Three Care Models for Elderly Patients with Hip Fracture

Hip fracture in the elderly is associated with excess mortality of 5 to 20%, and mobility problems that usually results in costly hospital stays and lengthy rehabilitation procedures. With this increase in the aging population, hip fracture represents a major and a fast growing health care problem in Taiwan. The purpose of this study is to compare the costs and effectiveness of three care models- acute/sub-acute, comprehensive, and routine care models for hip fractured elders in Taiwan. In a pilot study supported by the NHRI, we have developed and pilot tested an acute/sub-acute care for hip fractured elders and their families. Preliminary findings revealed promising effectiveness of this interventional program on improving physical functions of the patients. On the other hand, we found that depressive symptoms and malnutrition appeared in around 2/3 of our subjects. Therefore, we further developed a comprehensive care model to extend the original acute and subacute care model to include health maintenance interventions, including depression detection/management, fall prevention and nutrition consultation. Therefore, in this 5-year proposed study, we would like to compare the cost and effectiveness of the three different care models: routine care, acute/subacute care and comprehensive care model in a randomized clinical trial. For the first year, we have developed and pre-tested the comprehensive care model in the actual clinical situations. Based on the literature and the findings of our pilot study, we developed a comprehensive care model for hip fractured elders by adding health maintenance interventions including depression screening/management, fall prevention and nutrition assessment/consultation. We developed the protocol and health education materials for this comprehensive care model, pre-tested and completed the personnel training. A total of 297 subjects were recruited since July 2005 to October 2008 (99 in comprehensive, 98 in acute/subacute, and 100 in routine care model) and completed 1 year follow-up for 169 subjects (62 in comprehensive; 54 in acute/subacute, and 53 in routine care model).

Project ID:PG9804-0510
External Project ID:NHRI-EX98-9404PI