Abstract
Hip fracture is prevalent among elderly people, and it is more complicated in that group than in younger people because elderly people are more likely to have plural general comorbidities and have reduced physical function due to osteoporosis. Many studies have compared the progress of rehabilitation and length of hospital stay before and after introducing the use of critical pathways for hip fracture patients, but there are no clear criteria for the type of patients who qualify for the critical pathway, and the standards for qualification are different among clinicians. There are few studies about these criteria. This study was performed to explore the criteria and ratio of patients who stopped using critical pathways and to compare complications and patients' outcome between those who used critical pathways and those who did not. Data were collected from three hospitals that had introduced critical pathways in the care of hip fractures in Japan.
Although no comorbidities were significantly related to whether critical pathways were used or not, dementia was shown to be the most common reason for not using critical pathways. Dementia and delirium were significantly related to stopping the use of critical pathways. The possibility that patients with dementia stopped using critical pathways was high, and the outcomes of patients with dementia were difficult to assess;therefore, it is reasonable to assume dementia to be one of the reasons for not using critical pathways. In addition, it is necessary to consider the special critical pathways needed for people who have dementia, instead of not using critical pathways with them at all.
