Hip fracture patients. Background factors and function.

Abstract

The incidence of hip fractures increased from 3.3 per 1,000 inhabitants in 1966 to 5.1 in 1986 for persons more than 50 years old. The incidence almost doubled in persons more than 80 years old, from 13.3 to 25.6 per 1,000. The proportional increase was largest in men with cervical fractures. A higher incidence was found in the city compared to the rural area. The city of Lund had a lower incidence in comparison with larger cities, such as Stockholm, Göteborg and Uppsala. The early rehabilitation at home of hip fracture patients in cooperation with primary health care, rendered good results and a low consumption of resources, compared to continued care at the Orthopedic Department or in a nursing home. About 60 per cent of the patients returned directly to their own home. Most of them regained, within four months, their former capacity of daily life, in spite of their hip fracture and high age. Patients with hip fractures reported more signs of diseases, lower capacity for managing their daily life and were more often afraid of falling than the controls. Most falls, 75 per cent, preceding the fracture, occurred during walking or when rising from or sitting down on a chair. Two thirds of the hip fracture patients had fallen sideways. A test battery for assessing standing balance on a computerized force platform was evaluated. Postural sway in healthy subjects indicated that age and sex were important, when analysing the results. Men and older subjects had larger postural sway than women and younger subjects, respectively. Middle-aged patients with a previous hip fracture showed larger postural sway (= lower balance capacity), lower perceived balance and a lower walking speed than healthy controls. Eighteen 70-year-old women trained their postural control for five weeks. They had significantly better results in the tests after the training period than the controls. These balance tests are simple and applicable in clinical practice. Training of postural control might prevent some hip fractures, which is of the utmost importance both for the elderly person and society.