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Study to explore care seeking behavior of older adults with hip fracture in Odisha

Preliminary data emerging from a study on "Care seeking behavior of older adults with hip fracture in Odisha’’ has underscored the need for a quick decision to seek care to avoid delays resulting in death. 

The data also points the need for easily available appropriate mode of transport to reduce delays in arriving at a suitable health care facility. This, in turn, will facilitate best practice based management of older adults with hip fractures.

 Nearly about 30-40% older adults with hip fracture die within one year. Prompt hospital admission and surgery within 48 hours reduces mortality and delays are detrimental to life and health outcomes.  The first delay is often due to decisions in seeking care, which ultimately impacts health outcome. 

"Our study aims to document pre-hospital course and care seeking pathways for older adults with hip fractures in Odisha, determine the decision making process, identify causes for delay, and barriers and facilitators to seeking appropriate care,’’ says Dr. Santosh Rath, Professorial Fellow, Global Surgery, The George Institute for Global Health 

The exploratory study included interviews with people aged 50 years or older with history of fall and X-ray confirmed hip fracture admitted to seven treatment centres in two administrative districts of Khurda and Cuttack. Thirty participants and their carers equally from public and private facilities were recruited from two district hospitals, two public and  two  private tertiary care and one  traditional healing centre 

 Of the 30 people interviewed, 16 were females and 14 males within age range of 50-81 years. There were 19 fractures of neck of femur, nine trochanteric fracture and two with inaccurate diagnosis. Majority of patients had two or more referrals and time lag from injury to admission (or access care) varied from one day to six months.  

Around 15 per cent patients attended traditional bone setters as the first port of call and a further 15 per cent transferred to traditional bone setters from hospitals. Preliminary results show that the distance from home to health facility is a major challenge for many patients. Lack of awareness of appropriate treatment is a significant barrier.

The study intends to  influence policy and  intervention strategies to educate patients, carers and  health care providers, the serious nature of a hip fracture in older person and the need for early surgical intervention to save life.