Hip fracture incidence among the old and very old: A population-based study of 745,435 cases

Division of Biostatistics/Clinical Epidemiology, Medical College, Wisconsin, Milwaukee 53226.
American Journal of Public Health (Impact Factor: 4.55). 08/1990; 80(7):871-3. DOI: 10.1016/0022-4375(91)90022-N
Source: PubMed


Data were obtained from the Health Care Financing Administration and the Department of Veterans Affairs (formerly called Veterans Administration) on all hospital discharges among the elderly population from 1984 through 1987 and combined with census estimates to calculate incidence rates of hip fracture for the elderly population of the United States. Rates for White women were the highest, reaching 35.4 per 1,000 per year among 95 year-olds. Comparably, White men, Black women, and Black men experienced similar age-related increases in risk, although of less magnitude and relatively less rate of change, respectively.

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    • "It has been shown that AS affects 2–9% of the elderly population >65 and this number is expected to increase as medical advances enable patients to enjoy longer lifespans[4,5]. Geriatric hip fractures are a major public health concern affecting 2–4% of men and 3–9% of women >65 years old annually with an estimated lifetime risk of 5% and 16%, respectively678. One year mortality rates approach 35% with additional loss of functional ability[Introduction: Aortic stenosis (AS) is an established predictor of perioperative complications following both cardiac and non-cardiac surgery. "
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    ABSTRACT: Introduction: Aortic stenosis (AS) is an established predictor of perioperative complications following both cardiac and non-cardiac surgery. The purpose of this study was to evaluate the risk of mortality and perioperative complications among surgically treated hip fractures in elderly patients with moderate or severe AS compared to those without AS (negative controls). Materials and methods: A retrospective case-controlled review (1:2) of elderly (≥65 years) surgically treated hip fractures from 2011 to 2015 with moderate/severe AS (according to American Heart Association criteria) was conducted. Postoperative complication rates, 30 days and 1 year mortality were reviewed. Results: Moderate/severe AS was identified in 65 hip fracture cases and compared to 129 negative controls. AS cases were significantly older with higher rates of coronary artery disease and atrial fibrillation (p<0.05). Rates of any 30-day perioperative complication (74% vs. 37%, p<0.001) and severe non-cardiac 30-day perioperative complication (52% vs. 26%, p=0.002) were significantly higher among AS cases compared to controls. Kaplan Meier estimates of 30-day mortality (14.7% vs. 4.2%, p<0.001) and 1-year mortality (46.8% vs. 14.1%, p<0.001) were significantly higher in AS cases compared to controls. Multivariate analysis of severe 30-day postoperative complications identified moderate/severe AS (OR 4.02, p=0.001), pulmonary disease (OR 7.36, p=0.002) and renal disease (OR 3.27, p=0.04) as independent predictors. Moderate/severe AS (OR 3.38, p=0.03), atrial fibrillation (OR 3.73, p=0.03) and renal disease (OR 4.44, p=0.02) were independent predictors of 30-day mortality. Moderate/severe AS (OR 5.79, p<0.001) and renal disease (OR 3.39, p=0.02) were independent predictors of 1-year mortality. Conclusion: Aortic stenosis is associated with a significantly increased risk of perioperative complications, 30-day mortality and 1-year mortality in elderly patients undergoing surgical treatment of hip fractures.
    Full-text · Article · Oct 2015 · Injury
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    • "A rapidly ageing population in Western countries has lead to a predicted increase in worldwide incidence of hip fractures, up to 6.3 million in 2050 [3] [4] [5] [6]. Women make up at least 70% of all patients with a proximal femoral fracture according to the literature [7] [8]. Low preoperative haemoglobin levels in elderly patients have been shown to be associated with increased short-term morbidity and mortality after surgery, and still 24–33% of patients discharged following hospitalization for a hip fracture, die within 12 months after the incident [9] [10] [11] [12] [13] [14] [15]. "
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    ABSTRACT: Hip fractures are a significant cause of mortality and morbidity in the elderly. This study investigated the relationship between initial haemoglobin (Hb) levels and a prognostic parameter for outcome in those patients. A total of 3595 consecutive patients with diagnosed hip fractures were included in our study (72.2% females). Anaemia was defined according to WHO criteria, with according subgroups mild, moderate and severe anaemia. Data collection was performed prospectively and statistical evaluation was performed retrospectively. Mean follow up in our study group was 11.2±0.3 months. The mean age of our study group was 78.5 years (SEM±0.2 years). To facilitate analysis, patients were divided in two groups: ≤84 years (60.1%) and ≥85 years (39.9%). Mortality <12 months was 12.2% (n=439). In our study population lower Hb levels ad admission were associated with a markedly elevated short-term mortality. In a multivariate logistic regression model adjusted for age and sex, mild anaemia at admission caused a 1.5 (CI: 1.1-1.9), moderate anaemia a 2.6 (95 CI: 2.0-3.4), and severe anaemia a 3.6 (CI: 1.8-6.9) fold increase in three months mortality compared to patients without anaemia. Total lymphocyte count (1.2±0) did not show any differences between the subgroups. Those findings in our study population with 3595 patients over a period of twenty years have proven that initial Hb levels are a useful and cost effective parameter to predict mortality in elderly patients with a hip fracture. This prognostic factor may help to increase the outcome of elderly patients with a hip fracture. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Preview · Article · Jan 2015 · Injury
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    • "e l s e v i e r . c o m / l o c a t e / a r c h g e r tasks are significant predictors of use of nursing homes (Mor et al., 1994), use of hospital and of physician services (Chan et al., 1999), less use of primary and preventive care (Keller and Potter, 1994) and mortality (Jacobsen et al., 1990). "
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    ABSTRACT: Hip fracture represents the most dramatic expression of the disease, in terms of morbidity, medical cost and mortality. The incidence of hip fracture increases substantially with age. The purpose of this study was to evaluate the association between gender and geriatric rehabilitation outcome after traumatic hip fracture. Ninety-nine community-dwelling elderly patients (older than 65 years), 64 women and 35 men, who were admitted to geriatric rehabilitation after operated hip fracture were studied. We assessed the patients' clinical and demographic data, preoperative risk (ASA), type of fracture and orthopedic repair, pain intensity (VAS), cognitive (MMSE), mood (Zung IDS), and functional status (FIM) on admission and at the end of geriatric rehabilitation. Men had higher mean number of comorbid conditions at the time of the fracture. Men recovered more from depressed mood in comparison with women during the rehabilitation. Significant improvement in FIM motor subscore on discharge was found in both groups. The FIM motor subscore gain was higher in men (24.47) in comparison with women (19.22, p=0.036). Those differences were demonstrated in mean subscores of transfers (p=0.004), and locomotion (p=0.019). Women were more functionally dependent in locomotion, transfers and sphincter control. There were no differences between the groups by duration on rehabilitation stay. Recovery after hip fracture depends in large part on the pre-fracture health and functional ability of the patient. Gender differences in functional recovery may affect therapeutic and rehabilitative decision making. Functional recovery after traumatic hip fracture was better in men in comparison with women.
    Full-text · Article · Apr 2009 · Archives of gerontology and geriatrics
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