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This chapter addresses the following Geriatric Fellowship Milestones: #16, #21, #29, #42, #53

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LEARNING OBJECTIVES

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Learning Objectives

  • To be able to describe the medical issues commonly experienced by older hip fracture patients.

  • To be able to describe the physiological and functional trajectories experienced by older hip fracture patients during the year after the fracture event.

  • To be able to describe the psychosocial issues commonly experienced by older hip fracture patients and their families and/or caregivers.

  • To be able to describe the medical and psychosocial management strategies for older hip fracture patients in the acute care and rehabilitation settings.

  • To understand the role of the geriatrician in providing care to older hip fracture patients during the perioperative and recovery periods.

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Key Clinical Points

  1. Hip fracture in older adults is associated with significant morbidity and mortality.

  2. Complications of hip fracture can be prevented or mitigated, through careful perioperative screening and intervention strategies initiated during the acute hospitalization, period of formal rehabilitation services, and over the course of the year after the fracture event.

  3. Geriatricians can play a critical role in coordinating care for hip fracture patients, initiating appropriate state-of-the-art interventions, and optimizing communication between the patient, family members, and the health care team.

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INTRODUCTION

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Hip fracture is a major public health problem with significant consequences for older patients, their families, and the health care system. In 2010, there were approximately 260,000 adults aged 65 years and older hospitalized for a hip fracture in the United States and this number is expected to increase to 289,000 by 2030 due to the aging of the population and people living longer. Recent worldwide estimates are in the order of 1.7 million hip fractures annually, and are expected to surpass 6 million by the middle of this century. As seen in Figure 119-1, hip fracture incidence increases exponentially in both men and women with advancing age. The average age of a patient with hip fracture is 82 years. Among those who reach age 85, approximately 19% of women and 12% of men will experience a hip fracture and, of those who reach 90 years of age, 30% of women and 20% of men will sustain a hip fracture. Although the majority of hip fractures occur in older white women, 25% to 30% of hip fractures occur in men and, in the United States, 8% occur in nonwhites. Prominent risk factors for hip fracture are osteoporosis and propensity to fall. Underlying these essential conditions for having a hip fracture are the reduced bone strength and quality that are characteristic of osteoporosis and the multiplicity of medical, psychosocial, and environmental factors that lead to falls.

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FIGURE 119-1.

Age-specific incidence rates of hip fracture (per 1000 person-years): the Framingham study. (Samelson EJ, et al. Am J Public Health. 2002;92(5):858–862.)

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