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. We started the formal study from July, 2005 and have collected 180 subjects at October, 2007 (65 in routine care group, 53 in acute/subacute care group, and 62 in the comprehensive care group). Among them, 174 have finished the first month, 164 for 3 months, 149 for 6 months, and 103 for 12 months follow-up. In our initial findings, we found that clinical results, ADLs, depressive symptoms, nutritional state, health related quality of life did appear to be better in acute/subacute care group and comprehensive care group than in the routine care group. However, due to the small sample size and incomplete follow-ups, the significant differences in treatment effects among the three groups will need to be further explored. The development and results of the comprehensive care model can broaden our knowledge about care for hip fractured elderly persons and can provide a reference for development of discharge services and interventions for health care providers.

Project ID:PG9704-0359
External Project ID:NHRI-EX97-9404PI