Authors (including presenting author) :
CSY Yung(1), C Fang(1), KY Chan (1), L Tsoi (2), CC Tsang (2), KY Wan (3), YL Ng (3), YK Cheng (4), KK Fung (5), TM Wong (1), TW Lau (1), FKL Leung (1)
Affiliation :
(1) The Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong
(2) Physiotherapy Department, Macleohose Medical Rehabilitation Center, Hong Kong West Cluster
(3) Occupational Therapy, Macleohose Medical Rehabilitation Center, Hong Kong West Cluster
(4) Physiotherapy Department, Fung Yiu King Hospital, Hong Kong West Cluster
(5) Occupational Therapy, Fung Yiu King Hospital, Hong Kong West Cluster
Introduction :
Geriatric hip fracture is an ever-growing issue with the aging population. Over 20% are readmitted within 28 days, most commonly due to recurrent falls. The transitional impact from in-patient to out-patient in the early discharge period is understudied and often neglected. Caregiver empowerment is an emerging concept aiming to tackle patient vulnerabilities immediately after their return to home. Systematic training is geared towards the patient-caretaker synergism before discharge.
Objectives :
A structured Caregiver Empowerment Programme (CEP) was developed and aimed to promote effective self-help home rehabilitation; its’ effects were studied in a randomized control trial herein.
Methodology :
All geriatric hip fractures over 50 years old with identifiable caregivers were recruited from 9/2019 to 1/2022. 125 patients were block randomized into both groups (64 in the CEP intervention vs. 61 in the control group). Pathological fractures, bedbound or chairbound patients, patients directly discharged home or to an institution were excluded. The study obtained ethics approval after protocol finalization. Informed consent was obtained for all patients and caregivers.
Result & Outcome :
Baseline characteristics showed no statistical differences in age (mean 85-years-old, p=0.80), sex (F 76%: M 24%, p-value 0.33), premorbid AMT (control: 6.14 vs. intervention: 7.42, p=0.14) and premorbid MBI (control: 94.9 vs intervention: 95.7, p=0.69)
Superior quality of life in the interventional group (CEP) versus the control group was observed at 2 to 12 months. This was statistically significant for the following outcomes: EQ-5D-5L Level Sum Score (LSS) was significantly better at 12-months (control: 8.40 vs. intervention: 6.33, p=0.026), EQ5-VAS QOL assessment at 6-months (control: 56.5 vs. intervention: 69.9, p=0.003). Results clearly demonstrate patients who undergone Caregiver Empowerment Programme have better perceived health when compared to control patients. Better function, quality of life and physical recovery translated to less subsequent fractures within 1 year (intervention: 2 vs. control: 9, p=0.03) and reduction in mortality (intervention: 7 vs. control: 16, p=0.05).
The impact of caregiver empowerment has not been studied to geriatric hip fractures before. The interventional programme introduced in this study, helps solve the gap in rehabilitation immediately following hospital discharge and empowers caregivers to take control of the rehabilitation for their loved ones thereafter. Caregivers can perform rehabilitative exercises at home with perceived safety and confidence. The result from this study clearly demonstrates that caregiver empowerment leads to significantly improved early to mid-term quality of life outcomes. Readmission for subsequent fractures and mortality were also significantly reduced.
