Treating a Fractured Hip in a Nursing Home

Nursing home residents with hip fractures at risk for death and disability

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) For the elderly, a hip fracture can be dangerous and debilitating. People with a hip fracture who live in nursing homes may need extra care.

For a recent study, researchers looked at data on nursing home residents who fractured a hip.

These researchers found that one-third of the patients did not survive the first 180 days after the fracture.

Patients who were over 90 years old or who had very serious cognitive impairments were especially at risk.

"Talk to an orthopedic surgeon if your relative has fractured a hip."

Mark Neuman, MD, MSc, of the Department of Anesthesiology and Critical Care at the University of Pennsylvania's Perelman School of Medicine, led this study.

Hip fractures, often caused by falls or osteoporosis, occur more than 300,000 times per year among older adults in the US, according to the authors of this study.

Hip fractures can result in loss of independence and even higher rates of death.

Residents of nursing homes are more likely to fracture a hip than elderly individuals who live in communities, the authors wrote. Additionally, nursing home residents frequently fare worse after the fracture.

This study examined outcomes of hip fractures among older adults who use Medicare, a government program that provides medical insurance to Americans aged 65 and older.

Using Medicare claims and the Nursing Home Minimum Data Set, the researchers found files on 60,111 nursing home residents and Medicare users who were hospitalized with hip fractures between July 2005 and June 2009.

They looked to see how many patients had died within 180 days of the fracture and how many had developed total dependence during that time.

These researchers found that 21,766 patients died within 180 days of the fracture.

Additionally, among the patients who could walk independently at the start of the study, 53.5 percent died or depended on another person to walk after 180 days.

The patients' ability to perform activities of daily living also declined across the board.

Patients who were more than 90 years old were less likely than the average patient to survive for 180 days after a hip fracture.

Patients with very severe cognitive impairments were 1.66 times more likely than patients without those impairments to die or require total dependence to move.

Some patients did not undergo an operation for a hip repair, called a hip pinning or internal fixation. Those patients were 1.48 times more likely to die or require total dependence to move from one place to another over the first 180 days after a hip fracture.

The researchers concluded that hip fractures can be very dangerous for nursing home residents.

They suggested that care planning should involve extra precautions for elderly people with hip fractures, especially those who are older than 90, have multiple other conditions or do not undergo a hip operations.

This study was published in JAMA Internal Medicine on June 23.

The research was funded by the National Institute on Aging. One researcher has served on boards for medical organizations and pharmaceutical companies.

Review Date: 
June 23, 2014
Last Updated:
June 24, 2014