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Rehabilitation - Hip Fracture Rehabilitation

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Falls and hip fractures are unfortunately common in frail elderly patients, and hip fracture rehabilitation is an important concern. Breaking a hip can result in nursing home placement or even death. An important predictor of being able to return home is pre-fracture mobility. Ongoing communication with the orthopedic surgeon is important to establish hip precautions, to avoid dislocation of an artificial joint, and for guidance on when the patient can begin to bear his full weight on the operated leg. Older patients may be unable to cooperate with partial weight-bearing restrictions, because of poor balance, weakness, or cognitive impairment. Although pain must be adequately treated, it is important to avoid overmedication and delirium in frail older adults. Fear of falling can become a limiting factor, and confidence must be addressed. Strengthening exercises (sometimes including treadmill gait retraining), balance training, and walking aids are standard components of hip fracture rehabilitation. Therapy can continue on an outpatient basis.

Inpatient rehabilitation can take place on the acute care unit (medical or surgical) or on specialized geriatric rehabilitation wards. If the patient is well enough to go home, outpatient rehabilitation can be facility-based or home-based. In some areas, geriatric day hospitals offer an intermediate solution to frail patients who have returned to the community. The types of geriatric services available vary depending on local preference, economics, and cultural attitudes toward the elderly. Particularly as the population ages, resources may not keep pace with needs. Outcome in geriatric rehabilitation very often depends upon the type and degree of social support available to the patient.

SUSAN FRETER

BIBLIOGRAPHY

BARER, D. ‘‘Rehabilitation.’’ In Geriatric Medicine and Gerontology, 5th ed. Edited by J. C. Brocklehurst. London: Harcourt Brace, 1998. Pages 1521–1550.

BRUMMEL-SMITH, K. Clinics in Geriatric Medicine: Geriatric Rehabilitation. Philadelphia, Pa.: W. B. Saunders Co., 1993.

LÖKK, J. ‘‘Geriatric Rehabilitation Revisited.’’ Aging Clinical and Experimental Research 11 (1999): 353–361.

STEINBERG, F. U., and DEAN, B. Z. ‘‘Physiatric Therapeutics: Geriatric Rehabilitation.’’ Archives of Physical Medicine and Rehabilitation 71 (1990): S278–S280.

TAUB, E.; USWATTE, G.; and PIDIKITI, R. ‘‘Constraint-Induced Movement Therapy: A New Family of Techniques with Broad Application to Physical Rehabilitation—A Clinical Review.’’ Journal of Rehabilitation Research and Development 36 (1999): 237–251.

WEBER, D. C.; FLEMING, K. C.; and EVANS, J. M. ‘‘Rehabilitation of Geriatric Patients.’’ Mayo Clinic Proceedings 70 (1995): 1198–1204.

World Health Organization. ICIDH-2: International Classification of Functioning and Disability. Beta-2 draft. Geneva: World Health Organization, 1999. www.who.int/icidh

ZUCKERMAN, J. D.; FABIAN, D. R.; AHARANOFF, G.; KOVAL, K. J.; and FRANKEL, V. H. ‘‘Enhancing Independence in the Older Hip Fracture Patient.’’ Geriatrics 48 (1993): 76–81.

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