Hip Fracture

We live in a fractured world. I've always seen it as my role as an artist to attempt to make wholeness - Anish Kapoor

"Hip fractures rank worldwide in the top 10 impairments in terms of loss of mobility and long-term impairments. Part of the reason? Hip fractures are not easy to bounce back from. The plain and simple truth is that hip fractures can often lead to long-term complications, which can end up forcing you into assisted or nursing home living for an extended stay.

A 2009 study published in The Journal of the American Medical Association reported that roughly 20-30 percent of the 250,000 Americans over the age of 65 who fracture a hip each year will die within 12 months, and "many more will experience significant functional loss."

To give you an idea of the kind of "functional loss" the study is referencing:

• 90 percent of people who did not need assistance climbing stairs before fracturing a hip will not be able to climb five steps in the year after experiencing the fracture.
• 66 percent will not be able to get on or off a toilet without assistance.
• 50 percent won't be able to raise themselves out of a chair.
• 31 percent will be unable to get out of bed without help from a caregiver.
• 20 percent will not be able to put on a pair of pants without assistance.

Treatment for a hip fracture typically includes surgery and about a week of hospitalization, followed by admission to a rehabilitation center or nursing home to undergo physical therapy with added support. The U.S. Centers for Disease Control reports that "one in three adults who lived independently before their hip fracture [will remain] in a nursing home for at least a year after their injury."

A major component of your ability to thoroughly heal after a hip fracture is the kind of care you receive once you leave the hospital. We spoke to Dr. Adam Bitterman about the ways in which you can protect yourself or a loved one from suffering more than necessary after experiencing a hip fracture.

According to Dr. Bitterman, the postoperative course commences the instant the procedure is complete and continues through one's transition home. Despite what some may think, surgery to fix a broken hip can be the less complicated portion of one's recovery. The implantation of metal hardware is generally a straightforward process, while the postoperative course may be more challenging.

When choosing a rehabilitation facility, various factors must be taken into account.

LOCATION
First, it is critical to visit the facilities to see first-hand how they operate and to ensure the facility will be accommodating to the needs of you and your family member. Location is essential because you do not want to be inconvenienced by a long commute to visit your loved one; you want to ensure a distance that allows for easy follow-up care.

WORKING DYNAMIC
Observing the working dynamic of the facility helps gauge the care-level as well as the type of physical therapy that is offered. Why is this important? In some rehab settings, therapists are assigned to more than one patient. Usually therapists interact with those who are most active, leaving the less active patients doing limited exercises on their own. Also, physical therapy aids may assist in one's care.

STAFFING
It is also important to have a complete understanding of the facility's staffing infrastructure as well as their administrative hierarchy. While the team covering the floor can handle most concerns, it is comforting to know who is available should certain expectations or the needs of your family member are not met.

RETURNING HOME
In order to ensure a smooth and successful transition, certain items need to be addressed. The structure of the home needs to be fully understood, thereby allowing the therapist to ensure your family member is strong and mobile enough to navigate everyday household obstacles. There may need to be additional equipment to help support the patient. If there are concerns about hygiene and functionality, then certain additional tools must be put in place to allow the patient to thrive. Physical therapy should not end once they are discharged from the facility. Having access to outpatient physical therapy or home physical therapy is extremely important. Visiting nurse services and home health aides are available for those situations that require extra assistance.

It might seem overwhelming to think about all these things while also going through the trauma of the actual experience -- whether you are the patient or the caregiver -- but taking the time to make these decisions now, can affect your overall health later on. What's more important than that?"

Source: Hilary Young, Essential Guide to Surviving Hip Fracture, Huff Post, March 10, 2014.