Elsevier

Injury

Volume 33, Issue 5, June 2002, Pages 387-391
Injury

Outcome of hip fracture in older Irish women: a 2-year follow-up of subjects in a case–control study

https://doi.org/10.1016/S0020-1383(02)00025-6Get rights and content

Abstract

To assess outcome after hip fracture in older Irish women, 106 consecutive females aged over 50 years admitted to a general hospital with a hip fracture were compared to 89 age- and gender-matched controls from the same catchment area. Interview-based data were collected on socio-demographic factors, mobility and activities of daily living before recruitment and 2 years later. Information was also collected on residence, further falls and fractures and use of health and community support services during the 2-year period. Mortality at 2 years was higher in cases (23.6%) compared to controls (10.1%; P=0.01). Cases were significantly less mobile and more dependent in the activities of daily living. Of the cases who were community dwellers at baseline, 26.6% were institutionalised at 2 years compared with 9.2% of controls (P=0.01). During the 2 years cases were significantly more likely to have multiple falls and a further hip or pelvic fracture. Hospital and nursing home admissions and use of physiotherapy, day centre and home help services were also significantly greater among cases. The marked adverse impact of hip fracture reported in this study underlines the importance of public health strategies to prevent these injuries in older people.

Introduction

Hip fractures are a major public health problem in older people. They are associated with increased mortality [1], [2], [3], [4], [5], [6], [7], [8] and many survivors experience a decline in function [9], [10], [11], [12], [13], [14], [15]. There are increasing numbers of older people in our population and it has been predicted that by the year 2025 the number in western Europe over 50 years of age will have increased by 45% from the 1990 figure, with a consequent increase in the number of hip fractures [16]. This has major implications for planning of health-care delivery and services for older age groups. It is therefore important to consider the impact of hip fracture on older people and their subsequent health.

The aim of this study was to assess outcome at 2 years in hip fracture cases and controls who had been entered into a case–control study [17].

Section snippets

Methods

A case–control study examining the role of radiologically assessed bone mineral density in hip fracture was carried out in Dublin [17]. The cases comprised of 106 consecutive female patients over 50 years of age who sustained a hip fracture following a fall, who were admitted directly to St. Vincent’s University Hospital in Dublin and who lived in the hospital catchment area. Patients referred from other hospitals or those with a fracture due to malignancy or road traffic accidents were

Results

One-hundred and six cases and 89 controls were included in this study. At baseline, cases and controls were similar with regard to age, place of residence, social class and marital status (Table 1).

Mortality was significantly higher in cases at 1 and 2 years; 25 (23.6%) cases and nine (10.1%) controls died during the 2-year period (RR=2.3; 95% CI, 1.15–4.73; P=0.014); the mortality rate at 1 year was 16.0% for cases and 4.5% for controls (RR=3.6; 95% CI, 1.25–10.22; P=0.010). The remainder of

Discussion

Although there have been many studies on the outcome of hip fractures in older individuals, most have focused on mortality with less emphasis on other aspects of outcome. Furthermore, many studies have not included controls and have followed patients for relatively short periods of time after injury. Previous studies in Ireland provided only limited data on outcomes and did not include controls [4], [21]. This study examined the impact of hip fracture at 2 years on older Irish women in terms of

Acknowledgements

We thank the women who participated in the study and the research nurses, Veronica O’Neill and Bernadette Lynch. We also thank Dr. Elizabeth Dinn, Iris Van Rooij, Professor Geoffrey Bourke, Professor James Masterson and the staff of the Department of Radiology, St. Vincent’s University Hospital. The original case–control study was funded by the Health Research Board and Novartis Ireland. The Health Research Board funded the follow-up study.

References (31)

  • R.K. Beals

    Survival following hip fracture: long follow-up of 607 patients

    J. Chronic Dis.

    (1972)
  • J.R. Center et al.

    Mortality after all major types of osteoporotic fracture in men and women: an observational study

    Lancet

    (1999)
  • R.G. Cumming et al.

    Cohort study of risk of institutionalisation after hip fracture

    Aust. NZ J. Public Health

    (1996)
  • F.D. Wolinsky et al.

    The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study

    Am. J. Public Health

    (1997)
  • S.J. Jacobsen et al.

    Race and sex differences in mortality following fracture of the hip

    Am. J. Public Health

    (1992)
  • D.P. Moore et al.

    Mortality and morbidity associated with hip fracture

    Irish J. Med. Sci.

    (1989)
  • B.L. White et al.

    Rate of mortality for elderly patients after fracture of the hip in the 1980’s

    J. Bone Joint Surg.

    (1987)
  • J. Magaziner et al.

    Survival experience of aged hip fracture patients

    Am. J. Public Health

    (1989)
  • R.A. Marottoli et al.

    Predictors of mortality and institutionalisation after hip fracture: the New Haven EPESE cohort

    Am. J. Public Health

    (1994)
  • D.J. Wood et al.

    Factors which influence mortality after subcapital hip fracture

    J. Bone Joint Surg.

    (1992)
  • J. Magaziner et al.

    Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study

    J. Gerontol.

    (1990)
  • M.D. Marottoli et al.

    Decline in physical function following hip fracture

    J. Am. Geriatr. Soc.

    (1992)
  • K.J. Koval et al.

    Functional recovery after fracture of the hip

    J. Bone Joint Surg.

    (1994)
  • G.S. Keene et al.

    Mortality and morbidity after hip fractures

    Br. Med. J.

    (1993)
  • C.W. Miller

    Survival and ambulation following hip fracture

    J. Bone Joint Surg.

    (1978)
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