Quality of life after hip fracture surgery in older persons

Abstract

Objective: Hip fractures are classified as one of the most serious healthcare problems in older persons since they are associated with a high annual healthcare expenditure and account for a number of quality-adjusted life years lost due to functional losses. The main objectives of the study were (i) to evaluate health related quality of life in older persons (65 years and over) who had sustained a hip fracture and were eventually operated on and (ii) to compare and contrast pre-fracture variables with after-fracture variables and their impact on functional outcomes. Design: A prospective cohort study was carried out. Data was collected at two different time points one in the immediate postoperative phase that is before the older person was discharged from the acute phase of his / her care and three months after the fracture incident. Data was collected through the use of two questionnaires (one for each time point) which included a mixed-method research design, since it consisted of both closed and open ended questions which measured demographic data, pre-fracture variables, after-fracture variables and quality of life through the use of tools and instruments. This type of information helped in the process of triangulation so as to achieve validity of the data being studied. Setting: The study took place in various different settings. The first data collection was carried out at Malta’s general hospital - Mater Dei Hospital in the designated orthopaedic wards, which admit patients who had sustained any form of trauma. The second data collection was carried out at different locations. These included Karin Grech Rehabilitation Hospital, Mater Dei Hospital, various private residential nursing homes and older person’s own private residential homes. Participants: Twenty-five older persons (65 years and over) who were operated for a hip fracture between June and July 2016, had no cognitive impairment and did not suffer from any terminal illnesses were included in the study. Outcome Measures: Three standardized tools were used, both in the pre-fracture phase and once more three months after and included: the Barthel activities of daily living index, the Geriatric Depression Scale which measured the presence of depression in older persons and the EQ-5D which measured health related quality of life. Results: The majority of the study participants were females, had a mean age of 78.08 years, had up to a secondary level of education and were married. Significant differences were found out between the pre-fracture Barthel index scores and those scores three months later. This implies that hip fractures can have an impact on an older person’s ability to carry out activities of daily living. The incidence of comorbidities increased within three months, which was attributed to previously undiagnosed / unknown comorbidities and also some as a result of the negative events and effects associated with hip fractures. Subjects studied had a high probability of developing depressive symptoms whilst their quality of life was lower three months after the fracture incident when compared to their pre-fracture levels. Fracture variables such as vision, hearing, weight bearing status, pain intensity, time between fall and surgery, type of surgical operation carried out and the presence of postoperative complications were studied. Results show that vision and hearing status did not vary between the two studies. The type of fracture and weight bearing status were not found to be significantly related to one another. Pain intensity varied between the two different time points and when it was measured with the type of fracture sustained a statistical correlation was found. Furthermore, the longer the time elapsed between the fall and the time for surgery the more postoperative complications were likely to set in. Physiotherapy, occupational therapy and rehabilitation were compared together and it was determined that physiotherapy had a positive effect on rehabilitation, whilst adherence to occupational therapy was limited and had minimal or no effect on rehabilitation. Conclusions: With the sample analysed one can conclude that hip fractures can have an impact on the quality of life of older persons. Findings of this study together with suggested recommendations should be taken into account when devising guidelines and programmes on the management of hip fractures in older persons.