Some seniors recover faster than others after hip fracture and no one knows why

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A fall related hip fracture is a life-changing event for older adults, and can result in significant personal consequences.  Despite advances in surgical techniques and medical care for such injuries, as many as 20 percent of people die in the first year, and up to half will never regain their previous level of mobility,  and face a risk of further falls and fractures and loss of independence.

Researchers at the Centre for Hip Health and Mobility, located at Vancouver Coastal Health and UBC, are hoping to solve the puzzle as to why some older adults recover faster than others.

The research team has devised an innovative study that is being run through a clinic known as “B4” that operates within the Elder Care Clinic at St. Paul’s Hospital, part of Providence Health Care’s Elder Care program. The goal of the B4 clinic is to get participants back to the level of mobility they were at before their fall and fracture. The 4 B’s stand for bone health, balance, brain function, and bladder function. All four are related to falls or fracture risk.

Located in the Elder Care Clinic at St. Paul’s Hospital, B4 will enroll patients prior to discharge from hospital and randomize them in the study. Patients randomized in the “usual care” group will receive the standard orthopedic and post-operative rehabilitation treatment. Patients in the B4 group will attend the clinic and receive enhanced care for rehabilitation, follow up, and management of falls and fracture risk. Geriatrician, Dr. Wendy Cook, will lead the clinic.

“Based on the assessment of the four key areas that contribute to bone and fracture risk – balance, brain, bone health, and bladder function – we will involve additional health professionals such as our registered dietician, social worker, or other,” says Dr. Cook, director of the Elder Care Clinic and clinical assistant professor in the Division of Geriatric Medicine at UBC. “We believe the additional assessment and follow up with appropriate care team is the difference maker for optimum recovery.”

It is estimated that over 225,000 B.C. seniors will experience a fall in 2010/2011. The average hospital cost of a hip fracture that is the result of a senior falling is $18,508 and the annual average hospital costs for all senior hip fracture hospitalization cases in B.C. is over $75 million. With an aging population, the number of falls will likely double in 20 years if prevention strategies are not in place.

Dr. Maureen Ashe, research scientist at the Centre for Hip Health and Mobility and assistant professor in the Department of Family Practice at UBC, is an international leader in mobility and helped design this study.

“There is an enormous economic and social burden related to fall related fractures in older adults, and we need to aggressively seek community based solutions in falls management and prevention,” says Dr. Ashe. “Our pilot data for this project has demonstrated the need for this type of intervention. We are very excited to be conducting a larger study and one that is done in such a way that we have a ready made delivery model that would be acceptable to patients, their caregivers, and clinicians.”

Researcher plan to enroll at least 130 participants and those who are not randomized into the B4 Clinic group will be offered the care once the study has concluded. The team also plans to do a complete economic evaluation in parallel to determine operating costs and cost-effectiveness of the care and outcomes related to the study.

The B4 study is funded by the Canadian Institutes for Health Research (CIHR). To find out more about the study or how to participate, visit the Centre for Hip Health and Mobility at www.hiphealth.ca or VCH Research Institute at www.vchri.ca