the break itself than with the response
to the break, not just in the hours
immediately following but also in the
weeks and months post-injury.
NO T SURPRISINGLY, most young people
who fall don’t break a hip. When a person’s bones are strong, the hip resists
fracturing except from significant
trauma, such as a car accident or a fall
from a ladder. But as we age and our
bones weaken, a fall that our children
or grandchildren might walk away
from could put us in the hospital, facing major surgery. That surgery carries risks, yet so does the immobility
caused by a broken hip. When you’re
bedridden and hospitalized, your
odds of everything from bedsores to
pneumonia increase dramatically.
FROM TOP: ILLUSTRATION BY CHI BIRMINGHAM; ILLUSTRATION BY GAVIN POTENZA. SNACKING SOURCE: INSTITUTE OF FOOD TECHNOLOGISTS
As people age, they also experience
what doctors call comorbidity—
multiple ailments at the same time.
“Most older adults have at least one
chronic condition, such as diabetes
or heart problems. Many have two.
Then they fall and break a hip. Their
whole system is thrown into a tizzy,”
says Lynn Beattie, vice president of
injury prevention for the Center for
Healthy Aging in Washington, D. C.
TWO TYPES OF BONE
GOOD BONE
A healthy bone
is thick and
dense, which
can help
absorb the
impact if you
happen to fall.
SNACK A TTACK A new study finds that snacking
accounts for more than 25 percent of calorie intake
among Americans, or about 580 calories each day.
“A hip fracture is an insult to the
system, and that changes many meta-
bolic functions,” adds Jay Magaziner,
Ph.D., chair of the department of
epidemiology and public health at
the University of Maryland School of
Medicine in Baltimore and an expert
on hip fractures. “If you have people
who are struggling to begin with, this
will make it worse. There is some-
thing about this kind of injury that
amplifies things.”
You can, however, improve the
odds. The first thing to do is repair
the hip as soon as possible. A recent
study in the Canadian Medical
Association Journal finds that the
risk of death from a hip fracture
declined by 19 percent when surgery
was performed within three days of
the break.
Assuming reasonably good health
at the time of the fracture, standard
care consists of surgery within 48
hours, for a total of four to six days in
the hospital, followed by two to six
weeks in a subacute rehabilitation
facility, with another three to four
weeks of outpatient or home-based
rehabilitation.
Then the real work begins—a point
BONE LOSS
People with
osteoporosis
have thinner
bones, which
are susceptible
to fracturing
during a fall.
lost on many who have endured a hip
fracture.
“It’s not the fall, but the response
to the fall,” says Patti League, R.N.,
lead trainer of A Matter of Balance, a
program that works with older adults
to reduce their fear of falling. “How
do you live after the services end?
How do you keep your fear of falling
again in check? In short, how do you
get your life back?”
The answers are both simple and
complex. Simple in that you must take
advantage of all services available
until you are back to where you were
before the fracture. Complex in that
older adults are fighting a powerful
bias that says partial recovery is okay.
“We like to say it’s only a broken
bone, and bones heal,” says Rebecca
Craik, Ph.D., chair of the department
of physical therapy at Arcadia Univer-
sity in Glenside, Pennsylvania. “But
when you’re an older adult, the bar
is often set too low. ‘It’s good enough
just to be home. It’s time in your life
to rest.’ Patients and their caregivers
often don’t push to get where they
were before the surgery.”
Part of the problem, Magaziner
says, is that after a few months, just as
the patient gains the ability to endure
the intense physical therapy that will
restore pre-fracture mobility and
functionality, the infrastructure for
care evaporates. What’s needed, he
believes, is continuing, reimbursed,
multicomponent intervention tai-
lored to each patient.
After a week in a hospital and nearly two months of physical therapy,
Isabelle Jackson relied on a daily
dose of short walks and volunteer
activities to restore her physical and
mental well-being. “Therapy was a
lot of work,” she says. “You have to
make up your mind that you are going
to do it. It’s all about attitude.” ;
Tom Slear is a freelancer who writes
frequently about medical issues.
