How to predict return to the community after fractured proximal femur in the elderly

Background: There are numerous studies about morbidity and mortality, techn ical complications and in-hospital factors after proximal femoral fracture surgery in the elderly. Although experienced clinicians are often able to m ake an accurate prediction, little information is available about the facto rs that allow early determination of whether a patient may return to the co mmunity. The present study aimed to provide that information and, hence, al low better use of health resources. Methods: At Westmead Hospital a prospective study was conducted of 304 pati ents with a proximal femoral fracture who were previously residing at home. A number of different factors were analysed using statistical methods to d etermine their effect on outcome, which was defined simply in terms of whet her the patient was able to return to the community or whether they needed institutional care. Results: Factors that had an adverse influence on return to the community w ere: a low activities of daily living (ADL) score on admission; increasing age; dementia; the use of regional analgesia; and the occurrence of postope rative complications. Other factors such as gender, fracture type, delay to surgery and length of stay were not significant. Conclusions: Consideration of the ADL score, age and mental stare at the ti me of admission to hospital is all that is needed to determine return to th e community. This is helpful to the patient and their family, and allows an early and appropriate referral pattern to either community services or a n ursing home.