Volume 4 Issue 2 February, 2014
Consultation Liaison Psychiatry Focus: ‘Orthopaedics’
Hip is constituted by proximal femur and acetabulum. It’s a ball and socket joint. Hip fractures are the most severe type
of fall-related injuries among elderly patients and are associated with high morbidity, mortality and impairment in
quality of life. Fracture of hip generally means fracture of proximal femur which can be of head, neck (30%) or
peritrochanter (70%). The mean age at which hip fractures occur in Indian population is 58 years. It usually occurs due to low velocity injury; fall on ground being more common for reasons like impaired vision, ambulation, decreased reaction time, muscle weakness and various drugs they consume at that age. Incidence is more common among women.
When hip fracture happens in elderly they are subjected not only to physical trauma, also they are psychologically
traumatized as they become physically, economically dependent on care givers. Various psychiatric illnesses starts or pre existing illness precipitates. Not only the bone is broken, but also the heart and mind!! These aspects have long been neglected.
Unspecified cognitive impairment, delirium and depression are some of the common psychiatric illness reported. Added to this, drugs used in anesthesia, pain management, electrolyte imbalance and nutritional deficiency worsens the pre existing illness or the illness that sets in. People with co-morbid substance abuse particularly Alcoholics may develop delirium tremens.
Psychiatric illness in patients with hip fracture increases burden, financially and emotionally on the patients, care givers,
doctors and hospital staffs. Duration of hospital stay is increased. Such patients are more prone for complications of
fracture like, infection. Even at later stage they suffer impaired quality of life and persistent physical morbidity.
Therefore psychiatric intervention is required in such patients with adequate follow up. Psychiatric screening of elderly
patients with hip fracture at admission is necessary. This enables early detection of psychiatric morbidity, better
psychiatric care, early discharge and substantial cost savings.
Doctors, hospital staff, family members, care givers should be involved in rehabilitation of such patients. Adequate
physical environment, financial support should be provided. Such patients should be counseled. They should feel that
they are no burden to the family and care givers. They should be motivated to become physically and psychologically
independent at the earliest.
Therefore psychiatric liaison in the management of patients with hip fracture is necessary. More efforts need to be put
in this direction. Awareness should be created among doctors, hospital staff, family, and care givers and they must be
trained for early detection and management to prevent psychiatric morbidity, for better care, early independence
physically and psychologically.
Dr. Raghu H R., MBBS, MS (Ortho), Asst.Prof, Dept. of Orthopaedics BGS Global Institute of Medical Scinces, Bangalore.
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