Abstract
Background and aim
Functional deficits may increase the risk for further falls after hip fracture. The aim of this study was to elucidate function and range of movement (ROM)-related risk factors.
Methods
The consecutive, prospective study included all patients admitted to the rehabilitation unit. The geriatric assessment was performed after admission and before discharge; ROM was measured using the neutral zero method. Falls, defined as unintentionally coming to rest on the floor, were documented. Patients’ functions were analyzed comparing fallers to nonfallers.
Results
A total of 1,497 patients with a mean age of 81.1 ± 8.2 years were included. The incidence of falls during rehabilitation was 9.6 per 1,000 patient–days and was related to patients’ age: patients younger than 75 years had an incidence of falls of 5.0, those between 75–84 years had an incidence of 9.5, and those >84 years had an incidence of 12.0, respectively. Fallers showed significantly more functional deficits both in the operated and on the nonoperated leg. Using logistic regression models, especially ROM measured in the frontal plane (hip adduction and abduction) of the nonoperated hip was significantly associated with an increased risk of falling (OR 0.986, 95% CI 0.973–0.999, p = 0.037).
Conclusion
Patients are at high risk for falls after hip fracture, with age itself being one of the most dominant risk factors. In addition to previously identified gait and mobility disorders, the physical limitations of arthritis of the “healthy” hip seem to be responsible for the functional decline. Therefore, it would be of interest to include the examination of the hips into a falls risk assessment battery.
Zusammenfassung
Hintergrund und Ziel
Funktionelle Einschränkungen führen zu einem erhöhten Sturzrisiko nach proximaler Femurfraktur. Ziel der vorliegenden Studie war es, den Zusammenhang zwischen Funktionsdefiziten und Gelenkbeweglichkeit („range of movement“) zu erfassen.
Patienten und Methode
In die konsekutive, prospektive Studie wurden alle in der Abteilung für Akutgeriatrie und Remobilisation betreuten Patienten eingeschlossen. Nach der Aufnahme und vor der Entlassung wurde das geriatrische Assessment durchgeführt und die Gelenkbeweglichkeit mittels Neutral-Null-Methode gemessen. Stürze wurden dokumentiert. Die Funktionsparameter wurden zwischen Stürzern und Nichtstürzern verglichen.
Ergebnisse
Insgesamt wurden 1497 Patienten mit einem Durchschnittsalter von 81,1 ± 8,2 Jahren eingeschlossen. Die Sturzinzidenz lag bei 9,6 für 1000 Patiententage und korrelierte mit dem Patientenalter: Patienten unter 75 Jahren hatten eine Sturzinzidenz von 5, die zwischen 75 und 84 Jahren zeigten eine Inzidenz von 9,5 und jene älter als 84 Jahre eine Inzidenz von 12,0. Stürzer wiesen signifikant mehr funktionelle Defizite sowie Einschränkungen der Gelenkbeweglichkeit beider Hüften auf. In der Regressionsanalyse erwies sich die Einschränkung der Hüftadduktion und -abduktion als relevant.
Zusammenfassung
Patienten haben nach Hüftfraktur ein erhöhtes Risiko für weitere Stürze. Das Alter per se ist einer der wichtigsten Sturzrisikofaktoren. Neben den bereits früher identifizierten Gehstörungen und Mobilitätseinschränkungen scheinen die klinischen Zeichen der Koxarthrose auf der „gesunden“ Seite für das Sturzrisiko verantwortlich zu sein. Deshalb wäre es von Interesse, die Untersuchung beider Hüftgelenke in Sturzrisikoassessmentbatterien aufzunehmen.
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Pils, K., Meisner, W., Haas, W. et al. Risk assessment after hip fracture. Z Gerontol Geriat 44, 375–380 (2011). https://doi.org/10.1007/s00391-011-0256-4
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DOI: https://doi.org/10.1007/s00391-011-0256-4