Survival of Aged Nursing Home Residents With Hip Fracture
Survival of Aged Nursing Home Residents With Hip Fracture
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DOI：
10.1093/gerona/glp019
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发表时间：
2009-07-01
影响因子：
5.1
通讯作者：
Kiel, Douglas P.
中科院分区：
文献类型：
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作者：
Berry, Sarah D.;Samelson, Elizabeth J.;Kiel, Douglas P.
对疗养院髋部骨折患者的死亡率知之甚少。本研究探讨骨折前的特点，医院并发症，骨折后并发症对死亡率的影响在居民髋部fracture.This是一项回顾性队列研究的195名长期护理居民（153名女性，42名男性）髋部骨折（1999年至2006年）的死亡率，直到2007年6月30日。裂前特征（年龄、性别、认知、功能状态、合并症、体重指数）、住院并发症（急性心肌梗死、充血性心力衰竭、谵妄、感染）和6个月并发症（谵妄、肺炎、压疮、尿路感染[UTI]）被评估为死亡率的潜在预测因子。在中位随访1.4年期间，150例（76.9%）死亡。男性居民死亡的可能性几乎是女性居民的两倍（风险比[HR] = 1.9，95%置信区间[CI] 1.2-3.0）。与死亡率增加相关的其他骨折前特征包括年龄较大（HR/5年= 1.3，95% CI 1.1-1.6）、功能状态低下（HR = 1.7，95% CI 1.0-3.0）、贫血（HR = 1.6，95% CI 1.1-2.5）和冠状动脉疾病（HR = 2.0，95% CI 1.3-2.9）。髋部骨折6个月内有压疮或肺炎的居民死亡率高70%（压疮，HR = 1.7，95%CI 1.2-2.6;肺炎，HR = 1.7，95%CI 1.1-2.7）。个别医院并发症和骨折后谵妄和UTI不是死亡率的显著预测因子，除了骨折前的特征外，潜在的可改变的骨折后并发症，包括压疮和肺炎与髋部骨折的疗养院居民死亡率增加相关。减少压疮和肺炎的预防策略可能有助于降低这一脆弱人群的死亡率。
Little is known about mortality in nursing home residents with hip fracture. This study examined the effect of pre-fracture characteristics, hospital complications, and post-fracture complications on mortality in residents with hip fracture.This is a retrospective cohort study of 195 long-term care residents (153 women, 42 men) with hip fracture (1999-2006) followed for mortality until June 30, 2007. Pre-fracture characteristics (age, sex, cognition, functional status, comorbidities, body mass index), hospital complications (acute myocardial infarction, congestive heart failure, delirium, infection) and 6-month complications (delirium, pneumonia, pressure ulcer, urinary tract infection [UTI]) were evaluated as potential predictors of mortality.During a median follow-up of 1.4 years, 150 participants (76.9%) died. Male residents were nearly twice as likely to die compared with female residents (hazard ratio [HR] = 1.9, 95% confidence interval [CI] 1.2-3.0). Other pre-fracture characteristics associated with increased mortality included older age (HR per 5 years = 1.3, 95% CI 1.1-1.6), low functional status (HR = 1.7, 95% CI 1.0-3.0), anemia (HR = 1.6, 95% CI 1.1-2.5), and coronary artery disease (HR = 2.0, 95% CI 1.3-2.9). Mortality was 70% greater among residents with a pressure ulcer or pneumonia within 6 months of hip fracture (pressure ulcer, HR = 1.7, 95% CI 1.2-2.6; pneumonia, HR = 1.7, 95% CI 1.1-2.7). Individual hospital complications and post-fracture delirium and UTI were not significant predictors of mortality.In addition to pre-fracture characteristics, potentially modifiable post-fracture complications including pressure ulcer and pneumonia were associated with increased mortality in nursing home residents with hip fracture. Prevention strategies to reduce pressure ulcers and pneumonia may help reduce mortality in this frail population.