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Lancet. 2015 Apr 25;385(9978):1623-33. doi: 10.1016/S0140-6736(14)62409-0. Epub 2015 Feb 5.

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial.

Author information

1
Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatrics, St Olav Hospital, University Hospital of Trondheim, Trondheim, Norway.
2
Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
3
Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Clinical Services, St Olav Hospital, University Hospital of Trondheim, Trondheim, Norway.
4
Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
5
Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway.
6
Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway; The Central Norway Regional Health Authority, Stjørdal, Norway.
7
The Norwegian Directorate of Health, Trondheim, Norway.
8
Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK.
9
Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Orthopaedics, St Olav Hospital, University Hospital of Trondheim, Trondheim, Norway.
10
Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Geriatrics, St Olav Hospital, University Hospital of Trondheim, Trondheim, Norway. Electronic address: ingvild.saltvedt@ntnu.no.

Abstract

BACKGROUND:

Most patients with hip fractures are characterised by older age (>70 years), frailty, and functional deterioration, and their long-term outcomes are poor with increased costs. We compared the effectiveness and cost-effectiveness of giving these patients comprehensive geriatric care in a dedicated geriatric ward versus the usual orthopaedic care.

METHODS:

We did a prospective, single-centre, randomised, parallel-group, controlled trial. Between April 18, 2008, and Dec 30, 2010, we randomly assigned home-dwelling patients with hip-fractures aged 70 years or older who were able to walk 10 m before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department, to achieve the required sample of 400 patients. Randomisation was achieved via a web-based, computer-generated, block method with unknown block sizes. The primary outcome, analysed by intention to treat, was mobility measured with the Short Physical Performance Battery (SPPB) 4 months after surgery for the fracture. The type of treatment was not concealed from the patients or staff delivering the care, and assessors were only partly masked to the treatment during follow-up. This trial is registered with ClinicalTrials.gov, number NCT00667914.

FINDINGS:

We assessed 1077 patients for eligibility, and excluded 680, mainly for not meeting the inclusion criteria such as living in a nursing home or being aged less than 70 years. Of the remaining patients, we randomly assigned 198 to comprehensive geriatric care and 199 to orthopaedic care. At 4 months, 174 patients remained in the comprehensive geriatric care group and 170 in the orthopaedic care group; the main reason for dropout was death. Mean SPPB scores at 4 months were 5·12 (SE 0·20) for comprehensive geriatric care and 4·38 (SE 0·20) for orthopaedic care (between-group difference 0·74, 95% CI 0·18-1·30, p=0·010).

INTERPRETATION:

Immediate admission of patients aged 70 years or more with a hip fracture to comprehensive geriatric care in a dedicated ward improved mobility at 4 months, compared with the usual orthopaedic care. The results suggest that the treatment of older patients with hip fractures should be organised as orthogeriatric care.

FUNDING:

Norwegian Research Council, Central Norway Regional Health Authority, St Olav Hospital Trust and Fund for Research and Innovation, Liaison Committee between Central Norway Regional Health Authority and the Norwegian University of Science and Technology, the Department of Neuroscience at the Norwegian University of Science and Technology, Foundation for Scientific and Industrial Research at the Norwegian Institute of Technology (SINTEF), and the Municipality of Trondheim.

PMID:
25662415
DOI:
10.1016/S0140-6736(14)62409-0
[Indexed for MEDLINE]

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