Authors (including presenting author) :
Chu CY(1), Chu WH(1), Chan Y(1), Ma WL(1), Chan HH(1), Tiu KL(2), Lee KB(2), Li W(2)
Affiliation :
(1)Occupational Therapy Department, Queen Elizabeth Hospital (2)Department of Orthopedics & Traumatology, Queen Elizabeth Hospital
Introduction :
Following a fragility hip fracture, patients often experience functional decline which might lead to recurrent fall. Comprehensive structured assessment and intervention should be conducted to reduce potential fall episodes.
Objectives :
The aim of this study was to determine the clinical characteristics of patients with repeated fall after fragility hip fracture for early intervention.
Methodology :
In this retrospective study, patients who attended the Fragility Fracture Clinic (FFC) since January 2018 were included. The FCC provides secondary fracture prevention by anti-osteoporotic medication and multidisciplinary fall prevention program. All patients were aged 65 or above, had a fragility hip fracture and undergone either conservative or surgical treatments. They had previously received expeditious multidisciplinary rehabilitation. Patients were subdivided into two groups. Our target population, patients who reported one or more fall episodes after fragility hip fracture are classified into Group A. Those who reported no fall/near fall episode are classified into Group B. In addition, cognitive and activities of daily living performance were assessed by Abbreviated Mental Test (AMT) and Clock Drawing Test (CDT), Modified Barthel Index (MBI) respectively. Fall Risk Assessment Test (FRAT) was used to determine risk of fall.
Result & Outcome :
230 patients were included in the study. 40 patients (Group A) reported at least one fall episode. Analysis showed that these patients had a lower cognitive status when compared with Group B. AMT score was lower and reached significant difference (p=0.044). Group A also showed poorer performance in CDT but did not reach significant differences. In terms of functional level, Group A showed more impairment in MBI sub-tasks including bladder (p=0.009), toileting (p=0.044), bathing (p=0.028), and stairs climbing (p=0.024). In fall risk status, FRAT score (p< 0.001) and sub-score: psychological risk factor (p=0.005) were significantly higher in Group A.
Patients with history of fall after fragility hip fracture were found to have poorer cognitive function, functional level and more fall risk factors. These results reinforce the idea that cognitive status as measured by AMT and CDT is an important indicator of fall risk. Current intervention in daily activities needs to be adapted to specific circumstances as identified by this study. It should also be necessary to place more attention on psychological factors such as poor insight and judgement that influence patient’s risk of fall after discharge from the hospital. New treatment strategies will be developed and evaluated in a future study.
