Recent data from the Centers for Disease Control illumines an alarming rate of hip fractures in the U.S. An estimated 300,000 adults over 65 experience a hip fracture each year, with over 95% of those being caused by a fall. Women are 3 to 4x as likely as men to experience a hip fracture in part because they have greater rates of osteoporosis and are more likely to fall.

Hip fractures create a grave and potentially devastating situation for older adults. Not only is overall physical health and mobility negatively affected by a hip fracture, but risk of infection, cognitive decline, social isolation, and financial burden become mounting challenges as well. In many cases, hip fractures are the beginning domino to fall in a series of events that leads to death.

A 2014 report which measured mortality rates of hip fracture patients over 65 versus a control group found an increased mortality risk for those patients who experience a hip fracture - the main cause of death being sepsis. Long hospital stays, mismanagement of soft tissues, improper aseptic techniques during surgery, as well as age, existing chronic illness, and dementia which affected correct surgical wound dressing were all attributed to the rates of fatal infection. It is believed that potentially half of all hip fracture patients die within 6 months, and that more often than not, hip fracture patients are unable to return to normal living and basic functioning.

Pairing an understanding of the rates of hip fractures and ensuing complications with a look at rehospitalization rates of older adults paints an even more comprehensive picture.

In 2009, the New England Journal of Medicine released a report regarding re-hospitalization rates of Medicare recipients and the findings were astonishing. In a review of Medicare claims looking at an estimated 11.8M beneficiaries from 2003 to 2004 they found that:

*While Medicare does cover some patients under the age of 65 who have chronic disability, roughly 5 out of 6 Medicare beneficiaries are over the age of 65 according to a 2016 overview of Medicare from the Kaiser Family Foundation.

Not only did these findings shed light on a stark reality that post-hospital care, doctor follow-up, and caregiver support was lacking, but it was a driving force behind 2012 healthcare reform. The Affordable Care Act enacted in 2012 incorporated a brand new program focused on decreasing rehospitalization rates called the Hospital Readmissions Reduction Program. Medicare penalties played an important role in the program in that they would essentially fine hospitals for frequent readmissions of the same Medicare patients. The idea was to encourage quality care improvement, broaden the scope of post-discharge caregiver and patient support, as well as foster greater institutional support in staff training and rehospitalization reduction.

The Kaiser Family Foundation reports that in the past five years since the HRRP was enacted, hospital readmissions rates have declined. An estimated $528M in penalties will be assessed against hospitals in 2017 not meeting HRRP standards, however, implementation issues continue to be discussed as program guidelines are updated to meet inclusion of additional medical conditions and socioeconomic adjustments.

When it comes to hip fractures, the formula is clear. Patients 65 and older are not only more likely to experience a fall, most often in their own home, but from that fall they are incredibly likely to fracture a hip (typically from a sideways fall). From there, chances of developing an infection are high as is risk of dying.

What does this mean for clinicians? Formulating a strategic and effective plan for avoiding rehospitalization involves everything from equipping patients with easy to follow at-home treatment plans and medicine adherence guides, to educating caregivers about changing wound dressings, to encouraging rehabilitation with physical therapy and even gentle yoga for seniors. In addition to continuing to improve quality of care from surgery to day to day in-patient hospital treatment, it is absolutely necessary to seek out better post-discharge follow-up and communication with treating doctors and physical therapists.

The Baby Boomer generation will officially induct its last member into the 65+ age group around the year 2030, making it the second largest generation in the U.S. Hopefully proactive and precautionary steps taken by both healthcare institutions and patients will drive the hip fracture trend down.