Hip fractures in elderly patients are a major health problem in the industrialised world. Italy records more than 85,000 hip fractures/year; 77% of these occur in women, 79% of whom are aged over 75 years (data from Italian Health Ministry discharge records for 2005).Hip fractures generate 30% of overall hospitalisation costs. It is calculated that, in the over-65s alone, the annual cost of fractures exceeds 1 billion euros.The incidence of this disease is increasing constantly, and it is predicted that by 2030 there will be around 750,000 new cases in Europe each year (data from Italian Health Ministry discharge records for 2006).This is an extremely interesting phenomenon, not only from the economic and organisational perspectives, but also as regards the profile of healthcare required, given that hip fractures are often associated with a worsening of quality of life and increased mortality.Elderly fracture patients generally have comorbidities that need to be assessed before and after surgery. Recommendations for the care of these patients include: early surgical intervention, use of prophylactic antibiotics and thromboembolic prophylaxis, good control of perioperative pain to improve ambulation, prevention of malnutrition, urinary tract management, osteoporosis management and the promotion of early mobilisation to improve functional recovery; it is also necessary to detect and manage delirium and other cognitive disorders in order to reduce the risk of complications and of institutionalisation.Neuropsychiatric disorders such as dementia and delirium increase the mortality of these patients in the six months following hip fracture, while depression can have a negative effect on functional outcome and survival in the longer term. Delirium in hip fracture patients seems to be different from that observed in other types of patient, showing a different clinical course.Delirium is a frequent post-operative complication in elderly patients treated for hip fracture. Several fundamental factors have been identified in the genesis of this comorbidity. The use of psychotropic drugs in the preoperative period seems to significantly increase the risk of developing postoperative delirium.Hyperactive delirium, characterised by increased pyschomotor activity, agitation and behavioural disturbances, is the delirium subtype most often encountered in patients with proximal femur fractures.In short, cognitive and mood disorders in elderly hip fracture patients are associated with an increased risk of poor functional outcome and of reduced survival. Therefore, identification and treatment of these conditions is central to a correct therapeutic approach to the fragile elderly patient with hip fracture

Neuropsychiatric disorders in hip fracture patients

IOLASCON, Giovanni;GIMIGLIANO, Francesca
2010

Abstract

Hip fractures in elderly patients are a major health problem in the industrialised world. Italy records more than 85,000 hip fractures/year; 77% of these occur in women, 79% of whom are aged over 75 years (data from Italian Health Ministry discharge records for 2005).Hip fractures generate 30% of overall hospitalisation costs. It is calculated that, in the over-65s alone, the annual cost of fractures exceeds 1 billion euros.The incidence of this disease is increasing constantly, and it is predicted that by 2030 there will be around 750,000 new cases in Europe each year (data from Italian Health Ministry discharge records for 2006).This is an extremely interesting phenomenon, not only from the economic and organisational perspectives, but also as regards the profile of healthcare required, given that hip fractures are often associated with a worsening of quality of life and increased mortality.Elderly fracture patients generally have comorbidities that need to be assessed before and after surgery. Recommendations for the care of these patients include: early surgical intervention, use of prophylactic antibiotics and thromboembolic prophylaxis, good control of perioperative pain to improve ambulation, prevention of malnutrition, urinary tract management, osteoporosis management and the promotion of early mobilisation to improve functional recovery; it is also necessary to detect and manage delirium and other cognitive disorders in order to reduce the risk of complications and of institutionalisation.Neuropsychiatric disorders such as dementia and delirium increase the mortality of these patients in the six months following hip fracture, while depression can have a negative effect on functional outcome and survival in the longer term. Delirium in hip fracture patients seems to be different from that observed in other types of patient, showing a different clinical course.Delirium is a frequent post-operative complication in elderly patients treated for hip fracture. Several fundamental factors have been identified in the genesis of this comorbidity. The use of psychotropic drugs in the preoperative period seems to significantly increase the risk of developing postoperative delirium.Hyperactive delirium, characterised by increased pyschomotor activity, agitation and behavioural disturbances, is the delirium subtype most often encountered in patients with proximal femur fractures.In short, cognitive and mood disorders in elderly hip fracture patients are associated with an increased risk of poor functional outcome and of reduced survival. Therefore, identification and treatment of these conditions is central to a correct therapeutic approach to the fragile elderly patient with hip fracture
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11591/217853
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact