More needed in elderly hip fracture care

WELLINGTON: Doctors say more needs to be done to improve the treatment provided to often frail older people who fall and break a hip.

Nearly 4000 New Zealanders fracture their hip every year, costing health services $171 million annually.

Geriatrician Roger Harris is clinical lead for the Australia and New Zealand Hip Fracture Registry, which monitors patient care on both sides of the Tasman.

The registry released its latest report this week, which shows significant national improvement in hospital pain management and early rehabilitation for people being treated with a broken hip.

However, it also shows scope for improvement in New Zealand.

Dr Harris said the average patient was 82, likely to be a woman and possibly living in residential care.

He said for many, recovery from a hip fracture could be lifeshortening.

‘‘Mortality usually during hospital stays is about 5%, but at one year it’s 20% to 30%, and if they hadn’t had the fracture, 60% of those people that die would still be alive. So from a personal point of view, it’s pretty devastating on their general function. It takes them a long time to come right again,’’ Dr Harris said.

Among improvements in care, 75% of patients in New Zealand get a nerve block injection to help with pain following a fracture — up from just half four years ago.

Eightytwo percent of patients are also treated within 48 hours, although Dr Harris said access to busy operating theatres caused delays.

‘‘We are trying to promote that hip fracture should go first, because the data shows that if they’re seriously delayed they get an increased number of complications in terms of infections, clots, pressure areas, delayed mobility. All of these things add up.’’

A hipfracture case requiring three weeks in hospital cost $47,000, Dr Harris said.

He added attitudes toward the elderly were also changing, which was helping.

Hospital staff were realising that it was critical they got to theatre and fixed hip fractures quickly, he said. ‘‘There’s been a big attitude change to not delaying surgery.’’

But a shortage of geriatricians — meaning 30% of patients saw one before surgery, compared with 64% in Australia — might be less easy to solve.

‘‘Tauranga and Hawke’s Bay, for example, have struggled to attract geriatricians and you’d think of all places in New Zealand they’d be very attractive, but there’s just not enough and we’re currently employing overseastrained geriatricians,’’ Dr Harris said.

He said better data collection by the registry would help all hospitals improve care and reduce such costs. — RNZ