Why are hip fractures in the elderly so deadly?
In: Biology
And the immobility leads to pressure sores, usually in the buttocks but also anywhere the body is against a surface. In a population that already has reduced capacity to heal. Infections set in
From my understanding, it’s not so much a broken bone as much as it is which broken bone.
The fatality factor stems from immobility.
A broken arm, wrist, even a leg can be put in a cast and they can be given aids to walk, crutches or a walking frame etc.
With the hip broken, you can be made essentially bed bound – which if elderly can lead to much worse issues like blood clots and abnormal muscle tissue from simply not being able to move or use all muscles as normal.
Hope this helps 🙂
Your body’s ability to recover from physical injury slowly deteriorates as you get older. If a kid breaks their arm, they might get a cast for two weeks or so and then its like it never happened. An adult breaking their arm might be four plus weeks and then still have to take it easy with that arm for a few years. Someone elderly? It might not ever heal to completion in the time they have left. Especially if they have any injury that requires surgery, their bodies being more frail just limits the amount surgeons are actually able to do.
Well I have my wood shop and have been making all our furniture so I guess since my ‘real’ job is gone now I can fall back on to that….hopefully.
Roughly 1 in 3 who break their hip pass away within a year. A few pass away from complications related to the hip fracture itself (complications from surgery like blood loss or stress on the heart from anesthesia) and some pass away directly as a result of complications from the decreased mobility in the recovery period (pneumonias, blood clots, pressure sores, etx). However many that pass away don’t fall clearly into one of these groups. This is because the hip fracture itself is a symptom of increasing overall frailty and general poor health. In other words- a significant fraction of the people who pass away after a hip fracture would probably have passed away in that time frame or close to it whether the hip fracture happened or not. When people’s health is declining their balance gets worse, muscles get weaker, and bones get weaker and they are more likely to fall and break their hip in the first place.
There are a lot of factors at play. First, know that the surgery itself is very rarely fatal. 1 year mortality rates are around 25%, depending on the study you look at. Decreased mobility afterwards can lead to blood clots, exacerbate heart disease/heart failure, etc. The incidence of postoperative cognitive decline cannot be discounted either. Many patients lose a step physically & mentally as well from the anesthesia. Both of these factors play a role in the high mortality rate after surgical repair.
I broke my pelvis at the age of 26. I have broken quite a few bones in my life…fingers, arms, spine (twice). *Nothing* more painful or debilitating than the pelvis. Six weeks staring at a ceiling in Bethesda Naval Hospital. Re-learned how to walk in the pool in the basement of the hospital.
I was young and athletic…and the recovery was looong. (I couldn’t have the pelvis surgically repaired because I worked in nuclear reactors and couldn’t have metal in my body).
My mother fell and broke her pelvis at the age of 78. Surgery…threw a bunch of clots and died 48 hours later.
Hip is a big weight bearing joint so you can’t really walk without it. Takes a very long time to heal and be able to walk around normally again. There’s a lot of complications from being immobile for so long.
When you can’t walk, you’re gonna lay in bed all day. You’ll get pressure ulcers on your butt which can create big wounds that get infected. Pretty difficult to keep poop out of wounds on your butt.
When you can’t move your legs, the blood flow in the leg veins slows down a lot. This causes blood clots (deep vein thrombosis) which can migrate to the lungs (pulmonary embolism) which can be fatal.
When you do try to get around, there is a pretty high chance of falling and breaking something else. If you were already having difficulty walking and therefore fell the first time, well it’s gonna be even harder now.
Lots of old people are a bit confused at baseline. Now they’re in pain and they’ll be even more confused. You have an even more confused person who had trouble walking around and now they have even more trouble walking around.
You’ll be in the hospital for a while, after your first fall and surgery, after you get pressure ulcers, after your pulmonary embolism, after your second fall. You might be in and out of the hospital multiple times in a year. Hospitals have all sorts of bad drug resistant bacteria because that’s where all the sick people go to get their infections treated. Every day you’re in the hospital is another day you can get a pneumonia from a nasty drug resistant bacteria. Every day you’re in the hospital is another day you get a Foley catheter associated UTI.
All of the above basically is a “downward spiral” where the first bad misstep leads to a cascade of multiple more missteps. You can go from a “relatively healthy” old person to super super not good shape very quickly.
There are a lot of statistics floating around that when you break your hip, there’s a 50% chance to die in the next year and it’s due to a combination of all of the above.
On top of what everyone else has said (which is mostly true). The hip bone is a very sturdy piece of gear. If that’s breaking easily, it’s a good sign your body in general is pretty fragile. It’s not a coincidence that you rarely hear of people under 60 with a hip fracture.
A broken hip is a sign that your body is failing in other ways.
When I was a paramedic we were taught that it is a “will to live” issue. When an elderly person suddenly loses mobility and independence, sometimes they lose the will to live.
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