The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial)
Tóm tắt
Delirium is a common complication in patients with hip fractures and is associated with an increased risk of subsequent dementia. The aim of this trial was to evaluate the effect of a pre- and postoperative orthogeriatric service on the prevention of delirium and longer-term cognitive decline. This was a single-center, prospective, randomized controlled trial in which patients with hip fracture were randomized to treatment in an acute geriatric ward or standard orthopedic ward. Inclusion and randomization took place in the Emergency Department at Oslo University hospital. The key intervention in the acute geriatric ward was Comprehensive Geriatric Assessment including daily interdisciplinary meetings. Primary outcome was cognitive function four months after surgery measured using a composite outcome incorporating the Clinical Dementia Rating Scale (CDR) and the 10 words learning and recalls tasks from the Consortium to Establish a Registry for Alzheimer’s Disease battery (CERAD). Secondary outcomes were pre- and postoperative delirium, delirium severity and duration, mortality and mobility (measured by the Short Physical Performance Battery (SPPB)). Patients were assessed four and twelve months after surgery by evaluators blind to allocation. A total of 329 patients were included. There was no significant difference in cognitive function four months after surgery between patients treated in the acute geriatric and the orthopedic wards (mean 54.7 versus 52.9, 95% confidence interval for the difference -5.9 to 9.5; P = 0.65). There was also no significant difference in delirium rates (49% versus 53%, P = 0.51) or four month mortality (17% versus 15%, P = 0.50) between the intervention and the control group. In a pre-planned sub-group analysis, participants living in their own home at baseline who were randomized to orthogeriatric care had better mobility four months after surgery compared with patients randomized to the orthopedic ward, measured with SPPB (median 6 versus 4, 95% confidence interval for the median difference 0 to 2; P = 0.04). Pre- and postoperative orthogeriatric care given in an acute geriatric ward was not effective in reducing delirium or long-term cognitive impairment in patients with hip fracture. The intervention had, however, a positive effect on mobility in patients not admitted from nursing homes. ClinicalTrials.gov
NCT01009268
Registered November 5, 2009
Tài liệu tham khảo
Rubenstein LZ, Josephson KR: The epidemiology of falls and syncope. Clin Geriatr Med. 2002, 18: 141-158. 10.1016/S0749-0690(02)00002-2.
Tinetti ME, Kumar C: The patient who falls: "It's always a trade-off". JAMA. 2010, 303: 258-266. 10.1001/jama.2009.2024.
Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA: Osteoporosis in the European Union: medical management, epidemiology and economic burden: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos. 2013, 8: 136.
Juliebo V, Bjoro K, Krogseth M, Skovlund E, Ranhoff AH, Wyller TB: Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture. J Am Geriatr Soc. 2009, 57: 1354-1361. 10.1111/j.1532-5415.2009.02377.x.
Kammerlander C, Roth T, Friedman S, Suhm N, Luger T, Kammerlander-Knauer U, Krappinger D, Blauth M: Ortho-geriatric service: a literature review comparing different models. Osteoporos Int. 2010, 21: 637-646.
Giusti A, Barone A, Razzano M, Pizzonia M, Pioli G: Optimal setting and care organization in the management of older adults with hip fracture. Eur J Phys Rehabil Med. 2011, 47: 281-296.
Grigoryan KV, Javedan H, Rudolph JL: Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma. 2014, 28: e49-e55. 10.1097/BOT.0b013e3182a5a045.
Buecking B, Timmesfeld N, Riem S, Bliemel C, Hartwig E, Friess T, Liener U, Ruchholtz S, Eschbach D: Early orthogeriatric treatment of trauma in the elderly: a systematic review and metaanalysis. Dtsch Arztebl Int. 2013, 110: 255-262.
Diagnostic and Statistical Manual of Mental Disorders. 2013, Washington DC: American Psychiatric Association, Fifth
Bruce AJ, Ritchie CW, Blizard R, Lai R, Raven P: The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int Psychogeriatr. 2007, 19: 197-214. 10.1017/S104161020600425X.
Inouye SK: Predisposing and precipitating factors for delirium in hospitalized older patients. Dement Geriatr Cogn Disord. 1999, 10: 393-400. 10.1159/000017177.
de Jonghe A, van de Glind EM, van Munster BC, de Rooij SE: Underrepresentation of patients with pre-existing cognitive impairment in pharmaceutical trials on prophylactic or therapeutic treatments for delirium: a systematic review. J Psychosom Res. 2014, 76: 193-199. 10.1016/j.jpsychores.2013.12.007.
Krogseth M, Wyller TB, Engedal K, Juliebo V: Delirium is an important predictor of incident dementia among elderly hip fracture patients. Dement Geriatr Cogn Disord. 2011, 31: 63-70. 10.1159/000322591.
Lundstrom M, Olofsson B, Stenvall M, Karlsson S, Nyberg L, Englund U, Borssen B, Svensson O, Gustafson Y: Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study. Aging Clin Exp Res. 2007, 19: 178-186. 10.1007/BF03324687.
Deschodt M, Braes T, Flamaing J, Detroyer E, Broos P, Haentjens P, Boonen S, Milisen K: Preventing delirium in older adults with recent hip fracture through multidisciplinary geriatric consultation. J Am Geriatr Soc. 2012, 60: 733-739. 10.1111/j.1532-5415.2012.03899.x.
Marcantonio ER, Flacker JM, Wright RJ, Resnick NM: Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001, 49: 516-522. 10.1046/j.1532-5415.2001.49108.x.
Wyller TB, Watne LO, Torbergsen A, Engedal K, Frihagen F, Juliebo V, Saltvedt I, Skovlund E, Raeder J, Conroy S: The effect of a pre- and post-operative orthogeriatric service on cognitive function in patients with hip fracture. The protocol of the Oslo Orthogeriatrics Trial. BMC Geriatr. 2012, 12: 36-10.1186/1471-2318-12-36.
Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987, 40: 373-383. 10.1016/0021-9681(87)90171-8.
Wade D: Measurment in Neurological Rehabilitation. 1992, Oxford: Oxford University Press
Gladman JR, Lincoln NB, Adams SA: Use of the extended ADL scale with stroke patients. Age Ageing. 1993, 22: 419-424. 10.1093/ageing/22.6.419.
Jorm AF: A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychol Med. 1994, 24: 145-153. 10.1017/S003329170002691X.
Chumlea WC, Guo SS, Wholihan K, Cockram D, Kuczmarski RJ, Johnson CL: Stature prediction equations for elderly non-Hispanic white, non-Hispanic black, and Mexican-American persons developed from NHANES III data. J Am Diet Assoc. 1998, 98: 137-142. 10.1016/S0002-8223(98)00036-4.
Grant PM, Ryan CG, Tigbe WW, Granat MH: The validation of a novel activity monitor in the measurement of posture and motion during everyday activities. Br J Sports Med. 2006, 40: 992-997. 10.1136/bjsm.2006.030262.
Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI: Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990, 113: 941-948. 10.7326/0003-4819-113-12-941.
Breitbart W, Rosenfeld B, Roth A, Smith MJ, Cohen K, Passik S: The Memorial Delirium Assessment Scale. J Pain Symptom Manage. 1997, 13: 128-137. 10.1016/S0885-3924(96)00316-8.
Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV, Studenski S, Berkman LF, Wallace RB: Lower extremity function and subsequent disability. J Gerontol A Biol Sci Med Sci. 2000, 55: M221-M231. 10.1093/gerona/55.4.M221.
Welsh KA, Butters N, Mohs RC, Beekly D, Edland S, Fillenbaum G, Heyman A: The Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Part V. A normative study of the neuropsychological battery. Neurology. 1994, 44: 609-614. 10.1212/WNL.44.4.609.
Karrasch M, Sinerva E, Gronholm P, Rinne J, Laine M: CERAD test performances in amnestic mild cognitive impairment and Alzheimer's disease. Acta Neurol Scand. 2005, 111: 172-179. 10.1111/j.1600-0404.2005.00380.x.
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL: A new clinical scale for the staging of dementia. Br J Psychiatry. 1982, 140: 566-572. 10.1192/bjp.140.6.566.
Barca ML, Engedal K, Laks J, Selbaek G: A 12 months follow-up study of depression among nursing-home patients in Norway. J Affect Disord. 2010, 120: 141-148. 10.1016/j.jad.2009.04.028.
Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12: 189-198. 10.1016/0022-3956(75)90026-6.
Shulman KI: Clock-drawing: is it the ideal cognitive screening test?. Int J Geriatr Psychiatry. 2000, 15: 548-561. 10.1002/1099-1166(200006)15:6<548::AID-GPS242>3.0.CO;2-U.
Statistical analysis plan - the Oslo Orthogeriatric Study. Available at: [http://www.med.uio.no/klinmed/forskning/grupper/klinisk-geriatrisk-forskning/dokumenter/statistical_analysis_plan_oslo_orthogeriatric_study_final.pdf].
Handoll HH, Cameron ID, Mak JC, Finnegan TP: Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev. 2009, 4: CD007125
Goldberg SE, Bradshaw LE, Kearney FC, Russell C, Whittamore KH, Foster PE, Mamza J, Gladman JR, Jones RG, Lewis SA, Porock D, Harwood RH, Medical Crises in Older People Study Group: Care in specialist medical and mental health unit compared with standard care for older people with cognitive impairment admitted to general hospital: randomised controlled trial (NIHR TEAM trial). BMJ. 2013, 347: f4132-10.1136/bmj.f4132.
Stenvall M, Olofsson B, Nyberg L, Lundstrom M, Gustafson Y: Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1-year follow-up. J Rehabil Med. 2007, 39: 232-238. 10.2340/16501977-0045.
Liem IS, Kammerlander C, Suhm N, Blauth M, Roth T, Gosch M, Hoang-Kim A, Mendelson D, Zuckerman J, Leung F, Burton J, Moran C, Parker M, Giusti A, Pioli G, Goldhahn J, Kates SL, Investigation performed with the assistance of the AOTrauma Network: Identifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures. Injury. 2013, 44: 1403-1412. 10.1016/j.injury.2013.06.018.
Cogan L, Martin AJ, Kelly LA, Duggan J, Hynes D, Power D: An audit of hip fracture services in the Mater Hospital Dublin 2001 compared with 2006. Ir J Med Sci. 2010, 179: 51-55.
Adunsky A, Arad M, Levi R, Blankstein A, Zeilig G, Mizrachi E: Five-year experience with the Sheba model of comprehensive orthogeriatric care for elderly hip fracture patients. Disabil Rehabil. 2005, 27: 1123-1127. 10.1080/09638280500056030.
Vidan M, Serra JA, Moreno C, Riquelme G, Ortiz J: Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc. 2005, 53: 1476-1482. 10.1111/j.1532-5415.2005.53466.x.
Mazzola P, De Filippi F, Castoldi G, Galetti P, Zatti G, Annoni G: A comparison between two co-managed geriatric programmes for hip fractured elderly patients. Aging Clin Exp Res. 2011, 23: 431-436. 10.1007/BF03337767.
Gonzalez-Montalvo JI, Alarcon T, Mauleon JL, Gil-Garay E, Gotor P, Martin-Vega A: The orthogeriatric unit for acute patients: a new model of care that improves efficiency in the management of patients with hip fracture. Hip Int. 2010, 20: 229-235.
Shyu YI, Liang J, Wu CC, Su JY, Cheng HS, Chou SW, Chen MC, Yang CT: Interdisciplinary intervention for hip fracture in older Taiwanese: benefits last for 1 year. J Gerontol A Biol Sci Med Sci. 2008, 63: 92-97. 10.1093/gerona/63.1.92.
Naglie G, Tansey C, Kirkland JL, Ogilvie-Harris DJ, Detsky AS, Etchells E, Tomlinson G, O'Rourke K, Goldlist B: Interdisciplinary inpatient care for elderly people with hip fracture: a randomized controlled trial. CMAJ. 2002, 167: 25-32.
Davis DH, Terrera GM, Keage H, Rahkonen T, Oinas M, Matthews FE, Cunningham C, Polvikoski T, Sulkava R, MacLullich AM, Brayne C: Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study. Brain. 2012, 135: 2809-2816. 10.1093/brain/aws190.
Fong TG, Jones RN, Shi P, Marcantonio ER, Yap L, Rudolph JL, Yang FM, Kiely DK, Inouye SK: Delirium accelerates cognitive decline in Alzheimer disease. Neurology. 2009, 72: 1570-1575. 10.1212/WNL.0b013e3181a4129a.
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