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Care-related Quality of Life of informal caregivers of the elderly after a hip fracture.

ABSTRACT: Background:Reforms in the Dutch healthcare system in combination with the aging of the population will lead to a strong increase in the demand for informal care in the Netherlands. A hip fracture is one of the most important causes of hospital admissions among frail elderly and informal caregivers experience stress that may have significantly negative impact on the caregivers' Quality of Life. The purpose of the study was to determine the nature, intensity and the care-related Quality of Life (CarerQoL) of informal caregivers of elderly patients in the first six months after a hip fracture. In this cross-sectional study, were interviewed the primary informal caregivers of patients with a hip fracture about the informal care provided after one, three or six months following the injury. The CarerQoL of the informal caregivers was measured with the CarerQoL-7D instrument. Results:In total, 123 primary informal caregivers were included. The CarerQoL-7D score was on average 83.7 (SD 15.0) after one, three and six months, and there were no major differences between the measurement time points. The average amount of informal care provided per patient per week was 39.5 during the first six months.Partners of patients with a hip fracture provided significantly more hours of informal care (β 34.0; 95% CI: 20.9 - 47.1). Female informal caregivers stated a significantly lower level of CarerQoL (β -7.8; 95% CI: -13.3 - -2.3). Female caregivers were 3.0 times more likely to experience relational problems (aOR 3.02; 95% CI 1.08-8.43). Caregivers provided care at 6 months were associated with physical health problems (aOR 2.54; 95% CI 1.05-6.14). Conclusions:Informal caregivers, especially partners, are faced with providing care of greater intensity to elderly patients during the first six months after a hip fracture. The CarerQoL was not associated with the intensity of the provided informal care. However, this study shows that a considerable group of informal caregivers for elderly patients with a hip fracture experienced relational, physical and mental health problems that stemmed from providing intensive informal care during the first six months.

SUBMITTER: van de Ree CLP

PROVIDER: S-EPMC5934924 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Hip fracture is an important social and medical problem due to its increasing prevalence, the consequences for health and the economic impact on the health care system, but there is no doubt that it also has repercussions on health-related quality of life (HRQoL). Hence the importance of understanding and determining the impact of the condition on everyday life from the perspective of the patient's physical, emotional and social well-being. PURPOSE:To determine the impact of hip fracture on HRQoL of people over the age of 65 1 month after surgery, related factors and the effects on functional ability and mood. METHODS:Prospective observational study conducted in the traumatology units of two university hospitals in the province of Cáceres with consecutive sampling of all patients over the age of 65 admitted for hip fracture surgery during the study period. Sociodemographic and clinical data were recorded at the time of admission and prospectively at the follow-up visit 1 month later. Clinical, social, quality of life (EQ-5D-), basic functional and instrumental capacity (Barthel Index (BI) and Lawton & Brody Scale), and geriatric depression (Yesavage) variables were collected. RESULTS:The study included 224 patients with a median age of 84.6?years (SD?±?6.1), 76.3% were female. Charlson's comorbidity was 5.3 (SD?±?1.2). The EQ-5D index decreased from 0.62 (SD?±?0.35) to 0.16 at 1?month follow up (SD?±?0.20) p <? 0.001. The mean Visual Analog Scale (VAS) score of EQ-5D decreased from 72.8 (SD ±15.8) to 48.3 (SD?±?17.2) p?<? 0.001. All dimensions of EQ-5D showed a significant reduction from the time of pre-fracture status to 1 month after surgery. Independent factors associated with HRQoL 1 month after surgery were pre-fracture status Barthel Index score, Lawton and Brody scale, presence of depression, and type of surgery. CONCLUSIONS:After a hip fracture, patients experience considerable deterioration in their HRQoL, especially in self-care, daily activities, and mobility. There is also a significant decline in functional capacity for both the basic and instrumental activities of daily living. One month after surgery, HRQoL is a long way from pre-fracture levels.

Project description:ObjectiveTo apply continuing care to elderly patients with hip fracture undergoing surgery, and to explore its impact on life quality and long-term functional recovery.MethodsThis prospective study was performed in 136 elderly hip fracture patients, who were admitted to the department of orthopedics of our hospital for surgical treatment. According to the random number table, these patients were assigned to the control group and the experimental group (68 patients in each group). Patients in the control group received routine care and guidance for discharge, while those in the experimental group received routine care and continuing care for discharge. The hip joint function (Harris hip score), quality of life (MOS 36-item short form health survey score), compliance to functional exercise, anxiety (self-rating anxiety scale score), depression (self-rating depression scale score), postoperative complications (infection, joint stiffness, and deep vein thrombosis), and satisfaction in care after discharge were compared between the two groups.ResultsCompared with the control group, the compliance to functional exercise (rates of compliance to exercise time, exercise action, and exercise site), Harris hip score at 3 months after discharge, MOS 36-item short form health survey scores in physical functioning, general health, social functioning, role-emotional, and mental health, and satisfaction in care outside the hospital in the experimental group were all increased (p<0.05). Meanwhile, self-rating anxiety scale score, self-rating depression scale score, and the incidence of complications like lung infection, joint stiffness, and deep vein thrombosis in the experimental group were lower than those in the control group (p<0.05).ConclusionThe effect of continuous care on life quality and long-term functional recovery of elderly patients with hip fractures is significant. Significant reduction of anxiety, depression, and complications is beneficial to improve satisfaction of care.

Project description:ObjectivesThe aims of this study were to examine the pattern of changes over time in health status (HS) and quality of life (QoL) in the first year after hip fracture and to quantify the association between frailty at the onset of hip fracture and the change in HS and QoL 1 year later. The major hypothesis was that frailty, a clinical state of increased vulnerability, is a good predictor of QoL in patients recovering from hip fracture.DesignProspective, observational, follow-up cohort study.SettingSecondary care. Ten participating centres in Brabant, the Netherlands.Participants1091 patients entered the study and 696 patients completed the study. Patients with a hip fracture aged 65 years and older or proxy respondents for patients with cognitive impairment were included in this study.Main outcome measuresThe primary outcomes were HS (EuroQol-5 Dimensions questionnaire) and capability well-being (ICEpop CAPability measure for Older people). Prefracture frailty was defined with the Groningen Frailty Indicator (GFI), with GFI ≥4 indicating frailty. Participants were followed up at 1 month, 3 months, 6 months and 1 year after hospital admission.ResultsIn total, 371 patients (53.3%) were considered frail. Frailty was negatively associated with HS (β -0.333; 95% CI -0.366 to -0.299), self-rated health (β -21.9; 95% CI -24.2 to -19.6) and capability well-being (β -0.296; 95% CI -0.322 to -0.270) in elderly patients 1 year after hip fracture. After adjusting for confounders, including death, prefracture HS, age, prefracture residential status, prefracture mobility, American Society of Anesthesiologists grading and dementia, associations were weakened but remained significant.ConclusionsWe revealed that frailty is negatively associated with QoL 1 year after hip fracture, even after adjusting for confounders. This finding suggests that early identification of prefracture frailty in patients with a hip fracture is important for prognostic counselling, care planning and the tailoring of treatment.Trial registration numberNCT02508675.

Project description:Background:Hip fractures of elderly patients are a public health problem worldwide, mostly lying in bed for a long time; therefore, the importance of life quality in such patients is an issue beyond question. Orem's self-care model is a nursing pattern which is introduced with the purpose of improving the self-care ability of individuals, especially the patients suffering from diseases with limits on activity. Objective:The aim of this study was to determine the effects of Orem's self-care program on life quality of senile patients with hip fractures. Methods:A randomized clinical trial study was conducted on 130 eligible old patients suffering from hip fractures who were selected using easy sampling methods and allocated randomly into two groups of experiment and control. The data were collected through validated questionnaires including visual analogue scale (VAS) and Barthel index for them. The experiment group was treated according to Orem's self-care model, and the control group was treated on the basis of the traditional care model. The data of complications including pneumonia, deep venous thrombosis, urinary infection, wound problem, and bedsore were also gathered. Results:As revealed, mean scores of VAS and Barthel index one week after operation in the experiment group were significantly different from the control one (P < 0.05, P ? 0.001). The changes of VAS and Barthel index six weeks postoperatively of the two groups were also statistically significant (P < 0.05, P ? 0.001). Compared with the control group, the difference of complications reduced significantly in the experiment group (P < 0.05). Accordingly, educational intervention according to Orem's self-care model seemed to be effective in promoting self-care ability for these senile patients. Conclusions:According to the obtained results, a self-care program based on Orem's model for elderly patients with hip fractures can improve life quality and reduce perioperative complications significantly. Therefore, it is recommended that this nursing program should be taken into account as a part of treatment measures for these patients.

Project description:BackgroundHip fracture is an important and frequent health problem worldwide. To date, there are still limited studies focused on the analysis of health-related quality of life (HRQOL) after a hip fracture in the Spanish population, especially with long-term follow-up.ObjectiveTo determine the HRQOL at 12 months after hip fracture and to identify potential factors associated with HRQOL.DesignProspective observational study.SettingTraumatology units of two university hospitals in province Cáceres (Spain).ParticipantsA total of 224 patients were admitted to the unit and required immediate surgery due to a hip fracture.MethodsHRQOL was measured with the EuroQol-5D questionnaire (EQ-5D) and the SF-12 Health Survey.ResultsScores from the visual analog scale EQ-5D decreased significantly (p < 0.001) from 72.8 at baseline to 48.3 after 1 month, to 48.2 after 6 months and to 46.1 after 12 months. The EQ-5D index score showed a similar significant reduction (p < 0.001) from 0.6 to 0.1, 0.3 and 0.3, respectively. Values of the physical component summary (PCS-12) significantly decreased (p < 0.001) from 38.6 at baseline to 31.0, 33.1 and 33.5. The mental component summary (MCS-12) decreased from 46.5 to 44.8 after 6 months (p = 0.022) and 44.3 after 12 months (p = 0.005). Factors potentially associated with HRQOL at 12 months after hip fracture were depression status after 12 months (B = 0-1.876; 95% CI [-2.409 to -1.343]; p < 0.001), functional ambulation classification after 12 months (B = -12.133; 95% CI [-17.970 to -6.297]; p < 0.001), EQ-5D VAS at baseline (B = 0.223; 95% CI [0.115-0.330]; p < 0.001), and age (B = -0.323; 95% CI [-0.594 to -0.053; p = 0.015).ConclusionsPatients experience a significant impairment in HRQOL H after a hip fracture, especially in self-care, pain/discomfort, usual activities, mobility and anxiety/depression. The decline in the HRQOL is effective the first month and lasts at least 12 months after the surgical intervention.

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Care-related Quality of Life of informal caregivers of the elderly after a hip fracture.

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