A broken hip in the elderly is both common and painful. Because of weakening bones and the onset of medical issues such as osteoporosis or other ailments that limit mobility, seniors can become especially susceptible to breaking a hip as they age.
Learning about preventative measures can help to keep bones strong and decrease the risk of falling and becoming injured. Understanding treatment options and what to expect as a result of sustaining a hip fracture can also be helpful in minimizing pain and making a recovery as efficient as possible.
Statistics About Hip Fractures
The probability of hip fractures tends to rise in conjunction with age. A broken hip in the elderly becomes more likely for a few different reasons. One of the reasons is that the elderly are more likely to fall as they age because their bones aren’t quite as sturdy, they lose their balance more easily, and can lack the reflexes to recover if their momentum stars to carry them down.
A bone disease such as osteoporosis also increases the probability of a hip fracture because it makes the bones brittle and more likely to break upon impact.
Every year, more than 300,000 people age 65 and older are hospitalized for hip fractures, and more than 95% of these fractures are caused by a fall. Hip fractures are much more likely to occur in women because they fall more often than men and also develop osteoporosis at a higher rate.
A staggering amount of hip fractures happen in the elderly, with 90% of incidents occurring in those age 65 or older. The overall incidence of hip fractures has decreased over the last decade, but still represent roughly 25% of the geriatric fractures requiring hospital admission. The morbidity and mortality rate also remain elevated.
Risks of a Hip Fracture in the Elderly
Falls lead to the vast majority of broken hips in the elderly, so it becomes necessary to understand why falls happen as well as how to prevent them. The following video sheds some additional light on the topic:
According to the National Institute of Health (NIH), scientists have linked numerous personal risk factors to falling. Some of these factors include:
- Weak muscles—notably in the legs
- Poor balance, which can cause difficulty walking and lead to an increased risk of falls
- Sudden drops in blood pressure when getting up from either sitting or lying down
- Dizziness that results from postural hypertension
- Poor vision—not seeing as well as in the past
- Slower reflexes which can lead to difficulty re-gaining balance
Most of these falls occur in the home for a variety of reasons including clutter, loose rugs, limited access to railings and grab bars, or poor lighting.
Surgery for Hip Fractures
After sustaining a hip fracture, surgery is needed to repair the break. This type of surgery requires general anesthesia or spinal anesthesia. Spinal anesthesia includes injecting medicine into the back to numb the patient below the legs.
The type of broken hip surgery performed will depend on the kind of fracture sustained.
If the fracture has occurred in the neck of the femur, the patient is likely to undergo a hip pinning procedure. To perform this surgery, a doctor will have the patient lie on a table and use an x-ray machine to determine how the parts of the hip bone line up.
The surgeon will make a small incision on the side of the thigh and insert screws to keep the bones stabilized and in their correct position. This procedure typically lasts between 2 and 4 hours.
If the injury is an intertrochanteric fracture, which is the area below the neck of the femur, the surgeon will use a plate and compression screws to repair it.
This procedure is very similar to the one performed when the fracture occurs in the neck of the femur. The only difference being the inclusion of a metal plate in addition to the screws and that the surgery takes less time (2 hours or less).
Full hip replacement surgery may also be necessary if the ball portion of the hip joint was also damaged.
Without undergoing any of these procedures, a person with a broken hip winds up almost entirely confined to a chair or bed due to extreme difficulty in moving around. Bypassing surgical repair is incredibly risky because it can lead to life-threatening medical issues.
Although it is far riskier to forego surgery to repair a broken hip in the elderly, there are still quite a few risks attached to having a procedure done. Examples of these risks include:
- Blood clots that may form in the leg veins can break off and travel to the lungs or heart
- Infections can develop at the incision site and need antibiotics. If the infection is major, it may require additional surgery
- Other fractures may occur in the healthy portions of the hip joint during surgery
Preventing Hip Fractures
Seniors who sustain hip fractures are at the highest future risk of suffering another fracture. Many of these seniors are deficient in vitamin D, and vitamin D supplementation is generally believed to improve bone mineral density and also prevent falls. In addition to vitamin D supplementation, seniors should also look to add supplemental calcium to their daily regimen.
Because such a high rate of hip fractures occur among the elderly who have osteoporosis, addressing the osteoporosis itself is usually a good strategy towards preventing future incidents. Although there is no cure for osteoporosis, these FDA-approved medications are used to treat the condition:
- Bisphosphonates – These drugs create a reduction in the activity of cells that lead to bone loss
- Parathyroid Hormone – Approved for post-menopausal women as well as men with osteoporosis and a high probability of having a fracture
- Calcitonin – Promotes calcium regulation and bone metabolism and is approved for treating osteoporosis in women five years or more beyond menopause
- Estrogen and hormone therapy – Approved for the treatment of osteoporosis in women after menopause
Pain management is a big part of broken hip recovery. Often, the pain level will fluctuate from the period before surgery, the period directly following the operation, rehabilitation, and arriving back home afterwards. There are numerous options to manage the pain; the most effective option will depend on the individual and the amount of side effects.
The following are common pain management options:
Acetaminophen is a non-aspirin pain reliever used for general pain and soreness. It is unlikely to be strong enough to treat residual post-op hip pain by itself, but may be combined with certain medications to augment the effect.
Opioid analgesics are better known as codeine, morphine, and oxycodone. These are much stronger forms of pain relievers and can be administered in the form of a pill, shot, or IV.
These drugs can cause side effects such as nausea, vomiting, constipation, sleeplessness, or itchiness.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Common forms of NSAIDs are Ibuprofen and Naproxen. Much like acetaminophen, NSAIDs are not likely to provide enough relief on their own. However, they may be used in addition to other medications (if there are no interactions) or if the pain level is more manageable.
A few common side effects of NSAIDs include dizziness, nausea, and diarrhea.
Nerve Blocks numb the nerves in a localized area using an injected anesthetic medication. A nerve block is usually used when other oral medications cannot be taken and can be more effective than traditional pain medications. For a broken hip, the injection is usually given directly into the hip or groin area.
Acupressure and Muscle-Relaxation Therapy
As a standalone, neither of these treatment options are likely to be sufficient. However, used in conjunction with some of the previously mentioned medications or treatments, these options may help to abbreviate the overall broken hip recovery time. Another benefit to using acupressure or muscle-relaxation therapies is that there are no side effects or serious risks involved.
Although a broken hip in the elderly accounts for many of the injuries sustained beyond the age of 65, it doesn’t mean you also have to suffer. Understanding why these injuries occur, what you can do to improve your health and avoid them altogether can go a long way in ensuring stronger bones and happiness well into your golden years.
Have you or someone you love sustained a hip fracture? Let us know what your experience was like and how you dealt with it in the comments section below!