Evolution of the hip fracture population: time to consider the future? A retrospective observational analysis

Abstract

Objective: To examine how the population with fractured neck of femur has changed over the last decade and determine whether they have evolved to become a more physically and socially dependent cohort.

Design: Retrospective cohort study of prospectively collected Standardised Audit of Hip Fractures of Europe data entered on to an institutional hip fracture registry.

Participants: 10 044 consecutive hip fracture admissions (2000-2012).

Setting: A major trauma centre in the UK.

Results: There was a generalised increase in the number of admissions between 2000 (n=740) and 2012 (n=810). This increase was non-linear and best described by a quadratic curve. Assuming no change in the prevalence of hip fracture over the next 20 years, our hospital is projected to treat 871 cases in 2020 and 925 in 2030. This represents an approximate year-on-year increase of just over 1%. There was an increase in the proportion of male admissions over the study period (2000: 174 of 740 admissions (23.5%); 2012: 249 of 810 admissions (30.7%)). This mirrored national census changes within the geographical area during the same period. During the study period there were significant increases in the numbers of patients admitted from their own home, the proportion of patients requiring assistance to mobilise, and the proportion of patients requiring help with basic activities of daily living (all p<0.001). There was also a twofold to fourfold increase in the proportion of patients admitted with a diagnosis of cardiovascular disease, renal disease, diabetes and polypharmacy (use of >4 prescribed medications; all p<0.001).

Conclusions: The expanding hip fracture population has increasingly complex medical, social and rehabilitation care needs. This needs to be recognised so that appropriate healthcare strategies and service planning can be implemented. This epidemiological analysis allows projections of future service need in terms of patient numbers and dependency.

Figure 1

Number of hip fracture admissions 2000–2012 with ‘best fit’ time series model (red line: admissions=715.59+(8.72×number of years after 1999)−(0.06×(number of years after 1999)²), ie, year 2000=1). Green line represents the forecasted number of admissions based on this model beyond 2030. Hip fracture admissions can be approximated in any hospital using a simplified equation based on this model: predicted admissions in year X=admissions in specified unit in 2012+(0.01×admissions in specified unit in 2012×(X−2012))−(0.0001×admissions in specified unit in 2012×(X−2012)²).

Figure 2

Trends in the proportion of patients admitted with cardiovascular disease (CVD), diabetes mellitus (DM), renal disease (renal) and polypharmacy (4+ meds) between 2000 and 2012.

Figure 3

Number of admissions that were prescribed either clopidogrel (C) or warfarin (W). Percentages represent the proportion of admissions that were taking either of these agents in each year.

Figure 4

Patients requiring assistance with basic care (washing, dressing, feeding and toileting) as a proportion of all patients requiring assistance with their activities of daily living (n=6033).

Figure 5

Distribution in the pattern of presenting fracture by year (2000–2012).