3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item One year mortality following surgical intervention for neck of femur fractures in the elderly in a developing country.(2017) Pieterse, Barend HermanusBACKGROUND: Fractures of the neck of the femur are currently one of the most serious health care problems facing developed nations on account of their aging populations. The one-year mortality rate is in the region of 30%. Although less of burden in developing nations, the fractures still affect a significant proportion of the elderly population. Very little has been published on the subject in developing nations and outcomes in resource rich countries may not be applicable to the less developed world. We hypothesized that the one year mortality would be higher in our setting. AIM OF THE STUDY: To determine the one year mortality following operative treatment of neck of femur fractures in the elderly at Charlotte-Maxeke Johannesburg academic hospital. METHODS: We undertook a retrospective study of all patients admitted with a fractured neck of femur in a teaching hospital over a five year period. Males and females over the age of 65 who underwent surgical treatment for neck of femur fractures where included into the study. Excluded was open fractures of any nature, neck of femur fractures due to tumors or metastatic bone disease, hip fractures other than neck of femur fractures and hip fractures treated nonoperatively. The patient’s files were collected to identify their ID numbers. Home affairs records was used to determine if the ID numbers were registered as a death. The website http://www.dha.gov.za/status was used for this purpose. To determine the time of death of the deceased patients Home affairs was contacted using the Request for access to record of public body form. RESULTS: The study comprised of 66.2% females and 33.8% males with a age range of 65-93 and a mean age of 80. We found that females had a higher age at the time of surgery than males. Our one year mortality was 43% (p=0.00288781) and significance level of 99.7%. CONCLUSION: Our mortality rate was significant higher compared to international or local figures. This might be due to the higher age of patients that we are seeing or lack of proper treatment protocols for the elderly with neck of femur fractures. Further investigations are needed to determine the cause.Item Factors influencing the early post-operative functional outcome in elderly patients with a hip fracture.(2014-03-28) Adam, SaadiyaBackground: Hip fractures are among the most common causes of disability and hospitalisation in the elderly. Currently there are no studies available in South Africa that determine the factors that influence the early post-operative functional outcome in elderly patients with a hip fracture.Aim: To establish the factors influencing the early post-operative functional outcome in elderly patients with a hip fracture. Methodology: A prospective pre-test post-test observational study design was used. Consecutive sampling was used to recruit participants (n=72). Assessments were conducted pre-operatively, at discharge and six weeks post discharge at two public health care hospitals in Johannesburg, South Africa. Pre-operatively the pre-fracture functional mobility of the participants was determined using the New Mobility Score (NMS), the presence of pre-existing co-morbidities was assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and the cognitive function was assessed using the Six-Item Cognitive Impairment Test (6CIT). At discharge and at six weeks post discharge the participants post-operative functional level was assessed using the Elderly Mobility Scale (EMS) and the Lower Extremity Functional Scale (LEFS). A multiple regression analysis was used to determine associations. The study was set at p = 0.05 level of significance and 95% confidence interval (CI). Results: Participants were generally independent with pre-fracture mobility at baseline and presented with approximately three pre-existing co-morbidities. The presence of cognitive impairments in the participants decreased during the duration of the study, while the post-operative functional level in this population improved. Pre-fracture functional level was strongly related to and also the strongest predictor of post-operative functional outcome. The presence of co-morbidities and impaired cognitive function were also indirectly related. Conclusion: Pre-fracture functional mobility was found to be the strongest determinant of post-operative functional outcome, followed by cognitive function and the presence of pre-existing co-morbidities. By ensuring that these factors are optimal prior to sustaining a hip fracture, elderly patients are more likely to have better outcomes. For those patients who do sustain a hip fracture, intensive rehabilitation is especially necessary for the patient who presents with poor pre-fracture mobility, impaired cognition and pre-existing medical co-morbidities.Item Investigating institutional arrangements available to implement South African policy for older persons in KwaZulu-Natal(2011-11-08) Mabena, Mhlahlandlela MboboAccording to Lombard and Kruger (2009), the status of older persons has not changed considerably despite the promulgation of the Older Persons Act in 2005 and the adoption of the South African Policy for Older Persons in 2006. The researcher attempted to contribute to a better understanding of the problematic status of older persons through an exploratory study of institutional arrangements involved in the implementation of the policy using a case study approach. The network theory was used as a guiding theoretical framework. Findings from the study indicate a randomly related network affected by lack of robust, efficient and effective leadership and co-ordination. Formalization of network membership through written rules and a constitution that spells out the roles and responsibilities of network members, and continued interaction amongst network members is suggested to strengthen the network and the leadership. It is the conviction of the researcher that strengthening of the network will improve the implementation of the South African Policy on Older Persons, thereby improving the lives of older people.