are our goals. Our surgeons can perform a total hip replacement, anterior hip replacement, hip resurfacing, or hip arthroscopy. From diagnostic imaging to pain management and physical therapy, elderly patients with a broken hip can depend on us for the best care.
To learn more about Crystal Run Healthcare and find a hip specialist, contact us at 845-703-6999, submit your questions online, or request a callback today.
Dying From Dementia With Late
The death of your loved one can be a hard concept to wrap your head around and accept. But knowing what to expect can help you when your loved one has late-stage dementia. It might help to know what will happen in the future so that you can be prepared emotionally and logistically.
This article discusses how dementia progresses and what to expect during late-stage dementia.
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Increased Risk Of Death
In Australia, standard clinical care following a hip fracture begins with timely assessment, including X-rays, and pain and cognitive assessments. Australian data indicate more than three-quarters of people who sustain a hip fracture undergo surgery, the most common procedure being a joint replacement. Surgical intervention will generally occur within 48 hours.
But some patients may prefer not to undergo surgery. Or, their medical team may determine the risks are too great to expose the person to surgery.
Combined with the trauma of a fracture and surgery, an existing health condition may significantly increase the risk of death. Death after a hip fracture may also be related to additional complications of the fracture, such as infections, internal bleeding, stroke or heart failure.
One study showed heart disease, stroke and pneumonia resulted in a long-term doubling of risk of death after hip fracture, and this risk remained high for up to ten years in women and 20 in men.
Studies suggest issues related to the hospitalisation, surgery, or immobility after a fracture lead to other complications that ultimately result in earlier death.
Read more:Hip fractures and depression quicken frailty in the elderly
How Can Hip Fractures Be Prevented
Reduce Falls: Falls can happen so quickly, but by reviewing some of the common causes of falls and taking precautions, you may be able to prevent some of them. If a fall does happen, you should spend some time trying to figure out the root cause in order to reduce the chance of it happening again.
Regular Exercise: Physical exercise can help maintain balance, muscle tone, and bone strength, and some research has shown that exercise also can slow down cognitive decline in people with dementia. Falls and a resulting fracture are less likely to occur in those whose bodies are stronger and whose minds can evaluate safety issues.
Medications to Strengthen Bones: Some healthcare providers might prescribe medications such as calcium supplements to try to make the bones more resistant to fractures.
Medications that help people sleep at night may seem like a great solution for the person with insomnia, but they come with a higher risk of falls. Some practitioners recommend instead that a natural supplement such as melatonin be taken to hopefully decrease the risk of falls and fractures. Be sure to ask your healthcare provider before taking any over-the-counter medications or supplements.
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Hip Fractures In People With Dementia
People with dementia have a higher chance of experiencing a hip fracture. People with dementia who live in their own homes and take antipsychotic medications are also more likely to fracture their hips. And not surprisingly, those with both dementia and osteoporosis have the greatest risk for a hip fracture, according to some research.
Those with dementia who fracture their hip also have a higher likelihood of developing delirium during their hospital stay. If delirium develops, it can lead to longer hospitalizations, poorer recovery in terms of mobility and longer facility care. The recovery and rehabilitation of someone with dementia after a hip fracture can be complicated by memory loss. Often, a weight-bearing limit is placed on someone after surgery and the individual with dementia may not remember that she can’t just get up and walk.
Mortality rates in people who fracture their hip are between 12-33% after one year.
When an older adult with Alzheimer’s or other dementia experiences a hip fracture, several complications are possible.
- Less likely to rehabilitate to their previous level of functioning
- More likely to require ongoing facility care
- The higher rate of death following a hip fracture
- More likely to develop pneumonia related to decreased mobility
- Less likely to receive adequate pain medication, potentially increasing narcotic use when severe hip pain develops
A Note About Hip Protectors
In the past it has been suggested that wearing special padding around your hip might reduce the chance of breaking a hip if you fall. Early reports of some trials suggested that this was a good idea. However, further trials suggested that hip protectors are not effective in preventing a broken hip in those who live at home. Their effectiveness for patients who are particularly frail – for example, those living in a nursing home – is uncertain.
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Types Of Anaesthetic Used In Hip Fracture Surgery
You may be given a choice about the type of anaesthetic used for your surgery. The doctor who provides the anaesthetic will advise and help you decide. Options include spinal anaesthesia or general anaesthetic – you can find out all the details in our leaflet called Anaesthesic for Hip or Knee Replacement.