May 27, 2009 Potentially modifiable post-fracture complications, including pneumonia and pressure ulcers, are associated with an increased risk of death among nursing home residents who have suffered a hip fracture, according to a new study conducted by scientists at the Institute for Aging Research at Hebrew SeniorLife.
"Prevention strategies to reduce pressure ulcers and pneumonia may help reduce mortality in this frail population," says lead author Sarah D. Berry, M.D., M.P.H., a research fellow at the Institute and a staff geriatrician at Hebrew Rehabilitation Center.
Published online by the Journal of Gerontology: Medical Sciences, the study found that pneumonia and pressure ulcers, also called bed sores, contributed to a 70 percent increase in mortality within six months of a hip fracture among nursing home residents. Compared to other studies, says Dr. Berry, "we found an even greater prevalence of the post-fracture complications of pneumonia and pressure ulcer, which is likely a reflection of our frail, institutionalized population."
The study followed 195 long-term care residents with a hip fracture from 1999 to 2006, measuring pre-fracture characteristics such as age, sex, cognition and functional status; hospital complications such as heart attack and congestive heart failure; and six-month complications, including delirium, pneumonia and urinary tract infection. Consistent with studies of community dwellers, the Institute for Aging Research investigators found that male nursing home residents with a hip fracture were more likely to die than female residents with a hip fracture. The prevalence of delirium, an acute confusional state, in men after hip fracture may be responsible, at least in part, for the marked gender difference in survival. Fifty-four percent of male nursing home residents died within a year of their hip fracture, compared to 36 percent of female residents. Nationwide, about one of five hip fracture patients dies within a year of their injury, according to the Centers for Disease Control and Prevention.
Little is known about complications that occur after hospitalization for a hip fracture, particularly in the nursing home setting. Previous studies have found, however, a high prevalence of pneumonia and pressure ulcer development among hospitalized elders with a hip fracture.
"These findings are important given that marked variations in the incidence of both pneumonia and pressure ulcers exist between nursing home facilities, suggesting that these complications may be modifiable," the researchers write.
Dr. Berry says she is uncertain if aggressive vaccination and skin-management strategies might reduce these complications in nursing home residents who suffer a hip fracture or if they might lead to improved survival in this population.
Along with Dr. Berry, Institute for Aging Research investigators Elizabeth Samelson, Ph.D., Malynda Bordes, Kerry Broe, and Douglas Kiel, M.D., M.P.H., participated in the study.
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