Hip fractures in elderly often lead to bad outcomes


Dear Doctors: Our grandmother, who is 91, fell and broke her left hip. She wound up needing a partial hip replacement. I’ve read that hip fractures are dangerous for older adults. Can you explain why? Is she still at risk, even though the surgery went well?

Dear Reader: A hip fracture is a serious and yet common outcome when an older adult has a fall. It occurs due to the progressive decrease in bone mass that often affects women and men as they age. Another risk for hip fracture is osteoporosis, a skeletal disease marked by a loss of bone density, which leaves bones porous, thin and brittle.

Because of the hormonal changes that occur during menopause, women are at increased risk of developing osteoporosis. (Although it’s more common in women, men can develop osteoporosis, as well.) These skeletal changes are reflected in hospital records, which show that more than 300,000 adults over the age of 65 are admitted each year due to a hip fracture, nearly all the result of falling, usually sideways.

Unfortunately, it’s true that a hip fracture in older adults can contribute to poor outcomes, including an increased risk of death. A number of factors play a role. These include the age of the patient, their sex, and the health problems the person was living with before the fracture, such as cardiovascular, pulmonary or neurological issues; diabetes; declining cognition or frailty.

Elizabeth Ko, MD and Eve Glazier, MD

Most hip fractures in older adults require surgery to restore mobility and to manage pain. This puts patients at risk for a range of post-surgical complications, including infection, blood clots in the lungs or legs, bedsores, urinary tract infection and pneumonia. Recovery for adults who are older or frail can take months. This often leads to further loss of muscle mass, which then increases the risk of a subsequent fall. Due to the length of recovery, a hip fracture also often leads to a decrease in independence.

Following surgery, many patients are surprised to learn that physical therapy starts almost immediately. It’s an important part of the recovery process. Not only does physical therapy help patients regain mobility, but it also helps prevent the more serious complications associated with being immobilized, such as infection, developing a blood clot or pneumonia. Proper nutrition, with adequate protein, also plays a role in recovery. So does occupational therapy. It keeps the patient mentally and emotionally engaged, and can lessen the risk of depression.

One factor that can go overlooked, particularly among older adults, is pain management. It’s crucial to an optimal recovery. Make sure your grandmother’s pain levels are being clearly communicated, and that her health care providers are responding appropriately. It’s useful for her to think of pain in terms of a scale of 1-to-10, and important for her to communicate to her doctors and nurses what she is experiencing.

Unfortunately, many older adults won’t return to their same level of activity and independence following a hip fracture. Your family should be prepared to make arrangements to get your grandmother the future help she will need.

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