Why are hip fractures in the elderly so deadly?
In: Biology
There are a few reasons.
First, they’re old. Their body doesn’t heal like it used to. Broken bones are sharp. There’s a chance that the bone causes more damage internally.
They’re sick. They have lots of other health problems. This can effect how long it takes them to recover.
They’re fragile. Most hip fractures are accompanied by a fall. What most people don’t know, is that usually the hip fracture occurs first, which then causes the fall. They often hit things on their way down. Usually their head. The blood vessels, especially in the head, are also more fragile. This only makes things worse. A bonk on the head can cause irreversible brain hemorrhage which can be deadly or leave them totally dependent on others.
They’re on lots of meds. Goes hand in hand with the last 2 points. Maybe they’re on blood thinners. Even a simple fall on blood thinners can be lethal. Maybe they’re a diabetic and fell in between taking their meds and eating. So now they’re laying on the floor while their sugar is crashing because…
They’re weak. They don’t have the body strength to pick themselves up. They can’t drag themselves to the door or the phone to call for help. So they lay there and scream, except…
They’re alone. This happens most in older folk that live alone or with another elderly spouse. If they’re alone, they have no one coming to help them. Until family hasn’t heard from them in awhile, or the mail piles up, or someone finally hears screaming. Why can’t they use their cell phone?
They grew up without it. They aren’t used to carrying a phone around everywhere. A mobile phone is a relatively new invention for them. They also may or may not have the ability to see the screen. Maybe their glasses fell off. Maybe they cant roll around to get their body weight off the phone so that they can get it out of their pocket.
So they lay there. Until they’re found. Or until someone notices they’re gone. And then it’s too late.
ELI5: imagine if we left your baby brother home alone, and an emergency happened. He couldn’t get up and get help. He couldn’t help himself. He couldn’t call for help. All he could do is lay there and cry for help. He’d be entirely dependent on someone else coming to help him.
Life alert / medical alert pendants save lives. Do they get inadvertently activated sometimes? Sure. But they absolutely save lives for their designed audience. If you have an elderly person in your life that lives alone, they need one. If I had to recommend a single piece of equipment to elderly people for safety, it’s one of those.
Nurse here. It often leads to a lengthy hospital admission which is a dangerous place to be, particularly for older adults. Things like hospital acquired pneumonia and sepsis is very common. There is also deconditioning, pressure injuries and blood clots caused by immobility. Then there’s delirium caused by opiates or a UTI that ends up as urosepsis. I haven’t even touched on the surgical and assosciated infection risks.There’s just so many things I could talk about that can and do go wrong among older adults in hospitals. Throwing a fracture in the mix is sadly a death sentence for most older adults
Edit: Not exactly ELI5 but I’m sure you understand
You have large arteries that go through your pelvis and your pelvic cavity can hold more than enough blood to cause someone to bleed to death of one of those arteries are ruptured.
Then there’s the chronic decline that can happen when an old person fractures a hip. Basically, your health can decline really quickly if you aren’t moving. Your circulation gets worse and you lose muscle tone. Your cardiovascular health declines because you aren’t getting any exercise. All this can happen quickly to elderly people and they don’t recover as quickly from injuries. So a fractured bone can be the beginning of the end for an old person.
Generally, healthy people don’t fall and break their hip. On top of that, most hip fractures require some type of surgical fixation, and that can be a traumatic process, especially for someone who isn’t particularly well optimized for surgery. There is also a risk of anemia, blood clots, hardware failure and infection. On top of that, despite that physical therapy is initiated ASAP; often same day, there is often subsequent deconditioning, as well as a risk of subsequent dislocation (depending on the type of fracture and surgery) which sometimes requires revision surgery.
Source: Am an ortho surgery PA who’s first call for a major trauma hospital
My grandad died from this recently at 98.
They have to operate – and put them under and you end up with the anaesthetic repressing the breathing – so they manually breathe for them. They come out of the anaesthetic in pain so need relief which suppresses the breathing.
It then becomes a losing battle. It’s going to be a year of rehab when they are elderly and infirm and unlikely to live past the rehab anyway.
So you either lay off the pain meds and watch them be in pain for a long time when they havnt got long to live anyway – or you keep them on the pain meds and say goodbye.
Vale Stan the Man!!!!! Feb 2024!!!
1. As everyone already mentioned decreased mobility is a huge risk factor, this puts people at a massively increased risk of all sorts of circulatory diseases but also pneumonia, which is one of the most common causes of death following hip fractures.
2. Deep vein thrombosis is most common in the legs and the immobility combined with the injury itself can cause a blood clot that can turn into a deadly embolism.
3. Hip fractures happen almost exclusively to old people with lots of comorbidities, so it’s often the most at risk of the risk.
Immobility leads to a higher chance of pulmonary embolus/blood clots which can be fatal. Reduced mobility leads to more likelihood of pneumonia as well. Overall loss of independence results in higher morbidity, more hospitalizations, higher likelihood of falling and subsequent injury and illness. Not fixing a hip fracture results in an extremely high likelihood of death within a year as you result in a bed bound patient who spirals downward in health.
Think of daily body tasks like juggling balls, but the older you get the more delicate the balance of these balls is, and the more fragile the balls become. One wrong move and you drop them and they break. A broken hip brings all normal body tasks to a halt because you’re stuck laying in bed. That’s enough to drop all your glass balls: you’re no longer mobile so things in the body stop working. Your ability to clear your lungs especially goes down and pneumonia can set in pretty easily. Your bowels move slower when you’re not walking around so you can get constipation issues and that can mess up other body systems real quick.
When you’re old enough, a broken hip means you’ll never walk again because your body will just kinda decay in the meantime.
An orthopedist once told me that a huge factor is how much energy the body expends healing fractures. If one is fragile (in terms of health) and then placed additional demands on the body to not only live “normally” but also heal a fracture, the body can not keep up with demand.
Blood clots. My grand mother broke her wrist had it treated put in a cast came home. Woke up the next morning ate a bowl of cereal wel talked said she was gonna lay back down and never got back up.
Latest Answers