The effect of nutrition, depression, activity scores on mortality in patients with geriatric hip fractures.

Yıl 2020, Cilt: 5 Sayı: 2, 64 - 68, 31.08.2020

Savaş Çamur , Çağrı Özcan , Mehmet Sönmez Sefa Batibay

https://doi.org/10.25000/acem.708840

Öz

AİM: Hip fracture causes high mortality rates in elderly patients. Here we investigate the relationship between serum laboratory parameters, bone densitometers, malnutrition, depression and pre-fracture survival activity scores of patients who died within 24 months after surgery for hip fracture.
METHODS: 121 patients who underwent surgery for hip fracture between 2013 and 2016 and who met the study criteria were evaluated retrospectively. The patients who died within the first 24 months after surgery were evaluated as Group 1, and the patients who died after 24 months or who were still alive were evaluated as Group 2. Serum parameters before surgery, hip and vertebra bone densitometry were examined. The Barthel and Lawton life scale was completed, Mini nutritional assesment (MNA), geriatric depression scala short form (GDS-SF) and preoperative length of stay and BMI were evaluated.
RESULTS: Comparing the parameters between groups, we detected no significant difference between age, BMI, vertebral BMD preoperative length of stay. Albumin, total protein, hip BMD, barthel score, and the lawton scoring system, GDS-FM, MNA showed significant differences between the two groups (P<0.05). According to the regression analysis, Albumin, total protein, MNA, GDS-SF, Barthel Score and Lawton scoring systems showed a significantly correlation in patients with mortality in the first 24 months (P<0.05).
CONCLUSION: Geriatric hip fractures have many factors that determine the risk of mortality within the first 24 months. According to our study, low albumin, total protein , malnutrition, high depression as well as low pretreatment activity scores, indicate high mortality risk in the 24 months.

Anahtar Kelimeler

Hip fractures, depression, nutrition, geriatric mortality, bone densitometry

Geriatrik kalça kırığı hastalarında beslenme, depresyon, aktivite skorlarının mortalite üzerine etkisi.

Öz

AMAÇ: Kalça kırığı yaşlı hastalarda yüksek mortalite oranlarına sebep olur. Bu çalışmada kalça kırığı nedeniyle ameliyat sonrası 24 ay içinde ölen hastaların serum laboratuvar parametreleri, kemik dansitometreleri, yetersiz beslenme, depresyon ve kırık öncesi sağkalım aktivite skorları arasındaki ilişkiyi araştırdık.
GEREÇ VE YÖNTEM 2013-2016 yılları arasında kalça kırığı nedeniyle ameliyat edilen ve çalışma kriterlerini karşılayan 121 hasta retrospektif olarak incelendi. Ameliyattan sonraki ilk 24 ay içinde ölen hastalar Grup 1, 24 ay sonra ölen veya halen hayatta olan hastalar Grup 2 olarak değerlendirildi. Ameliyat öncesi serum parametreleri, kalça ve vertebra dansitometrisi ölçüldü. Barthel ve Lawton aktivite skorları, Mini beslenme değerlendirmesi (MNA), geriatrik depresyon skala kısa formu (GDS-SF) ve preoperatif yatış süresi ve BMİ değerlendirilmiştir.
BULGULAR: Gruplar arasındaki parametreleri karşılaştırarak yaş, BMİ, vertebra dansitometresi, preoperatif yatış süresi arasında anlamlı bir fark saptanmadı. Albümin, toplam protein, kalça dansitometresi, barthel ve lawton aktivite skorları, GDS-FM, MNA iki grup arasında anlamlı farklılıklar gösterdi (P <0.05). Regresyon analizine göre, albumin, total protein, MNA, GDS-SF, Barthel ve Lawton aktivite skorları ilk 24 ayda mortalitesi olan hastalarda anlamlı bir korelasyon gösterdi (P <0.05).
SONUÇ: Geriatrik kalça kırıkları ilk 24 ay içinde mortalite riskini belirleyen birçok faktöre sahiptir. Çalışmamıza göre, düşük albümin, total protein, yetersiz beslenme, yüksek depresyon ve düşük aktivite skorları geriatrik kalça kırıklarında ilk 24 ayda yüksek mortalite riskini göstermektedir.

Anahtar Kelimeler

kalça kırıkları, depresyon, beslenme, geriatrik mortalite, kemik dansitometresi

Kaynakça

• 1. Sheehan KJ, Sobolev B, Guy P.(2017) Mortality by Timing of Hip Fracture Surgery: Factors and Relationships at Play. J Bone Joint Surg Am. 2017: 18;99(20):e106 2. Katsoulis M, Benetou V, Karapetyan T et al.(2017) Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med. 281(3):300-310.
• 3. Neuman MD, Rosenbaum PR, Ludwig JM, Zubizarreta JR, Silber JH. (2014) Anesthesia technique, mortality, and length of stay after hip fracture surgery. JAMA. 311(24):2508-17.
• 4. González-Zabaleta J, Pita-Fernandez S, Seoane-Pillado T, López-Calviño B, Gonzalez-Zabaleta JL. (2016) Comorbidity as a predictor of mortality and mobility after hip fracture. Geriatr Gerontol Int. 16(5):561-9
• 5. Boyd CM, McNabney MK, Brandt N et al. (2012) Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc. 60(10):E1-E25 6. Sedlář M, Kvasnička J, Krška Z, Tománková T, Linhart A.(2015) Earley and subacute inflammatory response and long-term survival after hip trauma and surgery. Arch Gerontol Geriatr. 60(3):431-6 7. Alexiou KI, Roushias A, Varitimidis SE, Malizos KN.(2018) Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clin Interv Aging. 24;13:143-150. 8. Guigoz Y, Vellas B, Garry PJ.(1996) Assessing the nutritional status of the elderly: The Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev. 54(1 Pt 2):S59-65 9. Weng CF, Lin KP, Lu FP et al.(2019) Effects of depression, dementia and delirium on activities of daily living in elderly patients after discharge. BMC Geriatr. 11;19(1):261. 10. Imai N, Endo N, Hoshino T, Suda K, Miyasaka D, Ito T.(2016) Mortality after hip fracture with vertebral compression fracture is poor. J Bone Miner Metab. 34(1):51-4 11. Franzo A, Francescutti C, Simon G. Risk factors correlated with post-operative mortality for hip fracture surgery in the elderly: a population-based approach. Eur J Epidemiol 2005;20:985-91.
• 12. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 2005;331:1374.
• 13. Yoo J, Lee JS, Kim S.(2019) Length of hospital stay after hip fracture surgery and 1-year mortality. Osteoporos Int. 30(1):145-153 14. Ishidou Y, Koriyama C, Kakoi H.(2017) Predictive factors of mortality and deterioration in performance of activities of daily living after hip fracture surgery in Kagoshima, Japan. Geriatr Gerontol Int. 17(3):391-401. 15. Torbergsen AC, Watne LO, Frihagen F, Wyller TB, Mowè M.(2019) Effects of nutritional intervention upon bone turnover in elderly hip fracture patients. Randomized controlled trial. Clin Nutr ESPEN. 29:52-58. 16. Li S, Zhang J, Zheng H, Wang X, Liu Z, Sun T.(2019) Prognostic role of serum albumin, total lymphocyte count, and mini nutritional assessment on outcomes after geriatric hip fracture surgery: a meta-analysis and systematic review. J Arthroplasty. 34(6):1287-1296. 17. Peeters CM, Visser E, Van de Ree CL, Gosens T, Den Oudsten BL, De Vries J.(2016) Quality of life after hip fracture in the elderly: A systematic literature review. Injury. 47(7):1369-82. 18. Malafarina V, Reginster JY, Cabrerizo S, Bruyère O, Kanis JA, Martinez JA, Zulet MA.(2018) Nutritional Status and Nutritional Treatment Are Related to Outcomes and Mortality in Older Adults with Hip Fracture. Nutrients. 10(5). pii: E555. doi: 10.3390/nu10050555. 19. van Wissen J, van Stijn MF, Doodeman HJ, Houdijk AP.(2016) Mini Nutritional Assessment and Mortality after Hip Fracture Surgery in the Elderly. J Nutr Health Aging. 20(9):964-968. 20. Cheng BH, Chen PC, Yang YH, Lee CP, Huang KE, Chen VC.(2016) Effects of depression and antidepressant medications on hip fracture: A population-based cohort study in Taiwan. Medicine (Baltimore). 95(36):e4655. 21. Andrade C. (2019) Antidepressant Drugs and the Risk of Hip Fracture in the Elderly: Is There More to It Than Confounding by Indication? J Clin Psychiatry 30;80(4). pii: 19f12999. 22. Brännström J, Lövheim H, Gustafson Y, et al.(2019) Association between antidepressant drug use and hip fracture in older people before and after treatment initiation. JAMA Psychiatry;76(2):172–179. 23. Maharlouei N, Jafarzadeh F, Lankarani KB. (2019) Factors affecting recovery during the first 6 months after hip fracture, using the decision tree model. Arch Osteoporos. ;14(1):61. 24. Shi TT, Min M, Zhang Y.(2019) Depression and risk of hip fracture: a systematic review and meta-analysis of cohort studies. Osteoporos Int.;30(6):1157-1165 25. Oliveira A, Vaz C. (2015) The role of sarcopenia in the risk of osteoporotic hip fracture. Clin Rheumatol.;34(10):1673-80 26. Turkmen I, Ozcan C. (2019) Osteosarcopenia increases hip fracture risk: A case-controlled study in the elderly. J Back Musculoskelet Rehabil.;32(4):613-618 27. Harris MJ, Brovman EY, Urman RD. (2019) Clinical predictors of postoperative delirium, functional status, and mortality in geriatric patients undergoing non-elective surgery for hip fracture. J Clin Anesth. ;58:61-71. doi: 10.1016/j.jclinane.2019.05.010. 28. Kim JW, Kim DH, Jang EC, Lee YK, Koo KH, Ha YC. (2019) Mortality and its risk factors in nonagenarians after hip fractures. J Orthop Sci. 24(5):850-854