As I see it, by John Appleton
In 2016, some 3,750 New Zealanders suffered a hip fracture, often at the femoral neck. It’s the most common cause of orthopaedic admission to hospital. Ninety-five percent of these fractures are caused by a fall and women are twice as likely to suffer from a hip fracture as men. Forty-nine percent of cases are in folks over 85 years of age, but the numbers start climbing steeply from the age of 65.
Hospital admissions as a result of hip fracture cost our health system more than $100 million each year. This is a massive amount of money and with our ageing population the costs are likely to keep rising..
The really sad part about these statistics, is that a normally healthy person who has a fall and suffers from a fracture of the femur can have complications that significantly increase the risk of mortality. One in three people die within 12 months. The two most concerning complications are post-operative infection and pneumonia but there is also an ongoing risk of another fall.
Infection following surgery is something that is taken very seriously in our hospital system, but it seems that with antibiotic resistant infections becoming more prevalent, this battle is not being won. MRSA (Methicillin-resistant Staphylococcus aureus) the ‘hospital bug’, is a so-called ‘super bug’ that is becoming increasingly more difficult to treat.
Pseudomonas aeruginosa has become an important cause of infection, especially in patients with compromised immune function. It is the most common pathogen isolated from patients who have been hospitalised longer than one week, and it is a frequent cause of nosocomial (hospital acquired) infections.
Hospital admission following a fall and a fracture is unexpected and most folks would not have prepared for this as one can do with elective surgery. Vitamin C blood levels are likely to be at zero on arrival at the hospital. Vitamin D and zinc status are likely to be very low and these, in addition to age-related immune system function, surely increase the likelihood of infections.
Another problem for doctors is the potential for the patient to develop pneumonia. Aspiration pneumonia is a common form of the illness. Aspiration pneumonia occurs when a patient breathes something instead of swallowing it. Germs from food particles, saliva, vomit or other substances can infect the airways and lead to aspiration pneumonia. The mortality rate for patients who develop aspiration pneumonia is approximately 30%.
As I see it, there is little likelihood that hospital statistics will improve. Thus the most important intervention we can make is to do more to limit the number of falls that result in hip fracture. What if there is a way that this might be achieved? Recently after visiting a hip fracture patient in North Shore Hospital, I was thinking about the possibility of older folks walking around in a “Michelin’ suit. I was very surprised to discover that a French company has come up with an innovative inflating ‘belt’ (Helite Hip Safe) that has been shown to reduce the impact forces from a fall by 85%. The belt is the result of a lot of research and testing. Very simply the device detects that a fall is imminent, and two air bags inflate in less than one second to protect the wearer before there is any contact with the ground.
If such a device could reduce the number of hip fractures and keep our older folks enjoying life without the worry of all the issues associated with hospitalisation, it would be wonderful. Clearly there could be significant benefits for our health system too with big cost savings For anyone interested the website is https://senior.helite.com/en/ or type Helite ‘Hip Safe’ into google. There is a New Zealand distributor.
