6 ms·

I once overheard a doctor say something which has always stayed with me, along the lines that after a certain age then once you're off your feet for any length

by hanoz 7y ago

I once overheard a doctor say something which has always stayed with me, along the lines that after a certain age then once you're off your feet for any length of time, then that in itself puts you in big trouble.

JshWright 7y ago
This is why hip fractures are often "the beginning of the end". When someone over the age of 65 breaks their hip, there is a ~50% chance they'll be dead within a year.
- peeters 7y ago
  Do you have a source for that number by chance (assuming it wasn't just off the cuff)? I understand and don't argue the idea, but 65 isn't passing my smell test, that seems absurdly young.
  - luu 7y ago
    This study claims 28% mortality, 46% moderate-severe disability, 26% able to live independently after one year. https://www.ncbi.nlm.nih.gov/pubmed/31810636 https://www.ncbi.nlm.nih.gov/pubmed/31810636 METHODS: Older adults aged ≥65 years were included if they had an isolated hip fracture, were admitted to hospital between July 2009 and June 2016, inclusive, and were registered to the Victorian Orthopaedic Trauma Outcomes Registry. Mortality up to 12 months (365 days) post-injury, and functional outcomes (Glasgow Outcome Scale-Extended; GOS-E) at 12 months post-injury were examined. Multivariable Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs), and multivariable logistic regression was used to identify predictors of living independently compared with severe disability or death on the GOS-E. RESULTS: 4,912 patients were included, of whom 28% died, 46% had moderate-severe disability, and 26% were living independently 12 months post-injury. Mortality rates were lower in women (aHR=0.56, 95%CI: 0.50, 0.63), and in people injured in a high fall vs low fall (aHR=0.47, 95%CI: 0.31, 0.72). Mortality rates were higher in people in the older age groups (75-84 years: aHR=1.53, 95%CI: 1.21, 1.93; 95+ years: aHR=3.58, 95%CI: 2.68, 4.77), living in areas with the highest level of socioeconomic disadvantage (aHR=1.25, 95%CI: 1.01, 1.55), with a Charlson Comorbidity Index weighting of one (aHR=1.60, 95%CI: 1.36, 1.88) or more than one (aHR=2.21, 95%CI: 1.94, 2.53), whose injury occurred in a residential institution versus at home (aHR=2.63, 95%CI: 1.97, 3.52), that resulted in intensive care unit admission (aHR=1.68, 95%CI: 1.21, 2.32), and in people who did not have surgery versus people who had internal fixation (aHR=1.65, 95%CI: 1.33, 2.04). Independent living was inversely associated with most of the same characteristics; however, people also had lower odds of living independently if they were from metropolitan residential areas versus rural areas (aOR=0.77, 95%CI: 0.62, 0.96), or had mild to moderate (aOR=0.33, 95%CI: 0.27, 0.39) or marked to severe (aOR=0.13, 95%CI: 0.09, 0.20) preinjury disability vs no preinjury disability. Relatedly, this study from the same institution claims 5% mortality rate after a year for people under 65: https://www.ncbi.nlm.nih.gov/pubmed/27527378 https://www.ncbi.nlm.nih.gov/pubmed/27527378
    - AstralStorm 7y ago
      This suggests that sicker people get more disabled by surgery. Which we already knew. (Similarly institutionalised or not independent = sicker, having comorbidities, low fall injury suggests balance problems or advanced osteoporosis = sicker, just older = likely sicker) But it does point slightly towards surgery bring beneficial (fixation reduced risk)
  - sambroner 7y ago
    Just to tune your smell test, my suspicion is that the vast majority of people over 65 that break their hip are somewhere on the frailty scale from this article. Healthy people are very unlikely to trip and break their hip.
    - alkonaut 7y ago
      “Once someone who’d likely die from a broken hip breaks their hip, they are likely to die” This passes the smell test without problem.
    - newnewpdro 7y ago
      Post-menopausal women tend to suffer from osteoporosis, their bones are weak and all it takes is a fall. My grandfather who rode a bicycle everywhere into his 80s, never owned an automobile (Europe) broke his hip in a minor fall. He was moved to the USA to get the operation and lived with us permanently afterwards, it was definitely the beginning of the end.
      - superpermutat0r 7y ago
        https://www.youtube.com/watch?v=k6GHHzIByOk https://www.youtube.com/watch?v=k6GHHzIByOk Pretty simple way to reverse the osteoporosis.
        AstralStorm 7y ago
        Give me the RCTs proving that anything actually reverses osteoporosis. Best we have is minor prevention with effect sizes of below 20%. This including special exercises combined with collagen rich diet, D3, K2 and bisphosphonates. Teriparatide shows promise in reversal but effect sizes are low too. The main result is prolonging age until occurrence anyway, not prevention. And definitely not cure.
        newnewpdro 7y ago
        Are you trolling or do you actually believe that's "reversing osteoporosis"? It's just pushing it back a bit, of course she saw some improvement relative to a completely sedentary condition and that's great. It's not going to stay on that trajectory indefinitely, which is what's implied by "reverse".
- jackcodes 7y ago
  Thinking of my own experience with family, my guess is that a bone breaking is a symptom and not a cause here for this statistic. People lose their balance and get confused with Alzheimer’s and the like and my uninformed guess is that the breaking bone highlights that someone is on the way out anyway, and isn’t the reason for it.
  - jacquesm 7y ago
    People break their bones faster when they are older due to calcium deficiency. So that's a symptom but not of what you are thinking.
27182818284 7y ago
Same. I heard something from an RN like "If you break a bone after this age, you have 6 months to live" Every. Single. Time. since then this has been true in my anecdotal experience. Sometimes I've really regretted mentioning it because I've mentioned it to coworkers sort of casually and then, sure enough, their parent was dead within 6 months of the break. After the first few came true I said it more seriously like, "Listen, you need to prepare for their death..."
- rayhendricks 7y ago
  Took a healthcare economics class in college and heard the same thing. Basically if an older person breaks their pelvis or enters assisted living...they ain’t coming out.
- paulcole 7y ago
  At some point your frankness at work is going to come back to bite you. Honestly smarter to just stay quiet. “Your mom’s gonna croak by Christmas” tends to not go over well with everyone.
  - astura 7y ago
    Seriously. The only appropriate thing to see say to a co-worker in that situation is a polite "I'm so sorry to hear about that, I hope your mom feels better soon." Keep the prepare for death conversations for close friends and family. Even if in was a close friend you happened to work with, the workplace is not an appropriate place for such a conversation.
    - AstralStorm 7y ago
      Why is it not an appropriate place? What is an appropriate place? Do you get to spend over 2/3 of waking time there? If you do not wish to discuss it with coworkers, some of whom may or may not be friends, it's your choice to raise them or not. Focusing the attention on important matters could be done tactfully, which is very different from not talking about things. If it's by fiat, there is an ulterior motive of "think happy thoughts, preferably shallow". There are such workspaces. There are also those that keep grave silence by fiat or unspoken convention.
gadders 7y ago
That's why strength training should be a priority. Lifelong if possible, but even as you age: https://startingstrength.com/article/strength-training-for-people-my-age https://startingstrength.com/article/strength-training-for-p...
kuschku 7y ago
This isn't necessarily age-related - people at all ages need to be back upright, and ideally back walking on their own feet, as soon as possible again. I've got a planned surgery coming up in february (I'm 23), and despite it being a major surgery, part of the recovery process is that I'll have to be able to stand upright - even if just for a few minutes per day - already on the first day after surgery. This is also why, if you absolutely have to stay in bed, you should use the remote for your hospital bed to at least sit in bed for as much time as possible (and why you should buy beds which have such a mode at home, too)

by hanoz 7y ago

JshWright 7y ago

This is why hip fractures are often "the beginning of the end". When someone over the age of 65 breaks their hip, there is a ~50% chance they'll be dead within a year.

peeters 7y ago
Do you have a source for that number by chance (assuming it wasn't just off the cuff)? I understand and don't argue the idea, but 65 isn't passing my smell test, that seems absurdly young.
- luu 7y ago
  This study claims 28% mortality, 46% moderate-severe disability, 26% able to live independently after one year. https://www.ncbi.nlm.nih.gov/pubmed/31810636 https://www.ncbi.nlm.nih.gov/pubmed/31810636 METHODS: Older adults aged ≥65 years were included if they had an isolated hip fracture, were admitted to hospital between July 2009 and June 2016, inclusive, and were registered to the Victorian Orthopaedic Trauma Outcomes Registry. Mortality up to 12 months (365 days) post-injury, and functional outcomes (Glasgow Outcome Scale-Extended; GOS-E) at 12 months post-injury were examined. Multivariable Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs), and multivariable logistic regression was used to identify predictors of living independently compared with severe disability or death on the GOS-E. RESULTS: 4,912 patients were included, of whom 28% died, 46% had moderate-severe disability, and 26% were living independently 12 months post-injury. Mortality rates were lower in women (aHR=0.56, 95%CI: 0.50, 0.63), and in people injured in a high fall vs low fall (aHR=0.47, 95%CI: 0.31, 0.72). Mortality rates were higher in people in the older age groups (75-84 years: aHR=1.53, 95%CI: 1.21, 1.93; 95+ years: aHR=3.58, 95%CI: 2.68, 4.77), living in areas with the highest level of socioeconomic disadvantage (aHR=1.25, 95%CI: 1.01, 1.55), with a Charlson Comorbidity Index weighting of one (aHR=1.60, 95%CI: 1.36, 1.88) or more than one (aHR=2.21, 95%CI: 1.94, 2.53), whose injury occurred in a residential institution versus at home (aHR=2.63, 95%CI: 1.97, 3.52), that resulted in intensive care unit admission (aHR=1.68, 95%CI: 1.21, 2.32), and in people who did not have surgery versus people who had internal fixation (aHR=1.65, 95%CI: 1.33, 2.04). Independent living was inversely associated with most of the same characteristics; however, people also had lower odds of living independently if they were from metropolitan residential areas versus rural areas (aOR=0.77, 95%CI: 0.62, 0.96), or had mild to moderate (aOR=0.33, 95%CI: 0.27, 0.39) or marked to severe (aOR=0.13, 95%CI: 0.09, 0.20) preinjury disability vs no preinjury disability. Relatedly, this study from the same institution claims 5% mortality rate after a year for people under 65: https://www.ncbi.nlm.nih.gov/pubmed/27527378 https://www.ncbi.nlm.nih.gov/pubmed/27527378
  - AstralStorm 7y ago
    This suggests that sicker people get more disabled by surgery. Which we already knew. (Similarly institutionalised or not independent = sicker, having comorbidities, low fall injury suggests balance problems or advanced osteoporosis = sicker, just older = likely sicker) But it does point slightly towards surgery bring beneficial (fixation reduced risk)
- sambroner 7y ago
  Just to tune your smell test, my suspicion is that the vast majority of people over 65 that break their hip are somewhere on the frailty scale from this article. Healthy people are very unlikely to trip and break their hip.
  - alkonaut 7y ago
    “Once someone who’d likely die from a broken hip breaks their hip, they are likely to die” This passes the smell test without problem.
  - newnewpdro 7y ago
    Post-menopausal women tend to suffer from osteoporosis, their bones are weak and all it takes is a fall. My grandfather who rode a bicycle everywhere into his 80s, never owned an automobile (Europe) broke his hip in a minor fall. He was moved to the USA to get the operation and lived with us permanently afterwards, it was definitely the beginning of the end.
    - superpermutat0r 7y ago
      https://www.youtube.com/watch?v=k6GHHzIByOk https://www.youtube.com/watch?v=k6GHHzIByOk Pretty simple way to reverse the osteoporosis.
      - AstralStorm 7y ago
        Give me the RCTs proving that anything actually reverses osteoporosis. Best we have is minor prevention with effect sizes of below 20%. This including special exercises combined with collagen rich diet, D3, K2 and bisphosphonates. Teriparatide shows promise in reversal but effect sizes are low too. The main result is prolonging age until occurrence anyway, not prevention. And definitely not cure.
      - newnewpdro 7y ago
        Are you trolling or do you actually believe that's "reversing osteoporosis"? It's just pushing it back a bit, of course she saw some improvement relative to a completely sedentary condition and that's great. It's not going to stay on that trajectory indefinitely, which is what's implied by "reverse".
jackcodes 7y ago
Thinking of my own experience with family, my guess is that a bone breaking is a symptom and not a cause here for this statistic. People lose their balance and get confused with Alzheimer’s and the like and my uninformed guess is that the breaking bone highlights that someone is on the way out anyway, and isn’t the reason for it.
- jacquesm 7y ago
  People break their bones faster when they are older due to calcium deficiency. So that's a symptom but not of what you are thinking.

27182818284 7y ago

Same. I heard something from an RN like "If you break a bone after this age, you have 6 months to live" Every. Single. Time. since then this has been true in my anecdotal experience. Sometimes I've really regretted mentioning it because I've mentioned it to coworkers sort of casually and then, sure enough, their parent was dead within 6 months of the break. After the first few came true I said it more seriously like, "Listen, you need to prepare for their death..."

rayhendricks 7y ago
Took a healthcare economics class in college and heard the same thing. Basically if an older person breaks their pelvis or enters assisted living...they ain’t coming out.
paulcole 7y ago
At some point your frankness at work is going to come back to bite you. Honestly smarter to just stay quiet. “Your mom’s gonna croak by Christmas” tends to not go over well with everyone.
- astura 7y ago
  Seriously. The only appropriate thing to see say to a co-worker in that situation is a polite "I'm so sorry to hear about that, I hope your mom feels better soon." Keep the prepare for death conversations for close friends and family. Even if in was a close friend you happened to work with, the workplace is not an appropriate place for such a conversation.
  - AstralStorm 7y ago
    Why is it not an appropriate place? What is an appropriate place? Do you get to spend over 2/3 of waking time there? If you do not wish to discuss it with coworkers, some of whom may or may not be friends, it's your choice to raise them or not. Focusing the attention on important matters could be done tactfully, which is very different from not talking about things. If it's by fiat, there is an ulterior motive of "think happy thoughts, preferably shallow". There are such workspaces. There are also those that keep grave silence by fiat or unspoken convention.

gadders 7y ago

That's why strength training should be a priority. Lifelong if possible, but even as you age: https://startingstrength.com/article/strength-training-for-people-my-age https://startingstrength.com/article/strength-training-for-p...

kuschku 7y ago

This isn't necessarily age-related - people at all ages need to be back upright, and ideally back walking on their own feet, as soon as possible again. I've got a planned surgery coming up in february (I'm 23), and despite it being a major surgery, part of the recovery process is that I'll have to be able to stand upright - even if just for a few minutes per day - already on the first day after surgery. This is also why, if you absolutely have to stay in bed, you should use the remote for your hospital bed to at least sit in bed for as much time as possible (and why you should buy beds which have such a mode at home, too)