Improving the outcome of hip fractures in the elderly: the role of discharge assessment and a subsequent comprehensive interventional case management

Fall related hip fractures in elderly persons may substantially deteriorate a previously worthwhile life. Anxiety, isolation, depression and the immed iate need for help jeopardize surgery and successful rehabilitation. It was therefore of interest to evaluate the impact of a comprehensive case manag ement guided by a discharge assessment which included medical and social cr iteria. In a prospective, open study, conducted by a community hospital in Vienna a nd the Research Department of the Red Cross, 124 carefully selected patient s (117 female, 7 male, mean age 81.8 +/- 7.0 years) over a period of six mo nths were assessed one week before hospital discharge by a multiprofessiona l team. Patients were excluded for mental illness, dementia, disabling neur ological diseases and noteworthy surgical complications. Thirty-four patien ts (mean age 83.7 +/- 7.6 years) were considered as intervention group. Nin ety essentially independent patients (mean age 81.1 +/- 6.6 years) were con sidered as control group. A specialised nurse from the Community of Vienna was responsible for the link between the patients of the intervention group , the rehabilitation unit and the Social Services, for the discharge check lists and the feed back questionnaires (2, 6 and 12 weeks after discharge). All patients were asked for a check up 12 weeks after discharge in order t o investigate needs and substantial changes in the ADL or required care. In the control group, nearly all patients reached the pre-traumatic level, whereas in the intervention group a drop out rate of 1/5(th) and a higher o ver all need of Social Services care was observed. However, in respect of t he higher age, the more compromised health and activities, even this group of patients obviously profits by this case management strategy. In conclusion, surgery and rehabilitation need a thoroughly performed disch arge assessment followed by a network of comprehensive Social Services meas ures to treat successfully high risk elderly patients after fall related hi p fractures.