Aged care homes crucial to hip fracture recovery

The new national clinical standard for hip fracture care emphasises the role aged care providers play in ongoing care of individuals and minimising their risk of future falls and fractures.

Hip fractures are more common in older people. And most are the result of a fall – the most common cause of injury in older people. Following a fracture, people who are frail, and have cognitive impairment or other co-morbidities, are at higher risk of adverse outcomes, and often, these people will be residing in or discharged to aged care.

Associate Professor Carolyn Hullick – acting chief medical officer of the Australian Commission on Safety and Quality in Health Care – said the new clinical standard is important because 19,000 people a year in Australia have a hip fracture already and, with the ageing population, that number is expected to climb.

“Around 27 per cent of [hip fractures] are occurring in residential aged care. A pretty significant proportion will go to aged care as a new resident afterwards,” Dr Hullick told Australian Ageing Agenda.

According to government data, between 15 and 20 per cent of people who have a hip fracture enter an aged care home for the first time.

“The most startling thing for me is that one in four people will die within 12 months of having a hip fracture,” said Associate Professor Hullick – an emergency physician whose recent PhD investigated the management of acutely unwell people living in aged care. “It’s a life-changing injury.”

A key contributor to this statistic is that the affected population is often taking many medications and has more than one chronic health condition, she said.

The updated Hip Fracture Clinical Care Standard – a 50-page document launched at the Hip Fest 2023 conference on Monday – has seven quality statements that aim to improve hip fracture care and outcomes.

Key changes from the previous standard introduced in 2016 include surgery within 36 hours of presenting at any hospital, and more emphasis on multidisciplinary care including to identify and manage malnutrition, frailty and delirium, pain management and cultural safety for First Nations people.

“The last [quality statement] is around transition from hospital to home, and home can include aged care,” Dr Hullick said.

This statement includes the development of an individualised care plan – which covers mobilisation activities and expected function post-injury, wound care, pain management, nutrition, fracture prevention strategies, changed or new medicines, and specific rehabilitation services and equipment – and communicating that plan with all ongoing clinicians and care providers, including aged care services.

“They’re a high-risk population to start with, and because of this, it’s important that when we send them home from hospital, everyone’s on the same page, and everyone knows what’s going on.”

Ongoing care following a hip fracture important to the person’s recovery can involve:

• ensuring the person is supported to regain their mobility – for example by mobilising and walking the day after their hip fracture surgery and at least daily thereafter
• making sure that bone protection medicines are prescribed and administered to reduce the risk of a further fracture
• falls prevention strategies to prevent a further fall and another fracture
• adequate nutrition.

On a key message for people working in aged care, Dr Hullick said: “When someone’s coming home from hospital with a hip fracture, [it’s about] recognising that it’s been a life-changing injury and recognising that getting them back on their feet and back to their best condition is important.”

Main image (L to R): Professor Jacqueline Close, Associate Professor Carolyn Hullick and Associate Professor Catherine McDougall following the launch of the updated Hip Fracture Clinical Care Standard at HipFest2023

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