Abstract
Objective: Elderly patients with femoral neck fracture have varying degrees of cognitive capabilities when admitted to hospital. Following hemiarthroplasty, these patients are given standard precautionary advice in order to prevent dislocation of their prostheses. We aim to determine the relationship between mental state on admission and the ability to recollect these precautions postoperatively.
Design: Over a one-month period, 26 patients, aged 70 years and above admitted with hip fracture, were recruited prospectively for this audit study. Mini-mental test score on admission was used to classify non aphasic subjects into three groups: normal, mildly impaired and severely impaired. On the 2nd post-operative day (POD) the patients were given verbal instructions aimed at preventing dislocation of their hemiarthroplasty. Recollection of these precautions was then tested using a specially designed questionnaire (score: 1–10) on POD-6 and at 6 weeks.
Results: One patient died (3.8%). Of the remainder, 21 (84%) were female and 4 (16%) were male. The mean age was 80.4. There were 10 patients in Group-I (normal; 40%), 7 in Group-II (mildly impaired; 28%) and 8 in Group-III (severely impaired; 32%). The resulting score to the questionnaire in Group-I was 6.2 and 3.2; Group-II was 3.3 and 1.2; and Group-III was 0.3 and 0.3 on POD-6 and 6 weeks respectively.
Conclusion: 6 days following surgery, the best recollection of advice is only 2 thirds of what the patient had been told and 6 weeks following surgery, the best recollection of advice is only 1 third of the advice given. The recollection of advice in both mentally impaired groups was very poor throughout the study period. We recommend either not giving hip precautions advice to these patients or changing the way the advice is given to try to improve their recollection.
Editoral Secretary Mr Peter Howard. Correspondence should be addressed to BHS at the Royal College of Surgeons, 35 - 43 Lincoln’s Inn Fields, London WC2A 3PN.
