Task: Question Generation
Input (English): Context: Fragility fractures are a major health care problem worldwide. Both hip and non-hip fractures are associated with excess mortality in the years following the fracture. Residents of long-term nursing homes represent a special high-risk group for poor outcomes. Orthogeriatric co-management models of care have shown in multiple studies to have medical as well as economic advantages, but their impact on this high-risk group has not been well studied.', 'We studied the outcome of long-term care residents with hip and non-hip fractures admitted to a geriatric fracture center.', 'The study design is a single center, prospective cohort study at a level-I trauma center in Austria running a geriatric fracture center. The cohort included all fragility fracture patients aged over 70 admitted from a long-term care residence from May 2009 to November 2011. The data set consisted of 265 patients; the mean age was 86.8\xa0±\xa06.7\xa0years, and 80\xa0% were female. The mean follow-up after the index fracture was 789\xa0days, with a range from 1 to 1842\xa0days. Basic clinical and demographic data were collected at hospital admission. Functional status and mobility were assessed during follow-up at 3, 6, and 12\xa0months. Additional outcome data regarding readmissions for new fractures were obtained from the hospital information database; mortality was crosschecked with the death registry from the governmental institute of epidemiology.', '187 (70.6\xa0%) patients died during the follow-up period, with 78 patients (29.4\xa0%) dying in the first year. The mean life expectancy after the index fracture was 527 (±431) days. Differences in mortality rates between hip and non-hip fracture patients were not statistically significant. Compared to reported mortality rates in the literature, hip fracture patients in this orthogeriatric-comanaged cohort had a significantly reduced one-year mortality [OR of 0.57 (95\xa0% CI 0.31-0.85)]. After adjustment for confounders, only older age (OR 1.091; p\xa0=\xa00.013; CI 1.019-1.169) and a lower Parker Mobility Scale (PMS) (OR 0.737; p\xa0=\xa00.022; CI 0.568-0.957) remained as independent predictors. During follow-up, 62 patients (23.4\xa0%) sustained at least one subsequent fracture, and 10 patients (3.4\xa0%) experienced multiple fractures; 29 patients (10.9\xa0%) experienced an additional fracture within the first year. Nearly, half (47.1\xa0%) regained their pre-fracture mobility based on the PMS.
Answer: Despite the generally poor outcomes for fragility fracture patients residing in long-term care facilities, orthogeriatric co-management appears to improve the outcome of high-risk fragility fracture patients. One-year mortality was 29.4 % in this cohort, significantly lower than in comparable trials. Orthogeriatric co-management may also have positive impacts on both functional outcome and the risk of subsequent fractures.
Output (English): Does orthogeriatric co-management improve the outcome of long-term care residents with fragility fractures?