A hip fracture is a significantly debilitating life event leading to a high risk of death within 5 years of the fall. So, what is happening? Why is the 5 year mortality rate so high and what can be done to prevent it?
Approximately 90% of all fractures are the result of a fall. A significant number of falls in the elderly population result in a fracture of the hip. It has become quite clear that it is the risk of falls, among other associated physical aspects, which requires attention in order to reduce the incidence of hip fracture and early mortality. So, why are death rates so drastically brought forward to within 5 years following the hip fracture?
Hip fractures typically occur in the frail elderly population. These are individuals who suffer from low bone mineral density/ osteoporosis, poor balance and poor strength and physical function. Since it is most likely that a fall has caused the hip fracture, we will look at the risk of falling. The aforementioned physical aspects may not be the direct cause of the fall; for example an Occupational Therapist or Physiotherapist may describe environmental factors such as unnecessary rises in the flooring in the home as the cause of a fall. However, from an Exercise Physiologists perspective, the physical aspects are ones which could have been improved earlier in life and would have reduced the likelihood of the fall and even the fracture occurring.
This population of people are those which have already seen a decline in physical function. Thus, when a significant life event transpires, such as a lengthy hospital stay in order to recover from a hip fracture, a number of associated problems arise. This individual must be rested while recovering, resulting in muscle wastage and biomechanical alterations which reduces their capacity to walk. No walking means a very sedentary life and we all know how a sedentary lifestyle affects one’s health (blood sugar control, gain weight, circulatory system suffers etc.). Associated chronic health conditions set in and quite quickly will deteriorate the health of the individual.
This doesn’t seem like a path that anyone wants to take. But what do you do to prevent it if a hip fracture does occur? Simple…. everything your health care team says. Listen to the Physiotherapists, OT’s and doctors. If the rehabilitation plan is not followed by a proactive individual, they will never recover and may never regain physical function. Regaining the strength and balance to walk and participate in daily activities is the goal of rehabilitation and without achieving this; the 5 year post-hip fracture mortality rate is likely to remain.
When physical function has begun improving and exercise is required (as in most cases), a supervised program is ideal. Many Exercise Physiologists have programs available which are set up in group classes, reducing each individual’s costs. Adding a supervised exercise program to one’s rehabilitation program will ensure the most appropriate exercises are performed correctly and in a safe environment.