THE ROLE OF COMPREHENSIVE GERIATRIC ASSESSMENT IN THE COMPLEX MANAGEMENT OF SENIOR PATIENTS WITH HIP FRACTURE
The increased incidence of hip fracture in the frail elderly patients requires the development of differentiated care, adapted to their physical, psychological and emotional profile. Pre- and postoperative comprehensive geriatric assessment (CGA) is the most accurate tool for developing a personalized therapeutic and care plan. Aim: To investigate the consequences of the surgical treatment of hip fractures on senior patients using CGA preoperatively and in the immediate postoperative period. Material and methods: The prospective study, from which we present the preliminary data, was conducted on a group of 95 patients admitted in the Trauma Clinic with hip fracture. Of these, only 59 underwent CGA preoperatively and 48 hours postoperatively. Particular attention was given to frailty - evaluated with Groningen Frailty Index (GFI), neurocognitive status - evaluated with Mini-Mental State Examination (MMSE), and psycho-emotional status - evaluated with Geriatric Depression Scale (GDS). Results: Analyzing the GFI scores (p = 0.014) it was found that of the preoperatively robust patients 71.4% became frail postoperatively. No statistically significant differences in cognitive and psycho-emotional status were found in the immediate postoperative compared to the initial preoperative assessment, probably due to the small sample size. Conclusions: The results of this study confirm the importance of evaluating the degree of frailty for the prediction of the postoperative evolution of hip fractures in senior patients.
2. Foulke BA, Kendal AR, Murray DW, Pandit H. Fracture healing in the elderly: A review. Maturitas 2020; 92: 49-55.
3. Friedman SM, Mendelson DA. Epidemiology of fragility fractures. Clin Geriatr Med 2014; 30(2): 175-181.
4. Hartholt KA, Oudshoorn C, Zielinski SM, et al. The epidemic of hip fractures: are we on the right track? PLoS One 2011; 6(7).
5. Alexa O, Puha B, Veliceasa B, Paduraru D. Posterior dislocation of the hip associated with ipsilateral trochanteric fracture - a very rare case. Chirurgia 2009; 104(6): 761-764.
6. Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 2009; 20(10): 1633-1650.
7. Bertram M, Norman R, Kemp L, Vos T. Review of the long-term disability associated with hip frac-tures. Inj Prev 2011; 17(6): 365- 370.
8. Prestmo A, Hagen G, Sletvold O, et al. Comprehensive geriatric care for patients with hip fractures: a prospective, randomized, controled trial. Lancet (London, England) 2015; 385(9978): 1623-1633.
9. Nijmeijer WS, Folbert EC, Vermeer M, Vollenbroek-Hutten MR, Hegeman JH. The consistency of care for older patients with a hip fracture: are the results of the integrated orthogeriatric treatment model of the Centre of Geriatric Traumatology consistent 10 years after implementation? Archives of Osteoporosis 2018; 13: 131 / doi: 10.1007/s11657-018-0550-5.
10. Malancea RI, Gavriliuc ER, Veliceasa B, Puha B, Popescu D, Alexa O. Methodology of Three-dimensional Printing in Acetabular Fractures. Mater. Plast 2017; 54(3): 513-516.
11. Groot R, Nijmeijer WS, Folbert EC, Vollenbroek-Hutten MMR, Hegeman JH. ‘Nonagenarians’ with a hip fracture: is a different orthogeriatric treatment strategy necessary? Archives of Osteoporosis 2020; 15(1): 19 / doi: 10.1007/s11657-020-0698-7.
12. Kammerlander C, Roth T, Friedman SM, et al. Orthogeriatric service-a literature review comparing different models. Osteoporosis Int 2010; 21(4): S637-S646.
13. Grigoryan KV, Javedan HMS, Rudolph JLD. Ortho-geriatric care models and outcomes in Hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma 2014; 28(3): e49-e55.
14. Friedman SM, Mendelson DA, Kates SL, McCann RM. Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc 2008; 56(7): 1349-1356.
15. Abdulan IM, Ilie AC, Sandu IA, et al. Effects of sarcopenia and sarcopenic obesity on the health status of elderly population. Rev Med Chir Soc Med Nat Iasi 2018; 122(2): 240-246.
16. Auais M, Morin S, Nadeau L, Finch L, Mayo N. Changes in frailty-related characteristics of the hip fracture population and their implications for healthcare services: evidence from Quebec, Canada. Os-teoporosis Int 2013; 24(10): 2713- 2724.
17. Krishnan M, Beck S, Havelock W, Eeles E, Hubbard RE, Johansen A. Predicting outcome after hip fracture: using a frailty index to integrate comprehensive geriatric assessment results. Age Ageing 2014; 43(1): 122-126.
18. Alexa-Stratulat T, Neagu M, Neagu AI, Alexa ID, Ioan BG. Consent for participating in clinical trials - Is it really informed? Developing World Bioeth 2018; 18: 299-306.
19. Chen X, Mao G, Leng S. Frailty syndrome: an overview. Clin Interv Aging 2014; 9: 433-441.
20. Joseph B, Pandit V, Zangbar P, et al. Superiority of frailty over age in predicting outcomes among geriatric trauma patients: a prospective analysis. JAMA Surg 2014; 149(8): 766-772.
21. Ilie AC, Pislaru AI, Macsim IC, et al. Sarcopenia and the Importance of Biochemical Determinations in the Hospitalised Older Adults. International Conference on E-Health and Bioengineering (EHB) 2017.
22. Milte R, Crotty M. Musculoskeletal health, frailty and functional decline. Best Pract Res Clin Rheu-matol 2014; 28(3): 395-410.
23. Bhandari M, Swiontkowski M. Management of Acute Hip Fracture. The New England Journal of Medicine 2017; 377: 2053-2062.
24. Smith T, Pelpola K, Ball M, Ong A, Myint PK. Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 2014; 43(4): 464-471.
25. Partridge JS, Harari D, Dhesi JK. Frailty in the older surgical patient: a review. Age Ageing 2012; 41(2): 142-147.
26. Maştaleru A, Ilie AC, Stefaniu R, et al. Evaluation of frailty and its impact on geriatric assessment. Psychogeriatrics 2020; 20(3): 321-326.
27. Ireland AW, Kelly PJ, Cumming RG. Risk factor profiles for early and delayed mortality after hip fracture: analyses of linked Australian Department of Veterans’ Affairs databases. Injury 2015; 46(6): 1028-1035.
28. Goisser S, Schrader E, Singler K, et al. Malnutrition according to mini nutritional assessment is asso-ciated with severe functional impairment in geriatric patients before and up to 6 months after hip frac-ture. J Am Med Dir Assoc 2015; 16(8): 661-667.
29. Liu HY, Wang HP, Chen CY, et al. Subjective memory complaints predict poorer functional recovery during the first year following hip-fracture surgery among elderly adults. Int J Geriatr Psychiatry 2020; 35(10): 1209-1218.
30. Ruggiero C, Bonamassa L, Pelini L, et al. Early post-surgical cognitive dysfunction is a risk factor for mortality among hip fracture hospitalized older persons. Osteoporos Int 2017; 28(2): 667-675.
31. Xing H, Xiang D, Li Y, Ji X, Xie G. Preoperative prognostic nutritional index predicts postoperative delirium in elderly patients after hip fracture surgery. Psychogeriatrics 2020; 20(4): 487-494.
32. Mizrahi EH, Lubart E, Leibovitz A. Low Borderline Levels of Serum Vitamin B12 May Predict Cog-nitive Decline in Elderly Hip Fracture Patients. Isr Med Assoc J 2017; 19(5): 305-308.
33. Chan CK, Sieber FE, Blennow K, et al. Association of Depressive Symptoms With Postoperative Delirium and CSF Biomarkers for Alzheimer’s Disease Among Hip Fracture Patients. Am J Geriatr Psychiatry 2021: S1064-7481(21)00166-4 / doi: 10.1016/j.jagp.2021.02.001.
34. Pizzonia M, Giannotti C, Carmisciano L, et al. Frailty assessment, hip fracture and long-term clinical outcomes in older adults. Eur J Clin Invest 2021; 51(4): e13445 / doi: 10.1111/eci.13445
35. Lenze EJ, Munin MC, Ferrell RE. Association of the serotonin transporter gene-linked polymorphic region (5-HTTLPR) genotype with depression in elderly persons after hip fracture. Am J Geriatr Psy-chiatry 2005; 13: 428-432.
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