Four score years and ten: an analysis of the epidemiology of fractures in the very elderly

Abstract

Fragility fractures are becoming more common and with increasing longevity it seems likely that orthopaedic surgeons will see more such fractures in progressively older patients. We have examined the epidemiology of fractures in patients aged 90 years or more.

Introduction: The purpose of this study was to examine the epidemiology of fractures in the very elderly to see if it differed from the overall fracture epidemiology. The requirement for hospital admission and surgical treatment was assessed as was the patients' domicile, length of hospital stay and discharge location.

Materials and methods: All fractures presenting to the Royal Infirmary of Edinburgh and the Royal Hospital for Sick Children in 2000 were examined prospectively and recorded on databases. A retrospective examination of the clinical and social details of the 90+ age group was undertaken.

Results: The 90+ age group comprises 0.58% of the population but accounts for 3.02% of the fractures in the community, 8.7% of the in-patient admissions and 7.6% of the acute orthopaedic trauma surgery. About 56% of fractures in this age group are proximal femoral fractures but high prevalences were noted for all femoral fractures. About 65% of the fractures were in the lower limb. Over 86% of fractures occurred in falls and over 81% of patients were treated as in-patients. The average hospital stay was 9 days but only 23.9% were discharged to their domicile.

Discussion: It is forecast that this age group will increase and become less fit. This has significant implications for hospital treatment and costs.