Adunsky A.,Sheba Medical Center |
Adunsky A.,Orthogeriatric Unit |
Adunsky A.,Tel Aviv University |
Mizrahi E.H.,Sheba Medical Center |
And 7 more authors.
Archives of Gerontology and Geriatrics | Year: 2011
This retrospective cohort study investigated the possible interrelations of GFR and functional outcome in elderly hip fracture patients. The final analyses comprised 499 consecutive patients undergoing standard medical, surgical and rehabilitation treatment in an orthogeriatric unit of a tertiary care hospital. Functional outcomes were assessed by Functional Independence Measurement (FIM™) scores. Kidney function was assessed by blood urea and creatinine, as well as by GFR according to the modification diet of renal disease study (MDRDS) formula. Mean age was 83.60 ± 5.14 and mean GFR 61.07 ± 17.22. ml/min. GFR was <60. ml/min in 91.8% out of all patients. FIM admission and discharge scores, and gains, were not associated with GFR values, except for discharge motor FIM which was significantly higher in patients with GFR greater than 30. ml/min (p= 0.043). In regression analysis, GFR was associated with motor FIM at discharge (β= 0.028, p= 0.022). Neither GFR nor creatinine was associated with discharge total FIM. In contrast, lower admission urea levels were predictive of higher motor (correlation coefficient (CC) = 0.151, odds ratio (OR) 0.132, 95% confidence interval (CI) = 0.027-0.237, p= 0.013) and total FIM scores (CC = -0.022, OR = 0.978, 95%CI = 0.960-0.997, p= 0.022) at discharge. We suggest that GFR and creatinine are poorly associated with functional outcome. Instead, urea is more likely to predict functional outcome, and may serve as more reliable biomarker for the prognostication of functional outcome. © 2010 Elsevier Ireland Ltd.
Giusti A.,Galliera Hospital |
Barone A.,Galliera Hospital |
Barone A.,Galliern Hospital |
Razzano M.,Galliern Hospital |
And 2 more authors.
European Journal of Physical and Rehabilitation Medicine | Year: 2011
Hip fracture (HF) is a common event in the geriatric population and is often associated with significant morbidity, mortality and costs for the Healthcare Systems. The growing awareness of HF consequences and the expected rise in the total number of HF worldwide have led to the development and implementation of models of care alternative to the traditional ones for the acute and post-acute management of HF older adults. These services were set to minimize in-hospital complications, streamline hospital care and provide early discharge with the main objectives of improving functional and clinical outcomes, and reducing healthcare costs associated with hip and other fractures. Basically, the main feature that distinguishes these models is the different healthcare professional that retains the responsibility of the care during the acute and postacute phases. This review has been conceived to provide a brief description of the models implemented in the last twenty years, to describe their potential benefits on short- and long-term outcomes, to define the strengths and limitations of these models and the areas of uncertain, and to make some consideration about the future. Actually, on the basis of available studies, it is not possible to define the best model of care for HF older adults. However, the more complex and sophisticated services, characterized by a multi-disciplinary approach demonstrated, in randomizedcontrolled and before-after observational studies, to produce better outcomes compared to the traditional or simplest models. Further research is warranted to confirm long-term functional and clinical benefits of these models and to evaluate their cost-effectiveness.