Encyclopedia of Health and Medicine

hip fracture in older adults 327
• limited activity for two to three days to allow
the inflammation to subside
• MUSCLE RELAXANT MEDICATIONS to relieve MUSCLE
SPASM
• structured, progressive PHYSICAL THERAPY including
strengthening exercises for the back and
proper techniques for lifting
• gradual return to regular activities
When pain is severe or does not respond to oral
medications the doctor may inject the area with a
corticosteroid medication in combination with a
local anesthetic. Such an injection typically provides
rapid and direct relief that lasts from several
weeks to several months and may be sufficient to
heal the damage to the disk.
A small percentage of disk herniations continue
to cause pain and interfere with normal activities
after conservative treatment efforts. In such situations,
the doctor may recommend LAMINECTOMY, a
surgical OPERATION to remove the damaged disk.
Health experts strongly encourage a second opinion
consultation with another doctor who specializes
in treating back conditions before agreeing to
back surgery. Though successful back surgery both
relieves pain and restores function, complications
are high enough to have earned designation as a
health condition themselves: failed back surgery
syndrome (FBSS). Both orthopedic surgeons and
neurosurgeons perform surgeries for conditions of
the spine; it is often valuable to have opinions
from each type of doctor before making a decision
about back surgery.
Risk Factors and Preventive Measures
The key risk factors for herniated nucleus pulposus
are age and sudden stress to the back such as
heavy lifting or traumatic injury. Cigarette smoking
accelerates normal processes of deterioration
and reduces the flow of BLOOD to the structures of
the spine. Regular physical exercise to strengthen
back muscles and abdominal muscles improves
support for the spine, helping maintain proper
alignment of the vertebrae to reduce wear and
deterioration. Proper lifting methods reduce strain
on the back. Though there are no measures to
prevent herniation, such measures help protect
the spine from injury that exacerbates other factors.
Most people recover from an episode of ACUTE
PAIN with conservative treatment and are able to
return to their regular activities.
See also BACK PAIN; CHRONIC PAIN; SCIATICA; SMOK-
ING CESSATION; SURGERY BENEFIT AND RISK ASSESSMENT.
hip fracture in older adults An injury, often
preventable, that often results in significant disability
or premature death. One in four hip fractures
in adults over age 50 results in limited
mobility after HEALING; one in four is fatal. Hip
FRACTURE becomes a risk with increasing age for a
combination of factors that include
• increasing loss of BONE and MUSCLE mass resulting
in decreased STRENGTH and unsteady balance
• slowed reflexes and physical reactions
• diminished VISUAL ACUITY
• OSTEOPOROSIS (a condition of thin, weak bones
due to loss of BONE DENSITY)
• health conditions such as ALZHEIMER’S DISEASE
that impair judgment
• health conditions such as PARKINSON’S DISEASE
that impair mobility
• medication side effects such as drowsiness,
dizziness, and orthostatic HYPOTENSION (a sudden
drop in BLOOD PRESSURE that occurs when rising)
Falls, two thirds of which occur in the home,
account for 95 percent of hip fractures. Risks
include loose rugs on the floor, uneven or slippery
walking surfaces, and objects out of place that
become obstacles. Though women are more likely
to fracture a hip in a fall, men are more likely to
die after hip fracture. Hip fracture has such a poor
prognosis because recovery requires extended
immobility, which has high risk for complications
such as BLOOD clots and PNEUMONIA. Older adults
are often reluctant to tell family members or their
doctors when they fall for fear of losing independence.
Efforts to reduce the risk for falls are the
most effective measures for preventing hip fracture.
Measures to strengthen bone and muscle,
such as daily walking and light RESISTANCE EXERCISE
(weightlifting), also help.
See also ACCIDENTAL INJURIES; QUALITY OF LIFE;
REFLEX.