Elderly patients tend not to do well if kept immobilized, so early mobilization should be encouraged. Depending on the fracture configuration, strength of the bone and security of fixation, the surgeon may prefer partial or full weight bearing.
In reality, many elderly patients may not be able to comply with instructions for partial weight bearing.
In practice, it is often best overall to allow weight bearing as tolerated.
Prognosis of proximal femur fractures
After surgery the outcomes of greatest concern are:
- loss of independence
- loss of mobility
- residual pain.
Mortality generally occurs within the first six months after fracture; studies have shown that these rates range from 12-37%.
Predictors of higher mortality rates are patients who are:
- have other comorbid conditions (such as cardiac failure, diabetes, and chronic air flow limitation)
- have cognitive disorders.
Ability to return home
Besides mortality, the ability to return home is also an important outcome for patients with hip fractures. Studies have shown that as few as 50% of patients were able to return home, and that mortality rates are lower in those that do return home compared with rates in those that are transferred to nursing homes or rehabilitation centers.
Predictors of returning home include:
- a younger age (less than 85 years)
- ability to walk independently preoperatively
- ability to perform activities of daily living preoperatively
- living with another person
- ability to walk independently at the time of discharge from the hospital.
For more information see the additional material on perioperative care in elderly hip fracture patients.