Advertisement
Editorial| Volume 11, ISSUE 2, P81-83, February 2010

Download started.

Ok

Hip Fractures

  • John E. Morley
    Correspondence
    Address correspondence to John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Boulevard, M238, St. Louis, MO 63104.
    Affiliations
    Division of Geriatric Medicine, Saint Louis University School of Medicine, and GRECC, VA Medical Center, St. Louis, MO
    Search for articles by this author
Published:January 13, 2010DOI:https://doi.org/10.1016/j.jamda.2009.11.013
      Falls are the major reason for lawsuits in the nursing home.
      • Morley J.E.
      Falls and fractures.
      • Bass E.
      • French D.D.
      • Bradham D.D.
      A national perspective of Medicare expenditures for elderly veterans with hip fractures.
      This is mainly because they lead to hip fractures and other injuries. Ninety percent of hip fractures occur in persons who fall. The causes of fragility fractures are a result of loss of bone, a decline in bone strength, and an increase in falls (Figure 1). Persons with weight loss, sarcopenia, and frailty are particularly vulnerable to fracturing a hip.
      • Morley J.E.
      Developing novel therapeutic approaches to frailty.
      • Rolland Y.
      • Czerwinski S.
      • Abelland van Kan G.
      • et al.
      Sarcopenia: Its assessment, etiology, pathogenesis, consequences and future perspectives.
      • Morley J.E.
      Weight loss in older persons: New therapeutic approaches.
      • Abellan van Kan G.
      • Rolland Y.
      • Bergman H.
      • et al.
      The IANA Task Force on frailty assessment of older people in clinical practice.
      • Abellan van Kan G.
      • Rolland Y.M.
      • Morley J.E.
      • Vellas B.
      Frailty: Toward a clinical definition.
      • Bauer J.M.
      • Kaiser M.J.
      • Sieber C.C.
      Sarcopenia in nursing home residents.
      • Yeh S.S.
      • Blackwood K.
      • Schuster M.W.
      The cytokine basis of cachexia and its treatment: Are they ready for prime time?.
      • Morley J.E.
      • Thomas D.R.
      Cachexia: New advances in the management of wasting diseases.
      • Thomas D.R.
      But is it malnutrition?.
      This issue of the Journal focuses on hip fractures.
      Figure thumbnail gr1
      Figure 1Factors involved in the pathogenesis of fragility fractures.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Morley J.E.
        Falls and fractures.
        J Am Med Dir Assoc. 2007; 8: 276-278
        • Bass E.
        • French D.D.
        • Bradham D.D.
        A national perspective of Medicare expenditures for elderly veterans with hip fractures.
        J Am Med Dir Assoc. 2008; 9: 114-119
        • Morley J.E.
        Developing novel therapeutic approaches to frailty.
        Curr Pharm Des. 2009; 15: 3384-3395
        • Rolland Y.
        • Czerwinski S.
        • Abelland van Kan G.
        • et al.
        Sarcopenia: Its assessment, etiology, pathogenesis, consequences and future perspectives.
        J Nutr Health Aging. 2008; 12: 433-450
        • Morley J.E.
        Weight loss in older persons: New therapeutic approaches.
        Curr Pharm Des. 2007; 13: 3637-3647
        • Abellan van Kan G.
        • Rolland Y.
        • Bergman H.
        • et al.
        The IANA Task Force on frailty assessment of older people in clinical practice.
        J Nutr Health Aging. 2008; 12: 29-37
        • Abellan van Kan G.
        • Rolland Y.M.
        • Morley J.E.
        • Vellas B.
        Frailty: Toward a clinical definition.
        J Am Med Dir Assoc. 2008; 9: 71-72
        • Bauer J.M.
        • Kaiser M.J.
        • Sieber C.C.
        Sarcopenia in nursing home residents.
        J Am Med Dir Assoc. 2008; 9: 545-551
        • Yeh S.S.
        • Blackwood K.
        • Schuster M.W.
        The cytokine basis of cachexia and its treatment: Are they ready for prime time?.
        J Am Med Dir Assoc. 2008; 9: 219-236
        • Morley J.E.
        • Thomas D.R.
        Cachexia: New advances in the management of wasting diseases.
        J Am Med Dir Assoc. 2008; 9: 205-210
        • Thomas D.R.
        But is it malnutrition?.
        J Am Med Dir Assoc. 2009; 10: 295-297
        • Lapcevic W.A.
        • French D.D.
        • Campbell R.R.
        All-cause mortality rates of hip fractures treated in the VHA: Do they differ from Medicare facilities?.
        J Am Med Dir Assoc. 2010; 11: 116-119
        • Young Y.
        • Kuo Y.-H.
        Hip fractures among elderly women: Longitudinal comparison of physiological function changes and health care utilization.
        J Am Med Dir Assoc. 2010; 11: 100-105
        • Aman E.
        • Thomas D.R.
        Supervised exercise to reduce agitation in severely cognitively impaired persons.
        J Am Med Dir Assoc. 2009; 10: 271-276
        • Fox T.
        • Jacobs M.
        The magic of exercise.
        J Am Med Dir Assoc. 2008; 9: 689
        • Colberg S.R.
        • Somma C.T.
        • Sechrist S.R.
        Physical activity participation may offset some of the negative impact of diabetes on cognitive function.
        J Am Med Dir Assoc. 2008; 9: 434-438
        • Rolland Y.
        • Abellan van Kan G.
        • Vellas B.
        Physical activity and Alzheimer's disease: From prevention to therapeutic perspectives.
        J Am Med Dir Assoc. 2008; 9: 390-405
        • Morley J.E.
        The magic of exercise.
        J Am Med Dir Assoc. 2008; 9: 375-377
        • Kolanowski A.
        • Fick D.M.
        • Cambell J.
        • et al.
        A preliminary study of anticholinergic burden and relationship to a quality of life indicator, engagement in activities, in nursing home residents with dementia.
        J Am Med Dir Assoc. 2009; 10: 252-257
        • Kaufer D.I.
        • Williams C.S.
        • Braaten A.J.
        • et al.
        cognitive screening for dementia and mild cognitive impairment in assisted living: Comparison of 3 tests.
        J Am Med Dir Assoc. 2008; 9: 586-593
        • Smith D.A.
        Behavioral problems and symptoms in dementia.
        J Am Med Dir Assoc. 2008; 9: 622-625
        • Volicer L.
        Is aggression a common symptom of dementia?.
        J Am Med Dir Assoc. 2008; 9: 532
        • Rozzini R.
        • Trabucchi M.
        Managing persons with dementia in the nursing home.
        J Am Med Dir Assoc. 2008; 9: 368
        • Morley J.E.
        Managing persons with dementia in the nursing home: High touch trumps high tech.
        J Am Med Dir Assoc. 2008; 9: 139-146
        • Kaschel R.
        • Logie R.H.
        • Kazen M.
        • Della Sala S.
        Alzheimer's disease, but not ageing or depression, affects dual-tasking.
        J Neurol. 2009; 256: 1860-1868
        • Evans J.J.
        • Greenfield E.
        • Wilson B.A.
        • Bateman A.
        Walking and talking therapy: Improving cognitive-motor dual-tasking in neurological illness.
        J Int Neuropsychol Soc. 2009; 15: 112-120
        • Larson E.B.
        • Wang L.
        • Bowen J.D.
        • et al.
        Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older.
        Ann Intern Med. 2006; 144: 73-81
        • Young Y.
        • Xiong K.
        Pruzek RM, Brant CJ. Examining heterogeneity of functional recovery among older adults with hip fractures.
        J Am Med Dir Assoc. 2010; 11: 132-139
        • Levenson S.A.
        The basis for improving and reforming long-term care, Part 2: Clinical problem solving and evidence-based care.
        J Am Med Dir Assoc. 2009; 10: 520-529
        • Levenson S.A.
        The basis for improving and reforming long-term care. Part 1: The foundation.
        J Am Med Dir Assoc. 2009; 10: 459-465
        • Morley J.E.
        Rapid cycles (continuous quality improvement), an essential part of the medical director's role.
        J Am Med Dir Assoc. 2008; 9: 535-538
        • Zimmerman S.
        • Magaziner J.
        • Birge S.J.
        • et al.
        Adherence to hip protectors and implications for US long-term care settings.
        J Am Med Dir Assoc. 2010; 11: 106-115
        • Karakaya M.G.
        • Bilgin S.C.
        • Ekici G.
        • et al.
        Functional mobility, depressive symptoms, level of independence, and quality of life of the elderly living at home and in the nursing home.
        J Am Med Dir Assoc. 2009; 10: 662-666
        • Thakur M.
        • Blazer D.G.
        Depression in long-term care.
        J Am Med Dir Assoc. 2008; 9: 82-87
        • Garfinkel D.
        • Radomislsky Z.
        • Jamal S.
        • Ben-Israel J.
        High efficacy for hip protectors in the prevention of hip fractures among elderly people with dementia.
        J Am Med Dir Assoc. 2008; 9: 313-318
        • Maurer I.
        Aripiprazole for the treatment of agitation in persons with dementia?.
        J Am Med Dir Assoc. 2009; 10: 442
        • Kline T.F.
        • Duskin L.M.
        Placebo-controlled studies and the need for expanded disclosure rules.
        J Am Med Dir Assoc. 2009; 10: 441-442
        • Albert S.G.
        • Grossberg G.T.
        • Thaipisuttikul P.J.
        • et al.
        Atypical antipsychotics and the risk of diabetes in an elderly population in long-term care: A retrospective nursing home chart review study.
        J Am Med Dir Assoc. 2009; 10: 115-119
        • Dahl L.J.
        • Wright R.
        • Xiao A.
        • et al.
        Quality improvement in long term care: The psychotropic assessment tool (PAT).
        J Am Med Dir Assoc. 2008; 9: 676-683
        • Ozbolt L.B.
        • Paniagua M.A.
        • Kaiser R.M.
        Atypical antipsychotics for the treatment of delirious elders.
        J Am Med Dir Assoc. 2008; 9: 18-28
        • Jalbert J.J.
        • Eaton C.B.
        • Miller S.C.
        • Lapane K.L.
        Antipsychotic use and the risk of hip fracture among older adults afflicted with dementia.
        J Am Med Dir Assoc. 2010; 11: 120-127
        • Laurila J.V.
        • Strandberg T.E.
        • Tilvis R.S.
        • Pitkala K.H.
        Detecting delirium using different diagnostic criteria among long-term care residents.
        J Am Med Dir Assoc. 2009; 10: 511-512
        • Gokce Kutsal Y.
        • Barak A.
        • Atalay A.
        • et al.
        Polypharmacy in the elderly: A multicenter study.
        J Am Med Dir Assoc. 2009; 10: 486-490
        • Flaherty J.H.
        • Shay K.
        • Weir C.
        • et al.
        VA Delirium Working Group. The development of a mental status vital sign for use across the spectrum of care.
        J Am Med Dir Assoc. 2009; 10: 379-380
        • Morandi A.
        • Solberg L.M.
        • Habermann R.
        • et al.
        Documentation and management of words associated with delirium among elderly patients in postacute care: A pilot investigation.
        J Am Med Dir Assoc. 2009; 10: 330-334
        • Voyer P.
        • Richard S.
        • Doucet L.
        • Carmichael P.H.
        Detecting delirium and subsyndromal delirium using different diagnostic criteria among demented long-term care residents.
        J Am Med Dir Assoc. 2009; 10: 181-188
        • Cohen-Mansfield J.
        • Jensen B.
        Nursing home physicians' knowledge of and attitudes toward nonpharmacological interventions for treatment of behavioral disturbances associated with dementia.
        J Am Med Dir Assoc. 2008; 9: 491-498
        • Crecelius C.
        Dehydration: Myth and reality.
        J Am Med Dir Assoc. 2008; 9: 287-288
        • Thomas D.R.
        • Cote T.R.
        • Lawhorne L.
        • et al.
        Dehydration Council. Understanding clinical dehydration and its treatment.
        J Am Med Dir Assoc. 2008; 9: 292-301
        • Eeles E.
        • Rockwood K.
        Delirium in the long-term care setting: Clinical and research challenges.
        J Am Med Dir Assoc. 2008; 9: 157-161
        • Drinka P.J.
        Medications prescribed by specialists in nursing homes.
        J Am Med Dir Assoc. 2008; 9: 137-138
        • Morley J.E.
        Postprandial hypotension—the ultimate Big Mac Attack.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M741-M743
        • Flaherty J.H.
        • Rudolph J.
        • Shay K.
        • et al.
        Delirium is a serious and under-recognized problem: Why assessment of mental status should be the sixth vital sign.
        J Am Med Dir Assoc. 2007; 8: 273-275
        • Morley J.E.
        Polypharmacy in the nursing home.
        J Am Med Dir Assoc. 2009; 10: 289-291
        • Miles R.W.
        Hip fracture reduction in northwest Arkansas nursing homes.
        J Am Med Dir Assoc. 2008; 9: 449-453
        • Kumari J.
        • Dharmarajan T.S.
        Insulin glargine induced persistent intractable hypoglycemia, with variable presentations in older diabetic patients: An experience of 4 cases.
        J Am Med Dir Assoc. 2009; 10: 671-673
        • Meyers R.M.
        • Reger L.
        Diabetes management in long-term care facilities: A practical guide.
        J Am Med Dir Assoc. 2009; 10: 589
        • Feldman S.M.
        • Rosen R.
        • DeStasio J.
        Status of diabetes management in the nursing home setting in 2008: A retrospective chart review and epidemiology study of diabetic nursing home residents and nursing home initiatives in diabetes management.
        J Am Med Dir Assoc. 2009; 10: 354-360
        • Pandya N.
        • Thompson S.
        • Sanbamoorthi U.
        The prevalence and persistence of sliding scale insulin use among newly admitted elderly nursing home residents with diabetes mellitus.
        J Am Med Dir Assoc. 2008; 9: 663-669
        • Morley J.E.
        Caring for the vulnerable elderly: Are available quality indicators appropriate?.
        J Am Med Dir Assoc. 2008; 9: 1-3
        • Joseph J.
        • Koka M.
        • Aronow W.S.
        Prevalence of a hemoglobin A1c less than 7.0%, of a blood pressure less than 130/80 mm Hg, and of a serum low-density lipoprotein cholesterol less than 100 mg/dL in older patients with diabetes mellitus in an academic nursing home.
        J Am Med Dir Assoc. 2008; 9: 51-54
        • Perry 3rd, H.M.
        • Horowitz M.
        • Morley J.E.
        • et al.
        Longitudinal changes in serum 25-hydroxyvitamin D in older people.
        Metabolism. 1999; 48: 1028-1032
        • Mansdorf I.J.
        • Sharma R.
        • Perez M.
        • Lepore A.M.
        Falls reduction in long-term care facilities: A preliminary report of a new Internet-based behavioral technique.
        J Am Med Dir Assoc. 2009; 10: 630-633
        • Sloane P.D.
        • Ivey J.
        • Helton M.
        • et al.
        Nutritional issues in long-term care.
        J Am Med Dir Assoc. 2008; 9: 476-485
        • Messinger-Rapport B.J.
        • Thomas D.R.
        • Gammack J.K.
        • Morley J.E.
        Clinical update on nursing home medicine: 2009.
        J Am Med Dir Assoc. 2009; : 530-553
        • Peiris A.N.
        • Bailey B.A.
        • Manning T.
        • et al.
        Testing for vitamin D deficiency in veterans—Is there a seasonal bias?.
        J Am Med Dir Assoc. 2010; 11: 128-131
        • Morley J.E.
        Vitamin D redux.
        J Am Med Dir Assoc. 2009; 10: 591-592
        • Morley J.E.
        Probiotics and the nursing home: Should we give bacteria for breakfast?.
        J Am Med Dir Assoc. 2009; 10: 365-367
        • Lyles K.W.
        • Colon-Emeric C.S.
        • Magaziner J.S.
        • et al.
        Zoledronic acid in reducing clinical fracture and mortality after hip fracture.
        N Engl J Med. 2007; 357 (nihpa40967)
        • Gloth 3rd, F.M.
        • Simonson W.
        Osteoporosis is underdiagnosed in skilled nursing facilities: A large-scale heel BMD screening study.
        J Am Med Dir Assoc. 2008; 9: 190-193
        • Ryder K.M.
        • Bobo Tanner S.
        • Carbone L.
        • et al.
        Teriparatide is safe and effectively increases bone biomarkers in institutionalized individuals with osteoporosis.
        J Bone Miner Metab. 2009; (Oct 6 [Epub ahead of print])
        • Cummings S.R.
        • San Martin J.
        • McClung M.R.
        • et al.
        Denosumab for prevention of fractures in postmenopausal women with osteoporosis.
        N Engl J Med. 2009; 361: 756-765
        • Chapman I.M.
        • Visvanathan R.
        • Hammond A.J.
        • et al.
        Effect of testosterone and a nutritional supplement, alone and in combination, on hospital admissions in undernourished older men and women.
        Am J Clin Nutr. 2009; 89: 880-889
        • Wang C.
        • Nieschlag E.
        • Swedloff R.S.
        • et al.
        ISA, ISSAM, EAU, EAA and ASA recommendations: Investigation, treatment and monitoring of late-onset hypogonadism in males.
        Aging Male. 2009; 12: 5-12
        • Wittert G.A.
        • Chapman I.M.
        • Haren M.T.
        • et al.
        Oral testosterone supplementation increases muscle and decreases fat mass in healthy elderly males with low-normal gonadal status.
        J Gerontol A Biol Sci Med Sci. 2003; 58: 618-625
        • Kamel H.K.
        • Perry 3rd, H.M.
        • Morley J.E.
        Hormone replacement therapy and fractures in older adults.
        J Am Geriatr Soc. 2001; 49: 179-187
        • Sih R.
        • Morley J.E.
        • Kaiser F.E.
        • et al.
        Testosterone replacement in older hypogonadal men: A 12-month randomized controlled trial.
        J Clin Endocrinol Metab. 1997; 82: 1661-1667
        • Levenson S.A.
        The basis for improving and reforming long-term care, part 3: essential elements for quality care.
        J Am Med Dir Assoc. 2009; 10: 597-606
        • Levenson S.A.
        The basis for improving and reforming long-term care, part 4: identifying meaningful approaches (segment 1).
        J Am Med Dir Assoc. 2009; 10: 84-91