Neuropsychiatric disorders in hip fracture

Hip fractures most frequently occur in the elderly population. They are mainly caused by falls from standing position. The presence of several comorbidities, in particular neuropsychiatric disorders, are related to high percentages of falls, disability and mortality rates. Delirium and depression are the two most common mental disorders in this population. Delirium is strongly related to an increase of functional limitation in activities of daily living, a decline in walking autonomy, and a higher rate of nursing home placement or death. A multi-factorial intervention program, consisting of oxygen supplementation, intravenous fluid supplementation and extra-nutrition, accurate monitoring of vital signs, adequate pain treatment, daily delirium screening, reduction in drug use, and modification in peri-operative management, should always be performed in good clinical practice. Patients who undergo surgery frequently experience depression that can worsening functional outcome. An early detection and an adequate intervention based on psychological support and pharmacological treatment can give good results. We propose a simple flow chart for the management of elderly hip fracture patients that should be used in both Orthopaedics and Rehabilitative settings.