Hip Fracture

In the United States, approximately 300,000 people fracture their hip every year, and half of them are age 80 or older. The incidence of fracture has increased as people are living much longer, and elderly people's unsteadiness on their feet can be affected by medication, dementia, and general frailty. Often the reason for the hip fracture is a fall, either in the home or on the street, and it is the way that elderly people fall that makes them particularly vulnerable to this type of fracture. For the younger patient, hip fractures are often caused by accidents, often involving motor vehicles and to a lesser extent sporting activities. Studies have shown that it is essential that treatment be carried out quickly, within 24 hours. Treatment usually consists of surgery to insert a bone plate or, in some cases, a hip replacement. The average cost to the health services for a patient with a hip fracture estimated in 1990 was US$20,000, and the entire cost to both private and public providers is estimated to be about US$5 billion per year.

The prognosis for very elderly people surviving hip fracture is poor in the immediate to long term. Complications for elderly people include thrombosis, pneumonia, and infections after surgery. Even with ever improving medical and surgical techniques, the long-term prognosis for the older person is still poor. In a study in six New England states, 24 percent of hip fracture patients died in the first year following surgery. Class and gender affect rates; for example, women have better survival rates than men, and those from lower socioeconomic groups have the worst.

To aid recovery after surgery, ward off potential complications, and increase the likelihood of survival, patients are encouraged to move and begin to walk with aids as soon as possible. Generally, for the younger patient this presents few difficulties. However, many elderly people are not able to take advantage of the rehabilitation programs due to their frailty, so sometimes their ability to improve after surgery is limited. In some cases, rehabilitation programs are not available so many elderly people who have fallen endure a diminished quality of life due to the disabling effect of a hip fracture and the loss of confidence that it can cause. As to be expected, younger people have better rates of recovery, although total hip replacement may be required as the patient gets older.

[Page 851]Since the results following surgery remain mixed, it seems that prevention of hip fractures for elderly people may be the best way to ensure that they do not have to endure surgery, the threat of complications, the potential for long-term disability, and a reduction in their quality of life. Charities in Britain run fitness training courses particularly for elderly people in order that they retain some flexibility and strength. Engineers are developing aids that reduce the potential for a fractured hip if an elderly person does fall. These include hip guards that are inserted in pockets in a special undergarment and act as a type of body armor to protect the hip. As research into preventive strategies improves, it can be hoped that the incidence of hip fracture and its disabling effects, which can cause a significant reduction in the quality of life of individuals, can be limited.

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