Geriatric scales and rehabilitation after proximal femur fractures.

Czech version

Authors: MUDr. Vojtěch Mezera, Ph.D. ¹; MUDr. Dávid Fekete ²; MUDr. Ivo Bureš ¹
Authors‘ workplace: Geriatrické centrum, Pardubická nemocnice ¹; oddělení úrazové chirurgie, Pardubická nemocnice ²
Published in: Geriatrie a Gerontologie 2019, 8, č. 3: 107-111
Category: Original Article

Overview

Fractures of proximal femur are a serious injury in geriatric patients. Despite major advances in surgical treatment, these fractures impair significantly patients’ prognosis.

In this study, we evaluated the course of hospitalization of patients admitted between March 2015 and December 2018 to a long-term-care facility for rehabilitation after surgically treated proximal femoral fracture. At admission, every patient was assessed using MMSE, ADL and MNA scales. We measured association of the scales with the following parameters: incidence of delirium, pressure ulcers, thromboembolic disease, and pneumonia; duration of the hospital stay, type of discharge, mortality, necessity of walking aids.

We identified 122 patients (123 fractures). Of these, 10 % died, 63 % were discharged home, 60 % showed good mobility at discharge. In comparison to patients discharged to their homes, the patients discharged to nursing homes and patients who died had significantly worse initial MMSE, ADL and MNA (p < 0.05 resp. < 0.01 for MMSE; p < 0.01 resp. < 0.05 for ADL; 0.05 < p < 0.1 resp. p < 0.05 for MNA). Patients discharged to nursing homes were also significantly older than those discharged to their homes (p < 0.01). Patients with a record of delirium were older (p < 0.01), had worse initial MMSE, ADL and MNA compared to those without delirium (all p < 0.001). Patients who developed pressure ulcers had worse initial ADL than those with intact skin (p < 0.05).

In a subgroup of patients discharged home, poor initial ADL and MNA as well as high chronological age were associated with long hospitalization (p < 0.05 for ADL, p < 0.001 for MNA and p < 0.01 for age).

Keywords:

osteoporosis – hip fracture – femoral neck fracture – pertrochanteric fracture – pathological fracture – ADL – MMSE – MNA

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