According to a report, factors leading to increased mortality after hip fracture in nursing home residents are pressure ulcer and pneumonia.
Dr. Sarah D. Berry reported that, while these risk factors should be modifiable, prevention would be a better strategy.
Given the limited survival of nursing home residents with hip fracture, efforts to improve primary prevention of these fractures in the nursing home should occur, said Dr. Berry, from the Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.
Dr. Berry and colleagues investigated 195 nursing home residents with hip fracture to find the effect of pre-fracture characteristics, hospital complications, and post-fracture complications on mortality. During a median follow-up of 1.4 years, 150 of the subjects died.
The investigators report, as did a diagnosis of anemia or coronary artery disease, that advancing age, male gender, and moderate or low functional status before hip fracture increased the risk of mortality after hip fracture.
Pressure ulcer and pneumonia in the 6 months after hip fracture were associated with a 70% increased mortality, the researchers note, whereas hospital complications and 6-month post-fracture delirium and urinary tract infection were not significant predictors of mortality.
Infection was the most common cause of death following hip fracture, followed by dementia in women and cardiac-related causes in men.
Nursing home residents who experience a hip fracture have a limited life expectancy, Dr. Berry said, summing up. This is particularly true for male residents and those with poor functional status at the time of the fracture. Potentially modifiable complications, including pneumonia and pressure ulcers, are common and contribute to the high mortality following the fracture.
Post-operative care plans that include prevention strategies to reduce pressure ulcers and increase vaccination and timely treatment of pneumonia may help reduce mortality in this frail population, she and her colleagues conclude in their report.