Caregivers e-Learning Course for Hip Fractures

Fractures of the spine, pelvis, lower extremity and proximal femur are uncommon. Hip fractures are a common and very important condition. The most common cause is osteoporosis. In most patients hip fractures are treated conservatively in the home, usually with bed rest and with pain-control. A minority require immediate surgery in the emergency department. For these patients, in most cases, admission, surgical fixation and a course of anti-inflammatory drugs are required to reduce the likelihood of complications.

The most common cause of hip fracture is a fall from a height and about 80% of all hip fractures are from someone who is 65 years or older (elderly hip fractures). Older people fall more often and have more fractures and they have a higher risk of complications and death. In older people, women are more likely to get hip fractures and they have a higher rate of complications when they do. In all age groups, the risk of a fractured hip increases with advancing age, so the likelihood of hip fractures increases with age, and in elderly women it is the most common cause of death. The main risk factors for hip fractures are falling from a height.

Treatment of hip fracture injuries varies considerably and is an extremely important issue for people with hip fractures. There is little evidence on the use of an operation or intervention by medical professionals, such as anaesthetists, intensivists, or orthopaedic surgeons, in the management of such patients. However, an integral part of nursing care of people with hip fractures may be provided via the administration of a rehabilitation programme to minimise the burden of the surgery on the participants. There has been a lack of evidence to support any particular type of rehabilitation programme, except for the use of occupational or physical therapy, for a number of health conditions.

Based on the total population in the United States aged 65 years or older, 523,670 hip fractures are treated for traumatic and pathological fractures yearly. Hip fracture incidence remains highly age-dependent, with women most commonly affected, although only a small proportion of hip fractures are femoral neck fractures.

A number of clinical signs were associated with hip fractures in this study. The most powerful predictors were older age, female gender, and elevated WBC count. Recent findings have implications for the development of screening algorithms.

There have been no randomized controlled trials comparing the effects of hip fractures on patient-reported outcome measures, long-term patient and fracture survivals without any treatment intervention and there is no clear evidence to show that patients having hip fractures regain similar quality of life as patients not affected by fractures. In the absence of definitive evidence, the use of the World Health Organisation's (WHO) International Classification of Functioning, Disability and Health instrument (ICF) to determine what to do with people who are recovering from hip fractures is supported by the evidence and has facilitated development of an interdisciplinary, multidisciplinary care-pathway to facilitate recovery.

Caregivers e-learning courses seem effective with regard to knowledge, skills and attitude. For all outcomes, the caregiver-teachers e-learning course was beneficial in particular for the improvement of caregivers' attitudes.

In a recent study, findings reveals that age-related increase in fracture of the hip and other osteoporotic fractures in Canada is continuing and may represent a growing burden to both the health system and the society. This research illustrates that a detailed and consistent system which collects and reports the most current orthopedic fracture data is required.

Hip fracture-related mortality is a serious problem in the population. There is an increasingly large body of evidence which suggests early referral and active rehabilitation may reduce hip fracture-related mortality and improve survivorship.

Currently available pharmacologic agents used alone or in combination are not successful in preventing fractures in patients with hip fracture. We should look for new molecules that may be effective in preventing fractures.

While the majority of side effects reported are usually transient and do not preclude the caregiver from continuing intervention, the course can be improved with further attention to the key areas of concern for caregivers.