Fracture & Frailty

Lead investigators: Dr Kareeann Khow PhD Candidate, Professor Renuka Visvanathan, Assoc Prof Solomon Yu, Assoc Prof Mellick Chehade and Dr Pazhvoor Shibu

Hip fractures in older people are costly to healthcare system because of adverse outcomes. These fractures are commonly associated with significant blood loss, either from the fracture itself or postoperatively, resulting in anaemia. Consequently, blood transfusion is required but has associated risks. Anaemia may develop at different time points of a hip fracture with potentially differing effects on clinical outcomes such as mortality, postoperative functional recovery, length of hospital stay and readmission rates. Most studies examined the association of anaemia at various time points but no study has examined the impact of change in haemoglobin levels (i.e. discharge compared with pre-admission levels) on outcomes.

Frailty is also another important risk factor for adverse clinical outcomes after hip fractures. A systematic review of studies on perioperative anaemia and clinical outcomes in hip fracture surgery is currently being undertaken. This will be followed by an observational study on older people with hip fractures treated surgically to examine the relationship between peri-operative haemoglobin levels, blood transfusion, frailty and clinical outcomes. This research will provide vital data on future interventional studies to manage perioperative anaemia and frailty with hip fractures.

Media contact: Dr Kareeann Khow

Lead investigators: Mr. Unyime Jasper, Professor Renuka Visvanathan, A/Prof Solomon Yu, Dr Agathe Daria Jadcazk, Dr Joanne Dollard, Dr Mellick Chehade, and Dr Olga Theou

This project that aims to reduce sedentary behaviour and increase physical activity in older people following surgery for hip fracture by conducting three (3) studies.

The first is a scoping review of the epidemiology, assessment and treatment of sedentary behaviour and physical activity in hospitalised older people.

The second study will explore the knowledge, attitude and willingness to change sedentary behaviour and increase physical activity among older medical and orthopaedic patients and their carers. The knowledge of sedentary behaviour and physical activity, current strategies employed to reduce sedentary behaviour and concerns relating to reducing sedentary behaviour in older patients will be explored among clinical staff. These findings will be used to refine the intervention in the 3rd study.

The third study is an intervention to reduce sedentary behaviour and increase physical activity in older people following surgery for hip fracture. It is a is a pre-post design, with the control phase (pre) taking place over 6 months and the intervention phase (post) also lasting 6 months. The control arm will receive usual care, while the intervention arm will receive usual care + intervention. The intervention include: real-time objective feedback on level of sedentary behaviour and physical activity, extra exercises, goal-setting as well as health coaching. ActiGraph will provide objective feedback and physiotherapists will set daily goals with regards to step counts and number of times to break sedentary time. Health staff will be educated on sedentary behaviour and physical activity and they will in turn coach participants and family members on the benefits of breaking sedentary behaviour and increasing activity. The primary outcome is level of sedentary behaviour and physical activity measured by ActivPAL. The perspectives of participants, carers and staff will be evaluated in an acceptability study. It is expected that this intervention will help reduce sedentary behaviour and increase physical activity in older people following surgery for hip fracture.

Media contact: Unyime Jasper