Hip Fracture. A Fate Worse than Death?

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Recently, a study reported that 80% of elderly women (>74 years of age) reported they would rather be dead than face a hip fracture bad enough to warrant admission to a nursing home.  Although this may seem rather dramatic to those of us who would consider any fracture to be a major inconvenience, but one we would recuperate from, this ignores the cascade of change to the lives of the elderly when faced with a hip fracture.  For an elderly woman (or man), it is the first step towards what is often a total loss of independence and thus we must understand what a hip fracture means for the well-being of our loved ones, how to help prevent it, and what care options, outside the nursing home, are available.

What a Hip Fracture Really Means

A hip fracture is actually a break, or series of breaks, in the femur (thighbone) just below the hip.  They are most problematic in individuals over 65 years of age and are far more prominent in women (approximately 70% occur in women).  Because of the integral role the hip plays in our movement anything that impairs its mobility, impairs our mobility.

Treatment for a hip fracture includes surgery, hospitalization, and extended rehabilitation.  For many elderly individuals, the period of rehabilitation results in further stress on other parts of the body and total rehabilitation is highly unlikely.  Twenty percent of individuals who fracture their hip are dead within a year.  Thus, a hip fracture often means the end of independent living for an elderly individual, irrespective of how independent s/he was beforehand.

Risk Factors and Preventative Measures

Although there is no silver bullet that allows us to guarantee our loved ones (or ourselves) will never suffer a hip fracture, there are things that we should be aware of in order to help decrease the risk.  One of the major risk factors is bone strength.  Post-menopausal women and elderly men can both suffer decreased bone mass which continues to worsen with age, a condition called osteoporosis, and this is why hip fractures are far more likely in the elderly.  Anyone diagnosed with osteoporosis should look into treatments that can help build up bone strength.

A variety of prescription medications can help reduce bone weakening and possibly even build strength, and other treatments for osteoporosis include weight-bearing or balance exercises (such as tai chi) and calcium and vitamin D supplementation.  Importantly, exercise and a diet high in calcium and vitamin D are also preventative measures that will help decrease bone loss or weakening and should be a part of a healthy lifestyle starting early on.  Smoking and excessive alcohol use are also lifestyle factors that can increase bone loss and should be avoided for those at risk, especially later in life.

Other factors that family members should be aware of include those that increase the risk of a fall, regardless of bone strength as a severe fall can result in a hip fracture, even in an individual with healthy bone mass.  Physical impairments, such as poor eyesight, arthritis, and a frail or weaker body composition can all increase the likelihood of a fall, as can mental impairments such as dementia, senility, or Alzheimer’s disease.  This means that family members need to be aware of the limitations – both physical and mental – of those we love and do what we can to minimize risk.  Ensure glasses are up to date, walking aides (such as a cane or walker) are available, clutter in the house is minimized, or adding items like railings or seats into the shower are all ways to help prevent a bad fall.

Sometimes, however, the risk factor is something we think of as being good for our loved one: Medication.  Unfortunately, some medications cause dizziness, drowsiness, or even generalized weakness and our loved ones can end up falling when they otherwise wouldn’t have.  Making sure that you and your loved ones are aware of the medications an elder is taking, the possible side effects, and how an elder is responding to said medications is critical.  If an elder is taking medication that includes any side effect that may impair balance, it is a good idea to ensure someone can monitor how s/he responds to the medication before a fall happens.

Aftercare

What if a hip fracture does happen?  Does it spell the end of living at home?  After all, this is the biggest fear that the elderly report and it was the sole reason many women reported they would rather die than face a bad hip fracture.

In short: No, a hip fracture does not need to spell the end.

As mentioned, the healing process is quite intensive and this is where family often decide that a loved one is better off elsewhere, yet it is possible to get high-quality in-home care that can provide the type of care needed.  Contrary to popular belief, in-home care is not limited to companionship care (which includes housekeeping, meal preparation, grocery shopping, and more) or even basic personal care (which includes bathing, toileting, and more), but rather the right care provider can offer specialized care in the form of rehabilitation care or even nursing care if continued occupational therapy or pain management is needed.  These in-home services can mean that a hip fracture is no longer a fate worse than death, but a fate that enables your loved one to live as independently as possible in their own home.

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