# Presentation: 007660

## Hip Fracture Prevention

- The Benefits of Hip Protectors

## What is a Hip Fracture?

- A fracture of the proximal femur (Zuckerman 1996)
- Locations
- Trochanter Region
- Femoral Neck

## Hip Fracture Facts

- 3-5% of falls in older adults result in fractures
- Hip Fractures are one of the common types of fractures (Cooper 1992; Wilkins 1999)
- Other common types include vertebrae, forearm, leg, ankle, pelvis, upper arm and hand (Scott 1990)
- Hip fracture rates increase with age
- 85 year olds are 10 to 15 times more likely to suffer a hip fracture than people ages 60-65 (Scott 1990)

## Hip Fracture Facts

- In 1999, 338,000 hospitalizations were the result of hip fractures (Popovic 2001)
- Most patients are hospitalized for only on week (Popovic 2001)
- 25% of community-dwelling older adults are institutionalized for at least one year (Magaziner 2000)

## Hip Fracture Facts

- Compared to other fall-related fractures, hip fractures result in:
- More deaths
- Most severe health problems
- Reduced quality of life (Wolinsky 1997, Hall 2000)

## Hip Fracture Facts

- Hip Fractures occur more often and cost more than other fractures (CDC 1996)
- Incidence rate of 73.9 per 10,000
- the next highest rate was 21.8 per 10,000 for Proximal humerus fractures
- The total excess cost related to hip fracture was $18,152 in 1991-92
- the next highest total treatment cost was $11,411 for a non-hip femoral fracture

## Hip Fracture Facts

- By 2040:
- Over 500,000 hip fractures a year are expected (Cummings 1990)
- Total annual cost of treating hip fractures is projected to reach $240 billion (Schneider 1990)

## Hip Fracture Facts

- The average cost of treating hip fractures for participants at Patient Safety 202 was $33,785

## What Can We Do?

- Fall prevention
- One way to reduce the number of hip fractures is to institute fall prevention measures
- Goal: Reduce the number of anticipated falls – or falls that we can expect to occur
- Examples:
- Removing Environmental Hazards
- Bed/Wheelchair Alarms
- Medication Management
- Redesigning Environment – slip resistant flooring in bathrooms/showers

## What Can We Do?

- Injury prevention
- Another way to reduce the number of hip fractures is to reduce the risk of serious injury
- Goal: Reduce the risk of injury from unanticipated and anticipated falls
- Examples:
- Using hip protectors on high fall or fracture risk patients
- Placing floor mats at patient’s bedside
- Redesigning Environment – flooring that absorbs impact of falls

## Trends in Hip Fracture Prevention

- In the past, the focus has been on interventions that reduce the number of falls
- Facilities made great strides, but realized it is very difficult, if not nearly impossible to prevent all falls
- If we can’t prevent every fall what can we do?
- Participants in 4th Annual Evidence-Based Falls Prevention Conference (2003) moving toward injury prevention

## Trends in Hip Fracture Prevention

- Effective hip fracture prevention must include BOTH
- Fall Prevention Methods
- Injury Prevention Methods

## Trends in Hip Fracture Prevention

- Falls & Restraint Reduction
- JCAHO does not allow use of restraints for fall prevention
- Decreasing restraint use can lead to more falls and injuries
- Must increase the use of fall and injury prevention measures
- Using hip protectors on patients who frequently fall can increase their freedom

## References

- Centers for Disease Control and Prevention. Incidence and costs to Medicare of fractures among Medicare beneficiaries aged >65 years—United States, July 1991–June 1992. MMWR 1996;45(41):877–83.
- Cooper C, Campion G, Melton LJ. Hip fractures in the elderly: a world-wide projection. Osteoporosis International 1992;2(6):285–9.
- Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Numbers, costs, and potential effects of postmenopausal estrogen. Clinical Orthopaedics and Related Research 1990;252:163–6.
- Hall SE, Williams JA, Senior JA, Goldswain PR, Criddle RA. Hip fracture outcomes: quality of life and functional status in older adults living in the community. Australian and New Zealand Journal of Medicine 2000;30(3):327–32.
- Magaziner J, Hawkes W, Hebel JR, Zimerman SI, Fox KM, Dolan M, et al. Recovery from hip fracture in eight areas of function. Journal of Gerontology: Medical Sciences 2000;55A(9):M498–507.

## References

- Popovic JR. 1999 National Hospital Discharge Survey: annual summary with detailed diagnosis and procedure data. National Center for Health Statistics. Vital Health Statistics 2001;13(151):154.
- Schneider El, Guralnik JM. The aging of America: impact on healthcare costs. Journal of the American Medical Association. 1990;263(17):2335-40
- Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990;16(3):717–40.
- Wilkins K. Health care consequences of falls for seniors. Health Reports 1999;10(4):47–55.
- Wolinsky FD, Fitzgerald JF, Stump TE. The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. American Journal of Public Health 1997;87(3):398–403.
- Zuckerman, JD. Hip Fracture. New England Journal of Medicine. 1996 June 6;334(23):1519-25