Management of older adults with hip fractures in India: a mixed methods study of current practice, barriers and facilitators, with recommendations to improve care pathways

摘要

PurposeHip fracture in older adults is a significant public health issue in India. The current studysought to document current practices, identify barriers and facilitators to adopting bestpractice guidelines and recommend improvements in the management of older adultswith hip fractures in Delhi, India.MethodsThis mixed methods observational study collected data from healthcare providers,patients, carers and medical records from three major public tertiary care hospitals inDelhi, India. All patients aged ≥50 years with an X-ray confirmed hip fracture that wereadmitted to these hospitals over a 10-week period were recruited. Patients' data werecollected at admission, discharge and 30-day post injury. Eleven key informantinterviews and four focus group discussions were conducted with healthcare providers.Descriptive data for key quantitative variables were computed. The qualitative datawere analysed and interpreted using a behaviour change wheel framework.ResultsA total of 136 patients, 74 (54%) men and 62 women, with hip fracture were identifiedin the three participating hospitals during the recruitment period and only 85 (63%)were admitted for treatment with a mean age of 66.5 years (SD 11.9). Of these, 30%received surgery within 48 hours of hospital admission,95% received surgery within 39days of hospital admission and two (3%) had died by 30-days of injury. According tothe health care providers; inadequate resources and overcrowding prevent adequatecaring of the hip fracture patients. They unanimously felt the need for protocols basedmanagement of hip fracture in India.ConclusionThe development and implementation of national guidelines and standardisedprotocols of care for older people with hip fractures in India, has the potential toimprove both care and patient-related outcomes.