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Nancy Latham Photo by Vernon Doucette |
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By Brian Fitzgerald
Hip fractures are a common and often devastating health problem among
the elderly. Nearly half of all seniors who literally fall victim to
this danger permanently require canes or walkers.
“
About 300,000 hospital admissions in the U.S. are people who have fractured
their hip,” says Nancy Latham, a research assistant professor in
Sargent College’s department of rehabilitation sciences. About
12 percent of these older adults never return home and end up dying in
the hospital. However, with a recent grant, Latham and colleagues at
SAR hope to make the odds better for those patients, and help them get
back on their feet sooner, by improving the medical community’s
understanding of hip fracture rehabilitation.
The grant, from the Dudley
Allen Sargent Research Fund, was awarded to SAR’s Center for Rehabilitation
Effectiveness, in partnership with SeniorMetrix, a firm that studies
the best methods of post-acute care.
Their study will examine how different groups of hip fracture patients
in skilled nursing facilities respond over time so that therapy can be
properly targeted.
Latham points out that at present many different approaches
and interventions are used for hip fracture rehabilitation, but few studies
explore the
duration and intensity of these treatments and their effectiveness. Information
from the study will assist clinicians establishing more realistic rehabilitation
goals and monitoring progress during the course of recovery.
“
Ultimately, we want to help reduce the number of patients that have to
be institutionalized for a long period of time,” says Latham. “Our
goal is to provide health-care organizations with the necessary information
to help get these people back home and walking independently.”
In
the past, studies at Sargent have focused on preventing the elderly from
falling. Research by Roger Fielding (SAR’83), an assistant
professor in the department of health sciences, explores the effects
of strength training on elders’ ability to maintain balance. In
addition, SAR’s Roybal Center for Research in Applied Gerontology
developed a group intervention program called A Matter of Balance to
increase seniors’ self-confidence and sense of control over falling.
But
surprisingly, says Latham, once a senior falls and fractures a hip, the
medical opinion on what is the best rehabilitation option — along
with various recovery rate scenarios — is still undecided. The
efficacy of various rehabilitation programs is uncertain. “There
are a lot of unanswered questions,” she says. “Unlike stroke
rehabilitation, minimal research exists to guide the ideal timing and
dose of therapy for different subgroups of patients’ after hip
fracture.”
Nationally, efforts to shorten the length hip fracture
patients stay in acute-care hospitals have sometimes resulted in worse
long-term outcomes
and higher overall health costs. In fact, hip fractures cost hospitals
an estimated $6 billion annually, according to SeniorMetrix, and comprise
more than 28 percent of all the money spent on rehabilitation in skilled
nursing facilities.
“
One would think that this kind of research would be more common, given
the fact that the number of elderly people in society, along with the
number of hip fractures, is rising,” Latham says. “However,
there aren’t enough studies that address how different rehab treatments
work and what changes the patients are going through week by week.”
The
new project, entitled The Patterns of Functional Change Over Time During
Hip Fracture Rehabilitation, will review more than 1,300 cases
of hip fracture since 1998 from a database created by SeniorMetrix. “The
project design will lead to a generation of hypotheses, rather than the
testing of hypotheses,” says Reg Warren, principal at SeniorMetrix.
Still,
by measuring the effectiveness of different lengths of therapy time and
intensities of treatment, Latham says, the study will be an
important first step in determining appropriate therapies for different
types of fractures.
Hip fractures tend to be more serious than other
leg injuries, because surgery is often required and sometimes joint replacement
is necessary. “It’s
not just a matter of putting on a cast and healing,” she says.
Latham,
who came to the SAR center last summer as a postdoctoral fellow, has
a long history of working with the elderly, first as a physical therapist
in her native Toronto, and then researching health services for seniors
in New Zealand, where she lived from 1995 to 2002. “I’m a
physical therapist myself,” she says, “and I’ve seen
how problematic hip fractures can be. I’ve treated people who were
doing well at home and living independently, but all of a sudden they
go into a downward spiral because of a fall.”
SeniorMetrix is also
working with the center on a separate study on the ratio of nursing hours
available per resident at rehabilitation centers
and its effect on patients. The hip fracture project is expected to be
completed by April 2004.
5
September 2003
Boston University
Office of University Relations