As the country continues to age, fractures will be a major cause of concern for healthcare professionals, patients and their families. According to the American Academy of Orthopaedic Surgeons, the number of hip fractures in 2050 will reach 650,000 annually or 1,080 hip fractures a day.
The Center for Health Statistics reported that there were 220,000 hip replacement surgeries in 2003. 25 of these patients were able to experience full recovery while 50 percent will require a cane or walker; 40 percent will need nursing home care and 24 percent of people age 50 and over will die within the next 12 months.
Hip Fractures – Risks and Causes
The risk for hip fractures is higher in the elderly. Different factors that are sometimes unique to seniors contribute in making them a high risk population for falls and injury. Advancing age brings so many physical changes that simple accidents that they were able to walk away from in the past could easily cause hip fractures in the elderly. Risks for hip fractures are highest for people age 50 and over. From there the rate of hip fractures doubles every five or six years.
Osteoporosis. A report made by the National Institutes of Health estimates that 40 million Americans are already suffering from Osteoporosis or at high risk due to poor bone mass. This medical condition is the leading cause of spine, wrists, and hip fractures in the elderly. Natural bone mass loss due to aging coupled with osteoporosis increases the possibility of hip fractures from simple falls or injury.
Nutrition. Calcium is the most abundant mineral in the body. It is needed for the growth and long-term health of the bones. But adequate calcium intake should not be our only concern.
Lifestyle. Smoking and excessive alcohol drinking interferes with the uptake of calcium and weakens the bones. Seniors confined for long periods of time in beds or are unable to exercise due to a debilitating illness are at high risk for hip fractures. Prolonged inactivity weakens bones.
Heredity. Asians and Caucasians with smaller bone densities have a higher risk for hip fractures. Seniors who have a family history of weak bones and poor bone mass are at risk for hip fractures.
Medications. Long-term used of glucocorticoids and some anticonvulsants leads to bone loss and weakening. Increasing calcium and Vitamin D intake could help decrease the effects of these medications.
Sex. Women are two or three times more likely to suffer from hip fractures compared to men. Numbers show that almost half of all women over the age of 90 have suffered from hip injury. Women who are 5’8” and over also have twice the chances for hip fractures compared to women who are 5’2” and below. Women are at higher risk for poor bone health due to decreasing levels of estrogen levels as they age.
Hormonal factors. Low estrogen levels and menopausal women weaken the bones. Abnormal levels of thyroid stimulating hormones and thyroid hormones affect the levels of calcium in the bones. Men like women also experience changing levels of sex hormones with aging. Decreasing levels of testosterone also contribute to bone weakening in men.
Preventing Hip Fractures in the Elderly
Hip fractures are the second leading cause of hospitalization in the elderly. Incidents of hip fracture increase directly with age. It is estimated that 23 per 100,000 adults age 50 are hospitalized for hip fractures. By the age of 80, this number increases to 630 for men and 1300 women per 100,000 of the population.
Serious and life-threatening injuries caused by a simple fall increases with age. While we were able to shrug off falls when we were younger, advancing age and deteriorating bone health makes it impossible for adults age 65 and older to ignore the danger of fall and accidents. Fortunately, falls are very preventable. Below are simple tips on how seniors could reduce the risk of falls and injury.
Check your medications – Consult with your physician regarding prescribed and over the counter medications that may cause drowsiness or dizziness. Any medication which may affect your mental state or sense of balance increases risk for falls. If there are no alternative medications, ask your physician about the drug’s side effects and how long before you could resume activities of daily living.
Exercise – Keeping our bodies active improves overall body strength. Simple exercises such as walking or flexing exercises are an excellent way of building inner body strength. Low impact exercises and Tai Chi programs, swimming and walking for example help seniors improve strength and flexibility without causing injury.
Proper Nutrition – Osteoporosis is a real concern among seniors. Weak bones increase the risk for falls and hip fractures. The National Institutes of Health Consensus Development Conference on Optimal Calcium Intake found that a large percentage of Americans failed to meet the recommended daily intake of calcium.
- Men and women more than 65 – 1,500 mg per day
- Men 25 to 65 – 1,000 mg per day
- Postmenopausal women without estrogen therapy – 1,500 mg per day
Vitamin D helps the body absorb calcium, thus essential in building and maintaining strong bones. Inadequate amounts of Vitamin D in the body leads to calcium being taken out from the bones in an effort to maintain normal blood calcium levels.
Regular Eye checkups – Failing or poor eyesight increases the chance for falls. Regular eye checkups prevent further eyesight deterioration and maintain proper eye health. Good chances are that poor eyesight might be caused by improper eyeglasses.
Fall-proof your Home
- Proper lighting
- Install rails, grab bars on walls and stairs
- Place rugs and carpets on slippery surfaces
- Place the senior’s bedroom on the first floor and near the bathroom
- Position frequently used objects within easy reach
- Ensure that all furniture, chairs and tables are stable
- Wear low, non-slip shoes and slippers
Signs of Hip Fracture in the Elderly
Hip fractures can occur at any stage of life but a majority of injuries occur for seniors age 65 and older. Injuries from falls are more serious due to lower bone density or weaker bones. The signs of a hip fracture are immediately felt and visible after a fall. Pain radiates from the hip area and the senior is unable to move or standup.
Swelling, redness and bruising in the hip area are also tell-tale signs that a hip fracture has occurred. Stiffness, contusions and unequal leg length indicate that a senior has experienced hip fracture or trauma. However, there are some hip fractures where the head of the hip bone has impacted into the neck of the hip bone. This produces less pain which may mislead the senior or care provider that no serious injury has happened.
Any accident or fall where a senior clearly verbalizes pain in the hip area should not be taken lightly. Calling emergency services and preventing movement to avoid further injury are the first steps in emergency care. Doctors can confirm hip fractures through identification of symptoms or an MRI and x-ray is done to positively verify hip fracture has occurred.
Emergency Care and First Aid Treatment
If you suspect that a senior has suffered from a hip fracture, prevent movement unless necessary to avoid further injury. Hip fractures require immediate medical attention, call 911 or your local emergency number to report the injury.
Emergency care for seniors with hip fractures includes immediately stopping any bleeding arising from injury. This is done by applying direct pressure to the wound with a clean cloth and sterile bandage. After stopping the bleeding, immobilize the injured area. Only those medically trained to apply splints are advised to perform emergency care.
Placing pads or positioning the elderly in a more comfortable position is recommended to reduce stress and discomfort while waiting for professional medical help. If the senior appears to be in shock or shows short, rapid breathing position the head lower than the body and elevate the legs if possible. This is to improve blood flow to the head area and help the patient maintain consciousness.
Treating Hip Fractures in the Elderly
Treatment immediately starts by ensuring that the senior is medically stable. Once stable, the doctor assesses the best treatment available for the patient. Fractures are rarely stable and any movement could cause further injury in the patient.
Non-surgical treatment for hip fractures is possible if the fracture seems stable. Some hip fractures actually heal without surgery. This would require patients to be confined to bed for eight to twelve weeks. But doctors have found that placing seniors in bed for prolonged periods of time could cause serious medical complications than having the patient undergo surgical treatment for a hip fracture.
Almost all of hip fractures in the elderly are treated by surgery within 24 hours of hospital admission. The goal of surgery is to stabilize the fractured hip and help the senior recover from injury in the shortest possible time.
Metal Pins. Fractures that happen in the neck of the femur if still positioned correctly may only require the placement of two or three metal pins to stabilize the fracture. Also called hip pinning, it is a simple surgical procedure that allows patients to place weight down immediately after surgery.
Metal Plate and Screws. Hip fractures that are located below the femoral neck or in the intertrochanteric region are treated by the use of metal plate and screws. This type of fracture is usually the result of a fall that results to multiple breaks. It is one of the hardest fractures to treat requiring several pieces of bones to be joined together. Intertrochanteric fractures are treated by placing a metal plate and compression hip screw that aligns the bones and uses the muscles to compress fractured bones together.
Artificial Replacement of the Femoral Head. When hip fracture occurs at the neck of the femur and results to the ball being completely displaced, replacement of the femoral head is recommended. A fracture of this kind often results to disruption or blood supply to the femoral head. The femoral head collapses and dies a few weeks later.
The chances of the femoral head dying from this type of fracture are so high that a surgeon often recommend femoral head replacement immediately. Only half of the joint is replaced while the socket of the hip joint is untouched.
Recovering from a Hip Fracture
The goal of treatment for seniors with a hip fracture is to help them recover as quickly as possible. This is to avoid serious medical complication that can result to long-term inactivity that includes blood clots, joint stiffness, chronic pain and pneumonia in the elderly.
Patients who are physically able to undergo recovery treatment are usually assigned with a physical therapist. Exercises start by helping seniors move from their beds to a chair several times daily. All these exercises are designed to help seniors regain independence and return to their normal daily activities. Simple exercises are done to strengthen leg muscles and prevent blood clot formation. Walkers and crutches are assigned to free them from the confines of their beds.
The amount of weight that can be placed on the injured leg depends on the type of surgical treatment done. Most patients are able to place weight a few days after surgery. Those who have undergone artificial replacement of the femoral head however, are required to follow stricter guidelines or hip precautions.
Patients who have undergone femoral head replacements are advised to follow these guidelines for at least six weeks after surgery. This provides time for delicate tissues to recover enough strength to prevent the joint from dislocating. Precautions include limiting the amount of weight placed on the leg and using walkers or crutches.
Doctors may recommend elders recovering from a hip fracture to work with a physical therapist to assist the patient in transitioning safely to a home environment. These include instructing the patient on how to avoid placing too much weight on the injured leg and how to use crawlers and crutches when moving inside the home.
The goal of treatment is to help seniors slowly regain hip strength and resume their normal activities without aggravating the injury. Doctors and physical therapists could only do so much in helping senior recover from a hip fracture. The success of treatment ultimately lies in the hands of long-term care provider, family and patient.