Care of the Hip Fracture Patient课件1.pptVIP

Care of the Hip Fracture Patient An Evidence Based Review Debra L. Bynum, MD Division of Geriatric Medicine University of North Carolina Outline Hip Fracture: Some Background Preoperative Assessment and Cardiac risk stratification Perioperative Beta Blockade Other Perioperative Management Options Prevention of Venous thromboembolic events (VTE) Postoperative Care Delirium Other complications following surgery Prevention of Future Fractures Discharge Planning The Internists/Family Physician’s Role in the Care of the Hip Fracture Patient… Case: 84 year old man with mild dementia who lives at an assisted care facility is found on the floor complaining of severe hip and groin pain. He is taken to the ED and found to have an intertrochanteric hip fracture. Because of his past history of a CABG 15 years ago, HTN, CRI and dementia, he is admitted to the medicine service…. Questions… Men over the age of 90 have a _____% chance of having a hip fracture A. 10 B. 20 C. 30 D. 40 One year mortality following a hip fracture is nearly ______% A. 5 B. 10 C. 20 D. 50 The Problem: Hip Fractures Fastest growing US population: over 65 (20% by 2025) Life expectancy at age 65: 18.9 years; 75=11yrs; 85=7 yrs 10% people over age 90 will live to 100 Hip fracture= 2nd leading cause for hospitalization in older patients Increased incidence with increased age 4% in men age 64-69, 31% risk in men over age 90 Women over age 50: 15% lifetime risk hip fracture Bad Predictor Increased mortality No significant decline in mortality since 1980s 20% mortality over first year Decreased functional status 30% survivors discharged to skilled nursing facility The Case… The patient has a mild dementia, but is clear enough to direct you to his advanced directives and DNR form. He also is clear that he wishes to proceed with surgery, he was previously ambulatory and independent in his ADLs. ?Conservative Management Without surgery, many patients left with significant pain, shortened leg, immobil