Effective treatment of a hip fracture induced by a critical fall accident often involves a combination of surgery, rehabilitation, medication and at-home emergency medical monitoring.

SURGERY

The specific location of the fracture in the bone, the severity of the fracture and the age of the older adult are the determining factors to identify the type of surgical procedure an individual needs after a critical fall accident:

Repair with Hardware: surgeons might insert metal screws into the bone to hold it together while the fracture heals itself.  screws are attached to a metal plate that runs down and alongside the femur.  Or, a rod is inserted (known as a nail) into the marrow part of the thigh bone.  A screw passes through the upper part of the rod, through the femoral neck and then into the the ball-portion of the hip joint.

Replace Part of the Femur: Known as a “partial hip replacement”, the surgeon may remove the head and neck of the femur to then install a metal replacement (called a prosthesis).  This procedure is performed in the event the ends of the broken bone are not properly aligning or they have been damaged in some way.

Replace the Entire Hip Joint: A “total hip replacement” involves replacing the upper femur and the socket in the pelvic bone with artificial parts called a “prostheses”. A total hip replacement is a viable option if arthritis and/or a prior injury or chronic ailment has damaged the joint thereby affecting its function prior to the fracture.

To note, if the blood supply to the ball-part of the hip joint is damaged by a hip fracture, the bone is less likely to heal properly.  This condition occurs most often in elderly or older adults who have femoral neck fractures.  Surgeons may recommend partial or total hip replacement in these cases or conditions.

What should you do when you experience a sudden fall accident that results in a potentially serious hip fracture or related injury? Firstly, do not attempt any sudden or major movement after the accident.

If you have a personal emergency response system, press your help alert button to signal for local emergency medical assistance.  Wait for the paramedics to treat you on-site and move you safely into an ambulance.  If feasible, have a family member or friend come with you to the emergency room of the local hospital.  In a panic or high-stress state, he or she can help you answer any questions from the medical staff and to consider treatment options.

We advise all older adults and seniors to have at the ready a personal emergency medical data form (stored on the refrigerator door, in the car and purse) that emergency responders and hospital staff can use to treat you more effectively.  In decades past, this form was known as a Vial of Life and was stored inside the compartments of the refrigerator.  First Response has updated and modernized these standard forms to conform more to the end user- namely the emergency responders and the doctors who actually are providing treatment after the accident.

What Happens At The Hospital Emergency Room After Admission

Emergency Responders at the accident scene and hospital staff at the ER are likely to ask these type of questions:

• Have you been diagnosed with any medical conditions; chronic or otherwise?
• Have you recently fallen?
• Experienced a previous accident that resulted in a hip injury?
• How severe is your level of pain (they will provide examples)?
• Can you put weight on your leg on the side of the injured hip?
• Have you had a bone density exam?
• What medications are you currently taking (including vitamins/supplements)?
• Do you use alcohol/tobacco?
• Have you had surgery in the past 5 years? Was it successful?
• Do you have parents or siblings with a history of osteoporosis and/or bone fractures?
• Do you currently live alone?

Tests & Diagnosis By A Physician

Most often, a physician can readily determine that your fall has resulted in a hip fracture based on your symptoms and by observing the abnormal positioning of the hip and leg.  an X-Ray will confirm a fracture and show exactly where the fracture is located on your bone.  In the event an X-ray does not show a fracture but there still is obvious hip pain, a doctor may order a CT or an MRI scan to look for what could be a small hairline fracture.

To note, the majority of hip fractures occur in one of two locations along the femur- the long bone that extends from the pelvis to the knee.  The Femoral Neck is located in the upper section of the femus, just below its head- which is the ball-part of the ball-and-socket joint.  The Intertrochanteric region is farther down from the hip joint located in the section of the upper femur that juts outward.

Finally, effective medical response including initial on-site treatment and testing and diagnosis of the patient at the hospital (immediately following the accident) cannot occur without proper around-the-clock emergency medical monitoring.  Please consider a personal emergency medical alert system in the home for 24/7 local emergency medical response and dispatch.

Hip fractures suffered by seniors and older adults (age 65+) is a very serious injury and the post-accident complications can be life-threatening.  The elderly are at the highest risk level (particularly ages 80+) for fracturing of the hip because bone structure tends to weaken with age.  The medical community identifies weakening of the bone as “osteoporosis”.

Multiple use of medications, poor vision and/or balance instability are the main causes for older adults to trip or fall.  Falling is one of the most common causes of hip fracture and often result in long term functional impairment, nursing care and increased mortality.

A hip fracture usually requires treatment including surgical repair or replacement and hospitalization and is normally followed by admission to a nursing home or rehabilitation center.  Statistics show that up to one in four adults who lived an independent lifestyle before the hip fracture remain in a nursing home or similar  rehabilitation treatment facility for up to one year after the accident.  Although in some individual cases, it may be only a few months of physical therapy treatment.

Statistics

• Over 90% of hip fractures are caused by falls; most often falling sideways onto the hip.
• Since 2000, the annual number of reported hip fractures by older adults has remained constant
• in 2007, 281,000 hospital admissions among older adults (age 65+) for hip fracture accidents
• Medicare costs for hip fractures exceeded 3 billion dollars in 1991 (22 years ago)

Symptoms

• Severe sharp pain in the hip or groin
• Inability to place weight on the leg on the side of the injured hip
• Inability to move immediately after a fall accident
• Stiffness followed by bruising and swelling in and around the injured hip area
• Leg on the side of the injured hip turns outward

Risk Factors

One or more factors may increase the risk of a hip fracture, such as:

• Gender: Females lose bone density at a faster rate than males.  Accelerated bone loss is caused by the decrease in estrogen levels that occurs during menopause.
• Age: As older adults age in place, the rate of hip fracture accidents dramatically increases due to bone density and muscle mass loss.
• Medical conditions: Older age brings about vision and balance problems; slower reaction time to avoid a fall when unsteady
• Chronic medical conditions: Osteoporosis (see above) is the primary risk factor for hip fracture; overactive thyroid and intestinal disorders also lead to bone density loss
• Medications: Certain drugs or a combination of drugs can lead to dizziness to then fall; cortisone taken long term can weaken bone structures
• Nutrition: Lack of calcium and vitamin D in a diet particularly at an earlier stage in life lowers body’s peak bone mass; eating disorders can damage the skeleton
• Exercise: Lack of a regular weight-bearing exercise regimen (i.e. walking, stretching, aquatic) will weaken bones and muscles making falls more likely

Complications

Older adults may develop one or more of the following complications in the event a hip fracture keeps oneself immobile or  for a long period of time:

• Blood clots in the legs or lungs
• Urinary tract infection
• Pneumonia
• Bedsores

Like falling and recurring falls, seniors and older adults who have experienced a first-time hip fracture accident, their risk for suffering another fracture increases significantly.  As a result, physicians, health care providers and physical therapists who treat these at-risk elderly patients, usually prescribe or recommend the use of a personal medical alert system and 24/7 emergency monitoring service for the home.   In Part 2 of this Hip Fracture blog series, we will explore medical treatment and other effective interventions to aid in the recovery of hip fracture injuries.

Postural hypotension is one of the leading medical conditions that causes older adults and the elderly to fall. Quite simply, postural hypotension is when your blood pressure drops when you go from lying down to sitting up or from sitting to standing.  When your blood pressure drops, less blood can go to the vital organs and muscle groups.  This medical condition can cause older adults, seniors and the elderly to experience a fall or recurring falls.

Symptoms

Many people with postural hypotension experience no symptoms, while others do.  Symptoms associated with hypotension can differ from person to person and might include:

• Dizziness; lightheadedeness
• Feelings of fainting, passing out or falling
• Headaches
• Blurry or tunnel vision
• Feeling vague or muddled
• Feelings of pressure across the back of the shoulders or neck
• Feeling nauseous or hot/clammy
• Overall weakness or fatigue

Occurrence of Symptoms

• Standing or sitting up suddenly
• In the morning when blood pressure is normally lower
• After a large meal or consumption of alcohol
• During exercise
• straining on the toilet
• When ill
• When anxious or panicky

Causes or Linked to

• high blood pressure
• Diabetes, heart failure, hardening of the arteries
• ingesting diuretics, anti-depressants, or medicines to lower blood pressure
• Parkinson’s disease
• Some types of dementia
• Dehydration
• Vitamin B12 deficiency or anemia
• Alcoholism
• Prolonged bed rest

Management

• Report any symptoms to a physician or healthcare provider
• Ask physician if any specific medications should be modified or stopped
• Get out of bed slowly: a) sit up; b) sit on side of bed; c) stand up
• Change positions slowly (i.e. sitting in chair)
• Sit down when bathing, dressing or working in a room or kitchen
• Exercise gently before getting up or after standing
• Hold on to a support device when you stand up from being seated
• Do not walk if you experience dizziness
• Avoid taking very hot showers or baths
• Sleep with additional pillows to elevate your head
• Consume 6 to 8 glasses of water or low-calorie beverage each day (consult physician)

As everyone is medically different, please consult with your primary physician or local health care provider to discuss your specific concerns regarding possible symptoms and/or treatment for postural hypotension.  Those individuals at risk should strongly consider investing in a First Response personal medical alert system and 24/7 emergency monitoring service in the event of a medical emergency or fall accident caused by postural hypotension.