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Hip Fractures items clipped from the Internet   updated 5/06/01

  • Toronto Sun Dec 12, 2000 http://www.can-widecirculation.com/Health0012/12_linton.html

    • Don't fall - that first hip fracture may be your last

    Ask an older person which illness they fear the most and the answer is likely to be cancer, followed maybe by Alzheimer's, heart disease, and stroke.

    I've never heard anyone mention hip fractures, yet breaking your hip can be one of the most devastating things. And when your elderly parent breaks a hip, believe me, it's not just their problem -- it's also yours!

    In Canada, there are 25,000 hip fractures annually, the majority (but not all) of which are due to osteoporosis, the disease in which bones lacking in calcium become so brittle they easily break.

    The Osteoporosis Society of Canada says that of those who fracture their hips, around 20% will die within one year due to complications, which can include pneumonia and deadly blood clots in the lungs.

    The declining spiral from good health to ill health begins in a heartbeat: A seemingly healthy senior slips on a rug, crashes to the floor, breaks his hip, and is rushed to emergency, where they try to repair the break in the thighbone or pelvis.

    If the architecture of the bone is poor, repairing the break may be difficult. The senior ends up with one leg shorter than the other, much pain, and maybe on a waiting list for hip replacement surgery. Until then, his mobility is severely limited. He may need help dressing and bathing; he certainly needs a walker or cane, and he may even be wheelchair-bound or bedridden.

    His independence will suffered greatly; he may need to move to new living quarters; his self-confidence takes a nosedive. All because of that little rug in the hallway.

    Falls account for 86% of hospital admissions for people aged 65 or older, according to the Canadian Institute for Health Information, which studied more than 68,000 injury admissions to Ontario's acute-care hospitals a few years ago.

    One University of Toronto study projected that, by 2041, the number of hip fractures in seniors would be four times what they were in the 1990s and will occur in 88,000 Canadians.

    So the message, of course, is don't fall -- particularly if you're over the age of 65 -- because that first hip fracture just might be your last.
    - - - - - - clip - - - - - - - - - 

    http://www.glencoveems.com/InjuriesElderly.html

    The consequences to our elder citizens are serious --only about 25 percent of hip fracture patients will make a full recovery; 40 percent will require nursing home admission; 50 percent will be dependent upon a cane or walker; and 20 percent will die within one year. And according to the NCIP, half of all elderly adults hospitalized for hip fracture cannot return home or live independently after the injury.

    http://www.signalquest.com/research1.html

    In 1991 Nevitt et al.2 followed 189 men and women, aged 60 and older, who were ambulatory and had fallen once in the previous 12 months, for one year. At the end of the year 539 falls were reported. Forty participants fell twice and 68 participants fell three or more times; two falls resulted in a hip fracture. One out of ten falls was followed by a long lie. A long lie was defined by the Nevitt et al. study as a fall in which “the participant said that he or she lay on the floor or ground for 5 minutes or more before being able to get up or help arrived.” Fourteen percent of participants reported not being able to get up for 5 minutes or more after at least one fall. Three percent of participants reported lies longer than 20 minutes. Three falls resulted in lies longer than 8 hours. Long lies were reported in 9% of the total falls. Fifty percent of the participants reported being unable to get up without assistance in 41% of the total falls, indicating that this is a common occurrence.

    Causes and Characteristics of Falls

    The causes and characteristics of the falls in the participants of this study were also recorded: 9% of falls were preceded by a loss of consciousness; 39% of the falls occurred while walking; 20% of the falls occurred while ascending or descending stairs or curbs; 24% occurred while transferring into or out of a bed or chair; 13% were caused by turning or reaching; 12% occurred while engaging in high risk behavior such as standing on a chair, running, or climbing. Forty-seven percent of these falls were caused by environmental hazards such as ice, wet floors, obstacles, curbs, or stairs. In 25% of the falls the participants landed on hard surfaces.2 Past studies have found that 57% of falls in the elderly occur indoors. The bedroom was the most common place for falls, followed by the dining room and then the kitchen.3 Slipping and tripping have been found to account for 30-50% of all falls in the elderly.4

    http://www.caregiverzone.com/magazine/medical/me0023_index.asp

    Hip fractures are one of the major health problems facing aging adults. Women have been the primary focus of concern; 20 percent of women over 65 will fracture a hip in their lifetime. But men are not exempt. A recent study indicated men are equally at risk at a slightly older age. A 70-year-old man, for example, often has the same risk of a hip fracture as a 65-year-old woman.

    http://www.imaginis.com/osteoporosis/preventing_falls.asp - - -  

    approximately 95% of hip fractures are caused by falls

    According to Judy A. Stevens, PhD and Sarah Olson, M.S. of the CDCP’s National Center for Injury Prevention and Control’s Division of Unintentional Injury Prevention who wrote a report on hip fractures and falls, approximately 340,000 hip fractures occur each year, and 50% of all older adults who are hospitalized for hip fractures are not able to return home or live independently after a hip fracture. Approximately 80% of patients hospitalized for hip fractures are women, and the hospitalization rate for female hip fractures has increased 40% from 1988 to 1996.

    http://orthoinfo.aaos.org/fact/thr_report.cfm?Thread_ID=25&topcategory=Hip - - -- 

    More than 340,000 hip fractures occur each year.

    The total cost in medical bills and lost income resulting from hip fractures is more than $12.6 billion a year or an average of $37,000 per hip fracture.

    Because of the aging U.S. population, the number of hip fractures is expected to reach about 650,000 by 2050.

    More than 90 percent of hip fractures are among persons 65 and older. 
    White, post-menopausal women have a 1 in 7 chance of having a hip fracture during their lifetime.

    The aging Baby Boomer who may be caring for a parent with a broken hip also is in danger because the incidence of hip fractures starts to increase at age 45.

    Hip fractures are caused by a variety of factors that weaken bone and, often, are caused by the impact from a fall. The common characteristics of persons who are vulnerable to hip fractures are:

    • Age. The rate increases for people 65 and older.
    • Gender. Women have two to three times as many hip fractures as men.
    • Heredity. A family history of fractures in later life, particularly in Caucasians and Asians. A small-boned, slender body.
    • Nutrition. A low calcium dietary intake or reduced ability to absorb calcium.
    • Personal habits. Smoking or excessive alcohol use.
    • Physical impairments. Physical frailty, arthritis, unsteady balance and poor eyesight.
    • Mental impairments. Senility, dementia, e.g., Alzheimer's disease.
    • Weakness or dizziness from side effects of medication.

    Nearly one-in-four hip fracture patients die within 12 months after injury because of complications related to the injury and the recovery period.

    http://www.cdc.gov/ncipc/factsheets/falls.htm - - - - - - - 

    How serious is the problem?

    • In the United States, one of every three adults 65 years old or older falls each year.1,2
    • Falls are the leading cause of injury deaths among people 65 years and older.3
    • In 1998, about 9,600 people over the age of 65 died from fall-related injuries.4
    • Of all fall deaths, more than 60% involve people who are 75 years or older.3
    • Fall-related death rates are higher among men than women and differ by race. 
      White men have the highest death rate, followed by white women, black men and black women.3

    What other health outcomes are linked with falls?
    • Among older adults, falls are the most common cause of injuries and hospital admissions for trauma.5
    • Falls account for 87% of all fractures for people 65 years and older.5 
      They are also the second leading cause of spinal cord and brain injury among older adults.6
    • Each year in the United States, one person in 20 receives emergency department treatment because of a fall.7 
      Advanced age greatly increases the chance of a hospital admission following a fall.
    • Among older adults, fractures are the most serious health outcomes associated with falls. 
      About 3% of all falls cause fractures.8 
      The most common are fractures of the pelvis, hip, femur, vertebrae, humerus, hand, forearm, leg and ankle.9

    Where are people most likely to fall?
    • For adults 65 years old or older, 60% of fatal falls happen at home, 30% occur in public places, and 10% occur in health care institutions.10

    What is the impact of hip fractures?
    • Of all fractures from falls, hip fractures cause the greatest number of deaths and lead to the most severe health problems.11
    • In 1996, there were approximately 340,000 hospital admissions for hip fractures in the United States.12
    • Women sustain 75% – 80% of all hip fractures.13
    • People who are 85 years or older are 10-15 times more likely to experience hip fractures than are people between the ages of 60 and 65.9
    • Most patients with hip fractures are hospitalized for about 2 weeks.14
    • Half of all older adults hospitalized for hip fractures cannot return home or live independently after their injuries.9,13
    • In 1991, Medicare costs for hip fractures were estimated to be $2.9 billion.15
    • Because the U.S. population is aging, the problem of hip fractures will likely increase substantially over the next four decades. By the year 2040, the number of hip fractures is expected to exceed 500,000.16

    http://www.doctorhealthynet.com/Prevention/medical%20safety%20topics/falls_hip_fx_elderly.htm - - - - 

    Each year in the United States, one person in 20 receives emergency department treatment because of a fall. Advanced age greatly increases the chance of a hospital admission following a fall. Among older adults, fractures are the most serious health outcomes associated with falls. About 3% of all falls cause fractures. The most common are fractures of the pelvis, hip, femur, vertebrae, humerus, hand, forearm, leg and ankle.

    http://www.findarticles.com/m1272/1998_Nov/54879233/p1/article.jhtml - - - - - 

    USA Today (Magazine) Nov, 1998
    Falling DOESN'T HAVE TO BE SENIORS' LAST TRIP. (elderly people)
    Author/s: Thomas P. Sculpo
    Simple modifications around the home, various steps to build bone strength, and a commonsense approach to safety can prevent 30-40% of falls or make them less life-threatening.

    Each year, more than 11,000,000 people over the age of 65 will fall. Some will have bruises and aching muscles for a few days and go on to recovery without any further problems. Others will have fractures or broken bones that may require hospitalization and rehabilitation.

    A fall can be a major life-changing event. Many individuals will find their mobility is limited by the need to use a cane or walker. Some elderly people, who once were proud of their independence, will be forced to live in the care of their relatives or in nursing homes for the remainder of their lives.

    Moreover, many of those who already were debilitated by other medical conditions will die within a year of a serious fall. Some studies have shown that seven to 27% of hip fracture patients die within three months after injury as a result of complications related to the injury and the extended recovery period.

    It costs an estimated $20,200,000,000 annually in the U.S. for the treatment of injuries to older people after falls. Many of these involve the head, wrist, and spine, but the majority of the treatment cost is for hip fracture care. Annual expenses of the U.S. health care system for the treatment of hip fractures come to more than $9,800,060,000, or an average of $35,000 per patient.

    The expected hospital stay is almost two weeks. Continuing care, including nursing homes, paid caretakers, and assistance from family members, greatly increases the expense of hip fractures beyond that of hospitalization and surgery.

    Hip fractures are a significant problem for the elderly. About 25% of patients will make a full recovery: 40% will require nursing home care; 50% will need a cane or walker; and 20% will die within one year after the fall. Most hip fractures occur in older women. Women over age 65 have a 20% chance of sustaining a hip fracture during their lifetime.

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    http://www.nejm.org/content/1994/0331/0013/0872.asp - - - - - 

    Clipped from New England Journal of Medicine Sept 1994

    Nearly one third of people 65 years of age or older fall each year. This risk increases with age and is much higher among persons living in long-term care institutions than among those in the community . From 10 to 15 percent of falls result in serious injuries, at least half of which are fractures. In white women, only 1 percent of falls result in hip fractures, but such fractures account for a large share of the disability, death, and medical costs associated with falls. Falls can break self-confidence as well as bones: up to a quarter of those who have fallen limit their daily activities because they fear falling again. Some who fall are unable to get up, usually because of frailty, injury, or acute illness. If no help is available, they may become dehydrated, suffer pressure injuries, and even die.

    Falls can also be a signal of medical illness. Up to 10 percent of falls unrelated to syncope are related to acute illness, such as pneumonia, stroke, anemia, or dehydration . Fewer than 10 percent of falls are due to loss of consciousness,  and such falls warrant a different approach to evaluation and prevention (5). If a fall does not involve loss of consciousness, then an electrocardiogram or a search for a cardiac cause is not generally warranted (4).

     http://www.findarticles.com/cf_0/m3225/7_61/61432995/print.jhtml - -- 

    American Family Physician   April 1, 2000  Falls in the Elderly.  Author: George F. Fuller

    Falls are the leading cause of injury-related visits to emergency departments in the United States and the primary etiology of accidental deaths in persons over the age of 65 years. The mortality rate for falls increases dramatically with age in both sexes and in all racial and ethnic groups, with falls accounting for 70 percent of accidental deaths in persons 75 years of age and older. Falls can be markers of poor health and declining function, and they are often associated with significant morbidity. More than 90 percent of hip fractures occur as a result of falls, with most of these fractures occurring in persons over 70 years of age. One third of community-dwelling elderly persons and 60 percent of nursing home residents fall each year. Risk factors for falls in the elderly include increasing age, medication use, cognitive impairment and sensory deficits. Outpatient evaluation of a patient who has fallen includes a focused history with an emphasis on medications, a directed physical examination and simple tests of postural control and overall physical function. Treatment is directed at the underlying cause of the fall and can return the patient to baseline function. (Am Fam Physician 2000; 61:2159-68,2173-4.)

    - - - - - clipped - - - - - - 

    Epidemiology of Falls in the Elderly

    From 1992 through 1995, 147 million injury-related visits were made to emergency departments in the United States.(1) Falls were the leading cause of external injury, accounting for 24 percent of these visits.1 Emergency department visits related to falls are more common in children less than five years of age and adults 65 years of age and older. Compared with children, elderly persons who fall are 10 times more likely to be hospitalized and eight times more likely to die as the result of a fall.(2)

    Trauma is the fifth leading cause of death in persons more than 65 years of age,(3) and falls are responsible for 70 percent of accidental deaths in persons 75 years of age and older. The elderly, who represent 12 percent of the population, account for 75 percent of deaths from falls.(4) The number of falls increases progressively with age in both sexes and all racial and ethnic groups.(5) The injury rate for falls is highest among persons 85 years of age and older (e.g., 171 deaths per 100,000 white men in this age group).(6)

    Annually, 1,800 falls directly result in death.(7) Approximately 9,500 deaths in older Americans are associated with falls each year.(8)

    - - - - - clipped - - - - - - 

    Most falls do not end in death or result in significant physical injury. However, the psychologic impact of a fall or near fall often results in a fear of falling and increasing self-restriction of activities. The fear of future falls and subsequent institutionalization often leads to dependence and increasing immobility, followed by functional deficits and a greater risk of falling.

    clipped - - - - - - - 

    http://www.aafp.org/afp/20000401/2159.html

    Good description of causes, solutions, etc.