FOUR-SCORE YEARS AND TEN: FRACTURE EPIDEMIOLOGY OF THE SUPER-ELDERLY

Abstract

The epidemiology of adult fractures is changing rapidly. The longevity of the population continues to extend with increasing incidence of fragility fractures. The aim of this study was to map the epidemiology of fractures in patients 90 years and older.

A retrospective review of all orthopaedic trauma patients over the age of 89 years attending Edinburgh Royal Infirmary in 2000 was performed. All inpatients and outpatients were included. These patients were identified using a prospectively complied database held by the senior author. Patient notes were used to confirm place of residence, mobility, co-morbidity, management, length of admission and place of discharge.

236 fractures (4% of all fractures) were identified. There were 209 (89%) female patients. All were secondary to low energy trauma. More than 50% of the patients were admitted from home and mobilised independently or with a stick. 124 (53%) patients had nil or one co-morbidity, the commonest being dementia and hypertension. Of the 133 neck of femur (NOF) fractures 11 (8%) died as inpatients, and of the 66 patients residing independently in their own home only 5 (8%) returned with the other 61 needing step-up care. The average length of stay in hospital for NOF fractures was 13 days.

The majority of patients are female and reside at home, being independently mobile and have limited co-morbidity. The length of stay is relatively long and few patients’ return directly home following a NOF fracture. This, with the ever-growing super-elderly population, will have substantial financial implications in the future.