A fifth of people aged over 70 die within a year of a hip fracture, a new study has shown as it calls for better fall-prevention strategies and education.

And of the patients who suffered a hip fracture through a fall in their own home, almost a fifth ended up in a care home within six months of the accident

“This result highlights how a proximal femoral (hip) fracture is often a major life event, having both a medical and social impact,” according to the study ‘Hip fractures in older persons in Malta’, published in the recent edition of the Malta Medical Journal.

Researchers collected data of 195 people over 70 who had fractured their hip in Malta between May and October 2019 and followed them up a year later.

There were a total of 11 deaths (5.8%) in the first 30 days from the fracture. This increased to 33 deaths (17%) at six months and 41 (22%) deaths at one year from the hip fracture.

A proximal femoral (hip) fracture is often a major life event, having both a medical and social impact

During the six-month period, 34% of the patients were men and 66% women.

The majority ‒ 147 hip fractures (75%) ‒ occurred in patients who were living at their own home. The remaining 25% occurred in patients who were living in care institutions. 

Of the 147 patients who were living at home before the fracture, six were lost to follow-up as they left the island. Of the remaining 141 cases, 26 (18%) were living in a care home within six months.

Reducing operation time

A study called ‘Post-operative mortality related to waiting time for hip fracture surgery’, published in the National Library of Medicine in 2004, looked at the difference in one-year mortality between two groups of patients who were operated for hip fracture in Malta. Results showed that survival at one year was

better when patients, who are medically fit for surgery, were operated on the same day of admission.

Speaking in the context of a nurses’ industrial action in August last year, the Association of Orthopaedic and Trauma Surgeons had said: “Delaying surgery in any bed-bound, immobile trauma patient risks an increase in morbidity and even mortality. This is especially true with elderly patients who have sustained a hip fracture.”

Until a few months ago, patients were made to wait up to five days. But, over the past year, the situation improved, sources said.

They present a challenge to the anesthetist as they have poor heart, lung and kidney function

“Waiting time to surgery has improved at Mater Dei as we now have dedicated hip fracture lists so that these frail patients get priority for their surgery,” said a surgeon, adding that the waiting time was currently between 24 hours and two days.

An orthopedic surgeon noted that the issue with these patients was that most  were very frail and with multiple other health problems.

“They present a challenge to the anesthetist as they have poor heart, lung and kidney function. They can have several complications, such as chest infections, deep vein thrombosis and pressure sores before or after surgery. They usually have a few years to live in any case and the hip fracture is sometimes the last straw in a failing body,” the surgeon said.

Better fall prevention

The surgeon added that a lot needed to be done about fall prevention.

“Pavements are a disaster,” he said.

The dire need to repair Malta’s pavements was flagged recently in a report, compiled by the Faculty for Social Well-being, that laid out recommendations to address loneliness – that is impacting more than half the population.

In January, 82-year-old Carmelina Borg recounted how she lived in fear and ended up confined to her Sliema home after tripping over an uneven cobbled pavement and fracturing her hip.

Pavements are a disaster

While Borg had no control over the state of the pavement, some accidents are preventable.

“There needs to be more education to these elderly people. Like not to have loose carpets and not walking in darkness when they wake up at night. They could have physical therapy to remain fit and able bodied. All to reduce risk of fall,” he added.

His words were reinforced by the recent study that showed that over a quarter of the cases – 52 (27%) – had contact with the hospital emergency department or were discharged after a hospital admission, within the 90 days before the fracture. Most pre-fracture visits (48%) were due to medical problems and 21% due to falls.

“As a result, we would suggest that elderly patients admitted with acute medical problems, have sensory impairment or undergo elective surgeries should be screened for falls and fracture risk and be referred to falls prevention clinics,” the report said.