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Care of the Aging Patient: From Evidence to Action
Clinician's Corner
May 23/30, 2012

Hip Fracture ManagementTailoring Care for the Older Patient

Author Affiliations

Author Affiliations: Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York; and the Health Services Research and Development Research Enhancement Award Program, and the Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx (Drs Hung and Siu); and Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York (Dr Egol and Zuckerman), New York.

JAMA. 2012;307(20):2185-2194. doi:10.1001/jama.2012.4842
Abstract

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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