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Background Hip fractures are an increasingly common consequence of falls in older people that are associated with a high risk of death and reduced function. This review aims to quantify the impact of hip fracture on older people’s abilities and quality of life over the long term. Methods Studies were identified through PubMed and Scopus searches and contact with experts. Cohort studies of hip fracture patients reporting outcomes 3 months post-fracture or longer were included for review. Outcomes of mobility, participation in domestic and community activities, health, accommodation or quality of life were categorised according to the World Health Organization’s International Classification of Functioning and synthesised narratively. Risk of bias was assessed according to four items from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Results Thirty-eight studies from 42 publications were included for review. Most followed a clearly defined sample from the time of fracture. Hip fracture survivors experienced significantly worse mobility, independence in function, health, quality of life and higher rates of institutionalisation than age matched controls. The bulk of recovery of walking ability and activities for daily living occurred within 6 months after fracture. Between 40 and 60 % of study participants recovered their pre-fracture level of mobility and ability to perform instrumental activities of daily living, while 40–70 % regained their level of independence for basic activities of daily living. For people independent in self-care pre-fracture, 20–60 % required assistance for various tasks 1 and 2 years after fracture. Fewer people living in residential care recovered their level of function than those living in the community. In Western nations, 10–20 % of hip fracture patients are institutionalised following fracture. Few studies reported impact on participation in domestic, community, social and civic life. Conclusions Hip fracture has a substantial impact on older peoples’ medium- to longer-term abilities, function, quality of life and accommodation. These studies indicate the range of current outcomes rather than potential improvements with different interventional approaches. Future studies should measure impact on life participation and determine the proportion of people that regain their pre-fracture level of functioning to investigate strategies for improving these important outcomes.

This study evaluated whether frequent (fortnightly) audit and feedback cycles over a sustained period of time (>12 months) increased clinician adherence to recommended guidelines in acquired brain injury rehabilitation. A before and after study design. A metropolitan inpatient brain injury rehabilitation unit. Clinicians; medical, nursing and allied health staff. Fortnightly cycles of audit and feedback for 14 months. Each fortnight, medical file and observational audits were completed against 114 clinical indicators. Adherence to guideline indicators before and after intervention, calculated by proportions, Mann-Whitney U and Chi square analysis. Clinical and statistical significant improvements in median clinical indicator adherence were found immediately following the audit and feedback program from 38.8% (95% CI 34.3 to 44.4) to 83.6% (95% CI 81.8 to 88.5). Three months after cessation of the intervention, median adherence had decreased from 82.3% to 76.6% (95% CI 72.7 to 83.3, p<0.01). Findings suggest that there are individual indicators which are more amenable to change using an audit and feedback program. A fortnightly audit and feedback program increased clinicians' adherence to guideline recommendations in an inpatient acquired brain injury rehabilitation setting. We propose future studies build on the evidence-based method used in the present study to determine effectiveness and develop an implementation toolkit for scale-up.

To describe the population‐based incidence and epidemiological characteristics of hospitalised traumatic brain injury (TBI) in New South Wales (NSW), Australia. One‐year statewide hospital admission data from the NSW Department of Health were analysed. TBI cases were identified using a combination of TBI‐related diagnostic and external cause codes from the International Classification of Diseases (ICD‐10th Revision). Sociodemographics, causes, associated factors, severity and medical details of hospitalisation were examined. There were 6,827 hospitalised TBI cases that met review criteria. Incidence rate was 99.1/100,000 population. Incidence in persons older than 75 years of age and residents in remote areas was three times higher. Aboriginal and Torres Strait Islander peoples were 1.7 times more likely to sustain a TBI than the general population, and risk was greater for all NSW residents from areas that were remote and disadvantaged‐socioeconomically. Older adults and those with severe injuries showed prolonged hospitalisation, higher morbidity and mortality. Overall TBI incidence in NSW is lower than international estimates. Nevertheless, groups with higher incidence rates and/or poor in‐hospital outcomes were identified, highlighting directions for prevention and future research. There is a need for identifying risk factors/barriers and assessing the impact of recent policies on these population groups.

Background Frailty is a well known and accepted term to clinicians working with older people. The study aim was to determine whether an intervention could reduce frailty and improve mobility. Methods We conducted a single center, randomized, controlled trial among older people who were frail in Sydney, Australia. One group received an intervention targeting the identified characteristics of frailty, whereas the comparison group received the usual health care and support services. Outcomes were assessed by raters masked to treatment allocation at 3 and 12 months after study entry. The primary outcomes were frailty as assessed by the Cardiovascular Health Study criteria, and mobility as assessed by the Short Physical Performance Battery. Secondary outcome measures included disability, depressive symptoms and health-related quality of life. Results A total of 216 participants (90%) completed the study. Overall, 68% of participants were women and the mean age was 83.3 years (standard deviation, 5.9). In the intention-to-treat analysis, the between-group difference in frailty was 14.7% at 12 months (95% confidence interval: 2.4%, 27.0%; P = 0.02). The score on the Short Physical Performance Battery, in which higher scores indicate better physical status, was stable in the intervention group and had declined in the control group; with the mean difference between groups being 1.44 (95% confidence interval, 0.80, 2.07; P < 0.001) at 12 months. There were no major differences between the groups with respect to secondary outcomes. The few adverse events that occurred were exercise-associated musculoskeletal symptoms. Conclusions Frailty and mobility disability can be successfully treated using an interdisciplinary multifaceted treatment program. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12608000250336

The effect of financial compensation on health outcomes following musculoskeletal injury requires further exploration because results to date are varied and controversial. This systematic review identifies compensation related factors associated with poorer health outcomes following musculoskeletal injury. Searches were conducted using electronic medical journal databases (Medline, CINAHL, Embase, Informit, Web of Science) for prospective studies published up to October 2012. Selection criteria included: prognostic factors associated with validated health outcomes; six or more months follow up; and multivariate statistical analysis. Studies solely measuring return to work outcomes were excluded. Twenty nine articles were synthesised and then assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology to determine evidence levels. The results were mixed. There was strong evidence of an association between compensation status and poorer psychological function; and legal representation and poorer physical function. There was moderate evidence of an association between compensation status and poorer physical function; and legal representation and poorer psychological function. There was limited evidence of an association between compensation status and increased pain. In seven studies the association depended on the outcome measured. No studies reported an association between compensation related factors and improved health outcomes. Further research is needed to find plausible reasons why compensation related factors are associated with poorer health following musculoskeletal injury.

Background The International Consortium for Health Outcomes Measurement (ICHOM) was founded in 2012 to propose consensus-based measurement tools and documentation for different conditions and populations.This article describes how the ICHOM Older Person Working Group followed a consensus-driven modified Delphi technique to develop multiple global outcome measures in older persons. The standard set of outcome measures developed by this group will support the ability of healthcare systems to improve their care pathways and quality of care. An additional benefit will be the opportunity to compare variations in outcomes which encourages and supports learning between different health care systems that drives quality improvement. These outcome measures were not developed for use in research. They are aimed at non researchers in healthcare provision and those who pay for these services. Methods A modified Delphi technique utilising a value based healthcare framework was applied by an international panel to arrive at consensus decisions.To inform the panel meetings, information was sought from literature reviews, longitudinal ageing surveys and a focus group. Results The outcome measures developed and recommended were participation in decision making, autonomy and control, mood and emotional health, loneliness and isolation, pain, activities of daily living, frailty, time spent in hospital, overall survival, carer burden, polypharmacy, falls and place of death mapped to a three tier value based healthcare framework. Conclusions The first global health standard set of outcome measures in older persons has been developed to enable health care systems improve the quality of care provided to older persons.

Background To investigate the cumulative health burden and complex challenges to adjustment following road traffic injuries (RTIs), this study examined multiple environmental, personal, and health-related factors and outcomes over 12 months in a comprehensive and holistic way, comparing these outcomes between injured and non-injured controls. Methods A longitudinal controlled cohort study was conducted with two groups: adults with mild to moderate RTIs and non-injured controls. Assessments occurred at 1, 3, 6, and 12 months post-injury. The study involved 120 RTI participants and 112 controls. Data on physiological, psychological, cognitive, and social factors were collected and analyzed using the World Health Organization International Classification of Functioning, Disability, and Health (ICF) framework. The ICF Components—Impairments in Body Functions and Structures, Limitations in Activity, Restrictions to Participation, Environmental and Personal Contextual Factors—were used to link and categorize data and compare outcomes, allowing comprehensive evaluation of RTI-related burden and adjustment challenges. Results The RTI group exhibited significantly worse outcomes across all measured ICF Components, including higher pain, fatigue, psychological distress, and cognitive impairment. Despite some improvements over time, the RTI group continued to experience elevated symptoms, functional limitations, and restricted participation compared to controls at 12 months. Conclusions RTIs lead to sustained, multidimensional challenges to adjustment, emphasizing the need for early, comprehensive, and ongoing interventions for at least 1-year post-injury. These findings highlight the importance of evaluating multiple biopsychosocial factors and adopting a holistic framework to fully understand recovery patterns. Addressing these factors simultaneously across multiple systems is essential to improve recovery outcomes. Trial registration ACTRN12616001445460.

To the authors’ knowledge, no study has been conducted on life expectancy for aged care facility residents with hip fracture. We assessed life expectancy of 240 residents of aged care facilities in Australia who experienced recent hip fracture treated with surgery. 149 deaths occurred over a mean follow-up of 1.2 years. Being female and having better cognition were associated with longer life expectancy. Increased age was associated with shorter life expectancy. The cumulative mortality rate within three months after hip fracture was 25.0% while the cumulative mortality rate for the whole study period was 62.1%. Life expectancy was 8.2 years, 4.8 years and 2.8 years for 70, 80 and 90-years old female patients. Life expectancy was 3.8 years, 2.2 years and 1.3 years for 70, 80 and 90 years old male patients, respectively. In conclusion, age, gender and cognition level were associated with life expectancy of hip fracture patients living in aged care facilities and their life expectancy was much shorter than that of the general Australian population.

Background Serious injuries and fatalities among vulnerable road users on two wheeled motorised vehicles have increased across Australia and internationally in the past decade yet fallen for motor vehicle occupants. Almost half of all reported motorcycle injury crashes cause serious injury or death, nearly double that of motor vehicle police-reported crashes. This study explores associations with sociodemographic and pre-injury health characteristics and health outcomes after a road traffic injury; aiming to compare motorcyclists with other road users and inform recovery care. Methods An inception cohort study recruited 1854 individuals aged >  17 years, injured following land-transport crashes in New South Wales, Australia (July 2013–November 2016). Interviews conducted at baseline, 6-and 12-months post-injury elicited demographic, socioeconomic, and self-reported health conditions. Results Primary analysis involved 1854 participants who were recruited at baseline as three distinct road user groups; 628 (33.9%) motorcyclists, 927 (50%) vehicle occupants and 299 (16.1%) bicyclists. At baseline, injury patterns differed significantly between road user groups; motorcyclists were more than twice as likely to sustain lower extremity injury ( p  < 0.001); to have more severe injury severity scores ( p  < 0.001) and longer hospital stays versus vs vehicle occupants and bicyclists (< 0.001) across these measures. Injured motorcyclists were predominantly male (88.1%, p  < 0.001), were younger on average (38 years) than bicyclists (41.5 years), had lower income and education levels, and poorer pre-injury physical health than other road user groups. Despite these differences, at 12 months post-injury motorcyclists had better physical health (SF12-PCS 2.07 (0.77, 3.36), p  = 0.002) and reported lower pain scores (− 0.51 (− 0.83, − 0.2), p  < 0.001) than vehicle occupants. Motorcyclists displayed less evidence of psychological distress than vehicle occupants, but more than bicyclists across several measures used. Conclusions Road user types differ in important characteristics, including pre-injury health status and recovery after injury. As vulnerable road users experiencing transport crash and considering their higher initial injury severity, the degree of recovery among motorcyclists compared with other user types is remarkable and unexplained. Health and recovery outcomes after land-transport crashes is least favourable among vehicle occupants despite their higher levels of protection in a crash. This information is valuable for targeting early intervention strategies by road user type during the post-crash care phase, to improve long-term recovery.

Background Few older frail adults hospitalised with medical conditions other than stroke or post-surgery receive acute inpatient rehabilitation and most of these services are of short duration and low intensity. This study hopes to deliver an intensive frailty intervention to inform clinical practice guidelines and health policy for frail older adults who have been acutely hospitalised and are at risk of functional decline upon hospital discharge. Methods The FORTRESS PLUS trial is a single arm intervention study which will employ comparison to historical controls from the intervention arm of the 2020 FORTRESS Study. FORTRESS Plus expands on the 2020 FORTRESS study with broader eligibility, a longer follow-up period, and strengthened post-discharge support. The study aims to determine whether an intensive intervention addressing malnutrition, polypharmacy and sedentary activity in frail older adults will improve health-related quality of life outcomes, mood, physical function, social isolation, frailty, and hospital readmissions. Frail older people aged 75 or older who are admitted to 3 different study wards located within Hornsby Ku-ring-gai Hospital with no significant cognitive impairment measured by an MMSE (Mini Mental State Examination) score of 22 and above, who are expected to return home after discharge, will be eligible to participate. Participants will receive dietetic review, pharmacy review and a comprehensive geriatric assessment during their acute admission if indicated. All participants receive the pharmacy review to identify possible polypharmacy and those who have been identified will receive further intervention for the pharmacist to deprescribe potentially inappropriate medications. Only those who have been identified at the time of screening as having unintentionally lost 5 kg or 5% of their body weight over the past year receive the dietary intervention. They will receive nutritional education, informing them what their optimal oral intake is. Upon discretion from the dietician this may warrant possible referral for protein supplementation for continuation at home post discharge or requesting diet order during their admission to meet these requirements i.e. a high protein high energy diet. The dietician may also create short term goals with the patient such as “finish all meals” and refer onto a speech pathologist if there are concerns with swallowing or feeding at mealtimes. All participants receive a comprehensive geriatric assessment. Upon discharge home, participants will receive 7 weekly sessions of supervised home exercise delivered by an Exercise Physiologist, with additional unsupervised sessions encouraged throughout the week. The primary outcome is the improvement in quality of life measured using the EQ-5D-5 L and the secondary outcomes include number hospital readmissions within 12 months, frailty status measured using the 5 item FRAIL scale; physical function measured using the Short Physical Performance Battery test (SPPB) and mood will be measured using the short form Geriatric Depression Scale (GDS-15). Implementation outcomes will be collected as part of a process evaluation. Recruitment commenced in October 2023, and 141 participants have been recruited from three acute wards in Hornsby Ku-ring-gai Hospital. These wards are 2D (general medicine/cardiology), 3D (rehabilitation) and 4D (general medicine/stroke). The recruitment phase of the project concluded in July 2024. Discussion This study will reveal whether addressing factors contributing to frailty can improve quality of life, physical function, mood, and frailty status. If the FORTRESS Plus intervention provides a clinically significant result, it will demonstrate that an intensive intervention over a number of weeks is required for frail older people following discharge from hospital. Trial registration This study is registered under the ANZCTR Australian New Zealand Clinical Trials Registry with the trial ID of ACTRN12623001103651 registered 20 October 2023.