Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
BMC Geriatrics
Published in: BMC Geriatrics 1/2011

Open Access 01-12-2011 | Study protocol

Effect of in-hospital comprehensive geriatric assessment (CGA) in older people with hip fracture. The protocol of the Trondheim Hip Fracture Trial

Authors: Olav Sletvold, Jorunn L Helbostad, Pernille Thingstad, Kristin Taraldsen, Anders Prestmo, Sarah E Lamb, Arild Aamodt, Roar Johnsen, Jon Magnussen, Ingvild Saltvedt

Published in: BMC Geriatrics | Issue 1/2011

Login to get access

Abstract

Background

Hip fractures in older people are associated with high morbidity, mortality, disability and reduction in quality of life. Traditionally people with hip fracture are cared for in orthopaedic departments without additional geriatric assessment. However, studies of postoperative rehabilitation indicate improved efficiency of multidisciplinary geriatric rehabilitation as compared to traditional care. This randomized controlled trial (RCT) aims to investigate whether an additional comprehensive geriatric assessment of hip fracture patients in a special orthogeriatric unit during the acute in-hospital phase may improve outcomes as compared to treatment as usual in an orthopaedic unit.

Methods/design

The intervention of interest, a comprehensive geriatric assessment is compared with traditional care in an orthopaedic ward. The study includes 401 home-dwelling older persons >70 years of age, previously able to walk 10 meters and now treated for hip fracture at St. Olav Hospital, Trondheim, Norway. The participants are enrolled and randomised during the stay in the Emergency Department. Primary outcome measure is mobility measured by the Short Physical Performance Battery (SPPB) at 4 months after surgery. Secondary outcomes measured at 1, 4 and 12 months postoperatively are place of residence, activities of daily living, balance and gait, falls and fear of falling, quality of life and depressive symptoms, as well as use of health care resources and survival.

Discussion

We believe that the design of the study, the randomisation procedure and outcome measurements will be of sufficient strength and quality to evaluate the impact of comprehensive geriatric assessment on mobility and other relevant outcomes in hip fracture patients.

Trials registration

ClinicalTrials.gov, NCT00667914
Appendix
Available only for authorised users
Literature
1.
Gjertsen JE, Engesaeter LB, Furnes O, Havelin LI, Steindal K, Vinje T, Fevang JM: The Norwegian Hip Fracture Register: experiences after the first 2 years and 15,576 reported operations. Acta Orthop. 2008, 79 (5): 583-593. 10.1080/17453670810016588.CrossRefPubMed
2.
Bacon WE: Secular trends in hip fracture occurrence and survival: age and sex differences. J Aging Health. 1996, 8 (4): 538-553. 10.1177/089826439600800404.CrossRefPubMed
3.
Cooper C: The crippling consequences of fractures and their impact on quality of life. Am J Med. 1997, 103 (2A): 12S-17S. discussion 17S-19SCrossRefPubMed
4.
Melton LJ, Therneau TM, Larson DR: Long-term trends in hip fracture prevalence: the influence of hip fracture incidence and survival. Osteoporos Int. 1998, 8 (1): 68-74. 10.1007/s001980050050.CrossRefPubMed
5.
Haleem S, Lutchman L, Mayahi R, Grice JE, Parker MJ: Mortality following hip fracture: trends and geographical variations over the last 40 years. Injury. 2008, 39 (10): 1157-1163. 10.1016/j.injury.2008.03.022.CrossRefPubMed
6.
Pasco JA, Sanders KM, Hoekstra FM, Henry MJ, Nicholson GC, Kotowicz MA: The human cost of fracture. Osteoporos Int. 2005, 16 (12): 2046-2052. 10.1007/s00198-005-1997-y.CrossRefPubMed
7.
Osnes EK, Lofthus CM, Meyer HE, Falch JA, Nordsletten L, Cappelen I, Kristiansen IS: Consequences of hip fracture on activities of daily life and residential needs. Osteoporos Int. 2004, 15 (7): 567-574.CrossRefPubMed
8.
Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G: Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004, 59 (3): 255-263.CrossRefPubMed
9.
Ensrud KE, Ewing SK, Taylor BC, Fink HA, Stone KL, Cauley JA, Tracy JK, Hochberg MC, Rodondi N, Cawthon PM: Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007, 62 (7): 744-751.CrossRefPubMed
10.
Adams AL, Schiff MA, Koepsell TD, Rivara FP, Leroux BG, Becker TM, Hedges JR: Physician consultation, multidisciplinary care, and 1-year mortality in Medicare recipients hospitalized with hip and lower extremity injuries. J Am Geriatr Soc. 2010, 58 (10): 1835-1842. 10.1111/j.1532-5415.2010.03087.x.CrossRefPubMed
11.
Arinzon Z, Fidelman Z, Zuta A, Peisakh A, Berner YN: Functional recovery after hip fracture in old-old elderly patients. Arch Gerontol Geriatr. 2005, 40 (3): 327-336. 10.1016/j.archger.2004.10.003.CrossRefPubMed
12.
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 (1): 25-32.PubMedPubMedCentral
13.
Olofsson B, Lundstrom M, Borssen B, Nyberg L, Gustafson Y: Delirium is associated with poor rehabilitation outcome in elderly patients treated for femoral neck fractures. Scand J Caring Sci. 2005, 19 (2): 119-127. 10.1111/j.1471-6712.2005.00324.x.CrossRefPubMed
14.
Lundstrom M, Edlund A, Karlsson S, Brannstrom B, Bucht G, Gustafson Y: A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J Am Geriatr Soc. 2005, 53 (4): 622-628. 10.1111/j.1532-5415.2005.53210.x.CrossRefPubMed
15.
Marcantonio ER, Flacker JM, Wright RJ, Resnick NM: Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001, 49 (5): 516-522. 10.1046/j.1532-5415.2001.49108.x.CrossRefPubMed
16.
Crotty M, Unroe K, Cameron ID, Miller M, Ramirez G, Couzner L: Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people. Cochrane Database Syst Rev. 2010, CD007624-1
17.
Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM: Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ. 2010, 340: c1718-10.1136/bmj.c1718.CrossRefPubMedPubMedCentral
18.
Mak JC, Cameron ID, March LM: Evidence-based guidelines for the management of hip fractures in older persons: an update. Med J Aust. 2010, 192 (1): 37-41.PubMed
19.
Pioli G, Giusti A, Barone A: Orthogeriatric care for the elderly with hip fractures: where are we?. Aging Clin Exp Res. 2008, 20 (2): 113-122.CrossRefPubMed
20.
Saltvedt I, Mo ES, Fayers P, Kaasa S, Sletvold O: Reduced mortality in treating acutely sick, frail older patients in a geriatric evaluation and management unit. A prospective randomized trial. J Am Geriatr Soc. 2002, 50 (5): 792-798. 10.1046/j.1532-5415.2002.50202.x.CrossRefPubMed
21.
Saltvedt I, Saltnes T, Mo ES, Fayers P, Kaasa S, Sletvold O: Acute geriatric intervention increases the number of patients able to live at home. A prospective randomized study. Aging Clin Exp Res. 2004, 16 (4): 300-306.CrossRefPubMed
22.
Fitzgerald JF, Moore PS, Dittus RS: The care of elderly patients with hip fracture. Changes since implementation of the prospective payment system. N Engl J Med. 1988, 319 (21): 1392-1397. 10.1056/NEJM198811243192106.CrossRefPubMed
23.
Gehlbach SH, Avrunin JS, Puleo E: Trends in hospital care for hip fractures. Osteoporos Int. 2007, 18 (5): 585-591. 10.1007/s00198-006-0281-0.CrossRefPubMed
24.
Godlee F: Publishing study protocols: making them visible will prove registration, reporting and recruitment. BMC News and Views. 2001, 2 (4):
25.
Ellis G, Langhorne P: Comprehensive geriatric assessment for older hospital patients. Br Med Bull. 2004, 71: 45-59. 10.1093/bmb/ldh033.CrossRefPubMed
26.
Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB: A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994, 49 (2): M85-94.CrossRefPubMed
27.
Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV, Studenski S, Berkman LF, Wallace RB: Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000, 55 (4): M221-231.CrossRefPubMed
28.
Ostir GV, Volpato S, Fried LP, Chaves P, Guralnik JM: Reliability and sensitivity to change assessed for a summary measure of lower body function: results from the Women's Health and Aging Study. J Clin Epidemiol. 2002, 55 (9): 916-921. 10.1016/S0895-4356(02)00436-5.CrossRefPubMed
29.
Studenski S, Perera S, Wallace D, Chandler JM, Duncan PW, Rooney E, Fox M, Guralnik JM: Physical performance measures in the clinical setting. J Am Geriatr Soc. 2003, 51 (3): 314-322. 10.1046/j.1532-5415.2003.51104.x.CrossRefPubMed
30.
Podsiadlo D, Richardson S: The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991, 39 (2): 142-148.CrossRefPubMed
31.
Helbostad JL, Sletvold O, Moe-Nilssen R: Effects of home exercises and group training on functional abilities in home-dwelling older persons with mobility and balance problems. A randomized study. Aging Clin Exp Res. 2004, 16 (2): 113-121.CrossRefPubMed
32.
Kristensen MT, Foss NB, Kehlet H: Timed "up & go" test as a predictor of falls within 6 months after hip fracture surgery. Phys Ther. 2007, 87 (1): 24-30. 10.2522/ptj.20050271.CrossRefPubMed
33.
Jaglal S, Lakhani Z, Schatzker J: Reliability, validity, and responsiveness of the lower extremity measure for patients with a hip fracture. J Bone Joint Surg Am. 2000, 82A (7): 955-962.
34.
Ingemarsson AH, Frandin K, Mellstrom D, Moller M: Walking ability and activity level after hip fracture in the elderly--a follow-up. J Rehabil Med. 2003, 35 (2): 76-83. 10.1080/16501970306113.CrossRefPubMed
35.
Mendelsohn ME, Leidl DS, Overend TJ, Petrella RJ: Specificity of functional mobility measures in older adults after hip fracture: a pilot study. Am J Phys Med Rehabil. 2003, 82 (10): 766-774. 10.1097/00002060-200310000-00005.CrossRefPubMed
36.
Crotty M, Whitehead C, Miller M, Gray S: Patient and caregiver outcomes 12 months after home-based therapy for hip fracture: a randomized controlled trial. Arch Phys Med Rehabil. 2003, 84 (8): 1237-1239. 10.1016/S0003-9993(03)00141-2.CrossRefPubMed
37.
Foss NB, Kristensen MT, Kehlet H: Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score. Clin Rehabil. 2006, 20 (8): 701-708. 10.1191/0269215506cre987oa.CrossRefPubMed
38.
Mahoney FI, Barthel DW: Functional Evaluation: The Barthel Index. Md State Med J. 1965, 14: 61-65.PubMed
39.
Gladman JR, Lincoln NB, Adams SA: Use of the extended ADL scale with stroke patients. Age Ageing. 1993, 22 (6): 419-424. 10.1093/ageing/22.6.419.CrossRefPubMed
40.
Harwood RH, Ebrahim S: The validity, reliability and responsiveness of the Nottingham Extended Activities of Daily Living scale in patients undergoing total hip replacement. Disabil Rehabil. 2002, 24 (7): 371-377.CrossRefPubMed
41.
Brooks R: EuroQol: the current state of play. Health Policy. 1996, 37 (1): 53-72. 10.1016/0168-8510(96)00822-6.CrossRefPubMed
42.
Hartrick CT, Kovan JP, Shapiro S: The numeric rating scale for clinical pain measurement: a ratio measure?. Pain Pract. 2003, 3 (4): 310-316. 10.1111/j.1530-7085.2003.03034.x.CrossRefPubMed
43.
Parker M, Currie CC, Mountain JA, Thorngren K-G: Standardised audit of hip fracture in Europe (SAHFE). HIP International. 1998, 8: 10-15.
44.
Menz HB, Latt MD, Tiedemann A, Mun San Kwan M, Lord SR: Reliability of the GAITRite walkway system for the quantification of temporo-spatial parameters of gait in young and older people. Gait Posture. 2004, 20 (1): 20-25. 10.1016/S0966-6362(03)00068-7.CrossRefPubMed
45.
Moe-Nilssen R, Helbostad JL: Interstride trunk acceleration variability but not step width variability can differentiate between fit and frail older adults. Gait Posture. 2005, 21 (2): 164-170. 10.1016/j.gaitpost.2004.01.013.CrossRefPubMed
46.
Helbostad JL, Leirfall S, Moe-Nilssen R, Sletvold O: Physical fatigue affects gait characteristics in older persons. J Gerontol A Biol Sci Med Sci. 2007, 62 (9): 1010-1015.CrossRefPubMed
47.
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 (12): 992-997. 10.1136/bjsm.2006.030262.CrossRefPubMedPubMedCentral
48.
Taraldsen K, Askim T, Sletvold O, Einarsen EK, Gruner Bjastad K, Indredavik B, Helbostad JL: Evaluation of a Body-Worn Sensor System to Measure Physical Activity in Older People With Impaired Function. Phys Ther. 2011
49.
Friedman SM, Munoz B, West SK, Rubin GS, Fried LP: Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. J Am Geriatr Soc. 2002, 50 (8): 1329-1335. 10.1046/j.1532-5415.2002.50352.x.CrossRefPubMed
50.
Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C: Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing. 2005, 34 (6): 614-619. 10.1093/ageing/afi196.CrossRefPubMed
51.
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.CrossRefPubMed
52.
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 (3): 189-198. 10.1016/0022-3956(75)90026-6.CrossRefPubMed
53.
Sheikh JI, Yesavage JA, Brooks JO, Friedman L, Gratzinger P, Hill RD, Zadeik A, Crook T: Proposed factor structure of the Geriatric Depression Scale. Int Psychogeriatr. 1991, 3 (1): 23-28. 10.1017/S1041610291000480.CrossRefPubMed
54.
Vinkers DJ, Gussekloo J, Stek ML, Westendorp RG, Van Der Mast RC: The 15-item Geriatric Depression Scale (GDS-15) detects changes in depressive symptoms after a major negative life event. The Leiden 85-plus Study. Int J Geriatr Psychiatry. 2004, 19 (1): 80-84. 10.1002/gps.1043.CrossRefPubMed
55.
Koehler M, Rabinowitz T, Hirdes J, Stones M, Carpenter GI, Fries BE, Morris JN, Jones RN: Measuring depression in nursing home residents with the MDS and GDS: an observational psychometric study. BMC Geriatr. 2005, 5: 1-10.1186/1471-2318-5-1.CrossRefPubMedPubMedCentral
56.
Jongenelis K, Pot AM, Eisses AM, Gerritsen DL, Derksen M, Beekman AT, Kluiter H, Ribbe MW: Diagnostic accuracy of the original 30-item and shortened versions of the Geriatric Depression Scale in nursing home patients. Int J Geriatr Psychiatry. 2005, 20 (11): 1067-1074. 10.1002/gps.1398.CrossRefPubMed
57.
Sutcliffe C, Cordingley L, Burns A, Mozley CG, Bagley H, Huxley P, Challis D: A new version of the geriatric depression scale for nursing and residential home populations: the geriatric depression scale (residential) (GDS-12R). Int Psychogeriatr. 2000, 12 (2): 173-181. 10.1017/S104161020000630X.CrossRefPubMed
58.
Lin DY, Feuer EJ, Etzioni R, Wax Y: Estimating medical costs from incomplete follow-up data. Biometrics. 1997, 53 (2): 419-434. 10.2307/2533947.CrossRefPubMed
59.
Carides GW, Heyse JF, Iglewicz B: A regression-based method for estimating mean treatment cost in the presence of right-censoring. Biostatistics. 2000, 1 (3): 299-313. 10.1093/biostatistics/1.3.299.CrossRefPubMed
60.
Schulz KF, Altman DG, Moher D: CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010, 8: 18-10.1186/1741-7015-8-18.CrossRefPubMedPubMedCentral
61.
Twisk J, de Vente W: Attrition in longitudinal studies. How to deal with missing data. J Clin Epidemiol. 2002, 55 (4): 329-337. 10.1016/S0895-4356(01)00476-0.CrossRefPubMed
62.
Twisk JW, de Vente W: The analysis of randomised controlled trial data with more than one follow-up measurement. A comparison between different approaches. Eur J Epidemiol. 2008, 23 (10): 655-660. 10.1007/s10654-008-9279-6.CrossRefPubMed
Metadata
Title
Effect of in-hospital comprehensive geriatric assessment (CGA) in older people with hip fracture. The protocol of the Trondheim Hip Fracture Trial
Authors
Olav Sletvold
Jorunn L Helbostad
Pernille Thingstad
Kristin Taraldsen
Anders Prestmo
Sarah E Lamb
Arild Aamodt
Roar Johnsen
Jon Magnussen
Ingvild Saltvedt
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2011
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/1471-2318-11-18

Other articles of this Issue 1/2011

BMC Geriatrics 1/2011 Go to the issue

Research article

The assessment of renal function in relation to the use of drugs in elderly in nursing homes; a cohort study

Study protocol

Long-term consequences of an intensive care unit stay in older critically ill patients: design of a longitudinal study

Research article

Lighting and perceptual cues: Effects on gait measures of older adults at high and low risk for falls

Research article

Are old-old patients with major depression more likely to relapse than young-oldpatients during continuation treatment with escitalopram?

Research article

Depression after low-energy fracture in older women predicts future falls: a prospective observational study

Research article

Effectiveness of Oral Nutritional Supplementation for Older Women after a Fracture: Rationale, Design and Study of the Feasibility of a Randomized Controlled Study
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits