bs_bs_banner
Geriatr Gerontol Int 2016; 16: 28–36
ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH
Survival benefits of post-acute care for older patients with hip fractures in Taiwan: A 5-year prospective cohort study Li-Ning Peng,1,2,4 Wei-Ming Chen,2,3 Cheng-Fong Chen,2,3 Ching-Kuei Huang,2,3 Wei-Ju Lee2,5 and Liang-Kung Chen1,2 1
Center for Geriatrics and Gerontology, 3Department of Orthopedics, Taipei Veterans General Hospital, 2Aging and Health Research Center, Institute of Public Health, National Yang Ming University, Taipei, and 5Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Land, Taiwan 4
Aim: To evaluate the survival benefits of different models of post-acute care (PAC) services for older patients with hip fractures in Taiwan Methods: This was a prospective cohort study that recruited elderly patients with hip fractures receiving surgical treatment from 2007 to 2009 for study. All patients were provided home-based PAC, institution-based PAC or conventional home care (CHC) based on their capacity of family care resources. Functional status and survival status was followed for 4 years. Results: Overall, 453 hip fracture patients (mean age 81.9 ± 6.8 years, 58.8% men) were recruited for the present study. Among them, 29.4% (133/453) patients received home-based PAC, 25.6% (116/453) patients received institution-based PAC and 45.0% (204/453) received CHC. During follow up, 28.9% (131/453) died within the mean of 940.3 ± 453.40 days. Adjusted for age, sex, living status, visual acuity, mood status, previous fall history, and prefracture activities of daily living (ADL) and instrumental activities of daily living (IADL), ADL fully recovered patients were significantly more likely to survive in the 4-year follow up (HR 2.791, P = 0.01, 95% CI 1.261–6.149). Patients receiving either home- or institution-based PAC had better survival than the CHC group after adjustment for age, sex, living status, visual acuity, mood status, previous fall history, prefracture ADL and IADL (HR 0.486, P = 0.008, 95% CI 0.284–0.832 for home-based PAC; HR 0.546, P = 0.036, 95% CI 0.311–0.960 for institution-based PAC). Conclusions: PAC services were of great survival benefit for elderly hip fracture patients, and the home-based model was more likely to achieve complete functional recovery, which was important for long-term survival. Geriatr Gerontol Int 2016; 16: 28–36. Keywords: hip fracture, home care, institute care, osteoporosis, post-acute care.
Introduction Hip fracture has been described as a geriatric epidemic, which is associated with significant loss of function, institutionalization and mortality in older people, and will become a major international public health burden because of the escalation of the elderly population.1 As one of the fastest aging countries in the world, Taiwan
Accepted for publication 17 October 2014. Correspondence: Dr Liang-Kung Chen MD PhD, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, no. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan. Email: [email protected]
28
|
doi: 10.1111/ggi.12429
is facing the increasing burden of hip fracture care that will continue to escalate in the coming future. Previous studies have shown that 13.5% of elderly hip fracture patients die within 6 months,2 24% die in the first year and the life expectancy of hip fracture patients would be reduced by 1.8 years.3,4 Furthermore, approximately 50% of elderly hip fracture survivors might not regain their prefracture functional status,5,6 and 12.8% of them would require total assistance for ambulation.2 A number of risk factors for adverse clinical outcomes for hip fractures have been identified, such as male sex, old age, poor cognitive function or physical function, fracture type, time to surgery and pre- or postoperative blood loss.1,7–9 Previous reports have shown that functional recovery was of critical importance for elderly hip © 2015 Japan Geriatrics Society
Post-acute care for hip fracture
fracture patients to regain their abilities of independent living regardless of the effect of comorbidities, so the quality of hip fracture care was heavily dependent on optimal surgical care and post-acute care (PAC).8 Hip fracture surgery is usually reimbursed as a diagnosis-related group (DRG) internationally, which significantly shortens acute hospital stay. In addition to the DRG payment scheme for hip fractures, various PAC service models have been developed to promote functional recovery after hip fracture surgery. However, in Taiwan, 80% of hip fracture patients returned home immediately after surgery without proper PAC services.10 As Taiwan has not developed a PAC service system yet, the potential of elderly hip fracture patients to regain functional independence might be jeopardized, and could be related to a higher mortality risk. Although the effectiveness of community hospitalbased PAC services has been reported, home-based PAC services might be more important for hip fracture patients, because the vast majority of them eventually returned home immediately after acute hospital care in Taiwan.11 Home-based physical training programs have been reported to promote better recovery in physical function, balance confidence and quality of life compared with conventional home care services.12–14 Compared with the institution-based PAC, the effectiveness of home-based PAC in promoting functional outcomes of hip fracture patients has been reported.15 However, on the contrary, Tinetti et al., reported that home-based PAC was no better than usual home care in terms of physical activities, balance and lower limb strength at 6 or 12 months after hip fracture surgery.16 Therefore, the main aim of the present study was to evaluate the survival benefits and functional recovery of home-based PAC, institution-based PAC and conventional home care (CHC) for elderly hip fracture patients in Taiwan, in which PAC has not yet been systematically developed, and provide more information for an optimal model of hip fracture care to the world.
Methods Study design This was a prospective cohort study, which recruited elderly hip fracture patients admitted to Taipei Veterans General Hospital, Taipei, Taiwan, from January 2007 to December 2009. Patients meeting the following criteria were enrolled: (i) patients aged ≥65 years; (ii) patients with displaced femoral neck fractures or intertrochanteric fractures of the femur; and (iii) patients who were able to communicate with research staff and gave informed consent. In contrast, patients with the following conditions were excluded from the study: (i) patients aged
Geriatr Gerontol Int 2016; 16: 28–36
ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH
Survival benefits of post-acute care for older patients with hip fractures in Taiwan: A 5-year prospective cohort study Li-Ning Peng,1,2,4 Wei-Ming Chen,2,3 Cheng-Fong Chen,2,3 Ching-Kuei Huang,2,3 Wei-Ju Lee2,5 and Liang-Kung Chen1,2 1
Center for Geriatrics and Gerontology, 3Department of Orthopedics, Taipei Veterans General Hospital, 2Aging and Health Research Center, Institute of Public Health, National Yang Ming University, Taipei, and 5Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Land, Taiwan 4
Aim: To evaluate the survival benefits of different models of post-acute care (PAC) services for older patients with hip fractures in Taiwan Methods: This was a prospective cohort study that recruited elderly patients with hip fractures receiving surgical treatment from 2007 to 2009 for study. All patients were provided home-based PAC, institution-based PAC or conventional home care (CHC) based on their capacity of family care resources. Functional status and survival status was followed for 4 years. Results: Overall, 453 hip fracture patients (mean age 81.9 ± 6.8 years, 58.8% men) were recruited for the present study. Among them, 29.4% (133/453) patients received home-based PAC, 25.6% (116/453) patients received institution-based PAC and 45.0% (204/453) received CHC. During follow up, 28.9% (131/453) died within the mean of 940.3 ± 453.40 days. Adjusted for age, sex, living status, visual acuity, mood status, previous fall history, and prefracture activities of daily living (ADL) and instrumental activities of daily living (IADL), ADL fully recovered patients were significantly more likely to survive in the 4-year follow up (HR 2.791, P = 0.01, 95% CI 1.261–6.149). Patients receiving either home- or institution-based PAC had better survival than the CHC group after adjustment for age, sex, living status, visual acuity, mood status, previous fall history, prefracture ADL and IADL (HR 0.486, P = 0.008, 95% CI 0.284–0.832 for home-based PAC; HR 0.546, P = 0.036, 95% CI 0.311–0.960 for institution-based PAC). Conclusions: PAC services were of great survival benefit for elderly hip fracture patients, and the home-based model was more likely to achieve complete functional recovery, which was important for long-term survival. Geriatr Gerontol Int 2016; 16: 28–36. Keywords: hip fracture, home care, institute care, osteoporosis, post-acute care.
Introduction Hip fracture has been described as a geriatric epidemic, which is associated with significant loss of function, institutionalization and mortality in older people, and will become a major international public health burden because of the escalation of the elderly population.1 As one of the fastest aging countries in the world, Taiwan
Accepted for publication 17 October 2014. Correspondence: Dr Liang-Kung Chen MD PhD, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, no. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan. Email: [email protected]
28
|
doi: 10.1111/ggi.12429
is facing the increasing burden of hip fracture care that will continue to escalate in the coming future. Previous studies have shown that 13.5% of elderly hip fracture patients die within 6 months,2 24% die in the first year and the life expectancy of hip fracture patients would be reduced by 1.8 years.3,4 Furthermore, approximately 50% of elderly hip fracture survivors might not regain their prefracture functional status,5,6 and 12.8% of them would require total assistance for ambulation.2 A number of risk factors for adverse clinical outcomes for hip fractures have been identified, such as male sex, old age, poor cognitive function or physical function, fracture type, time to surgery and pre- or postoperative blood loss.1,7–9 Previous reports have shown that functional recovery was of critical importance for elderly hip © 2015 Japan Geriatrics Society
Post-acute care for hip fracture
fracture patients to regain their abilities of independent living regardless of the effect of comorbidities, so the quality of hip fracture care was heavily dependent on optimal surgical care and post-acute care (PAC).8 Hip fracture surgery is usually reimbursed as a diagnosis-related group (DRG) internationally, which significantly shortens acute hospital stay. In addition to the DRG payment scheme for hip fractures, various PAC service models have been developed to promote functional recovery after hip fracture surgery. However, in Taiwan, 80% of hip fracture patients returned home immediately after surgery without proper PAC services.10 As Taiwan has not developed a PAC service system yet, the potential of elderly hip fracture patients to regain functional independence might be jeopardized, and could be related to a higher mortality risk. Although the effectiveness of community hospitalbased PAC services has been reported, home-based PAC services might be more important for hip fracture patients, because the vast majority of them eventually returned home immediately after acute hospital care in Taiwan.11 Home-based physical training programs have been reported to promote better recovery in physical function, balance confidence and quality of life compared with conventional home care services.12–14 Compared with the institution-based PAC, the effectiveness of home-based PAC in promoting functional outcomes of hip fracture patients has been reported.15 However, on the contrary, Tinetti et al., reported that home-based PAC was no better than usual home care in terms of physical activities, balance and lower limb strength at 6 or 12 months after hip fracture surgery.16 Therefore, the main aim of the present study was to evaluate the survival benefits and functional recovery of home-based PAC, institution-based PAC and conventional home care (CHC) for elderly hip fracture patients in Taiwan, in which PAC has not yet been systematically developed, and provide more information for an optimal model of hip fracture care to the world.
Methods Study design This was a prospective cohort study, which recruited elderly hip fracture patients admitted to Taipei Veterans General Hospital, Taipei, Taiwan, from January 2007 to December 2009. Patients meeting the following criteria were enrolled: (i) patients aged ≥65 years; (ii) patients with displaced femoral neck fractures or intertrochanteric fractures of the femur; and (iii) patients who were able to communicate with research staff and gave informed consent. In contrast, patients with the following conditions were excluded from the study: (i) patients aged
