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Aging News & Information
As Millions Become Centenarians Interest Sparks in
Their Health Care
Study finds few hip and knee replacements in patients
over 100
Aug. 1, 2007 It is astounding, but the Department
of Census projects there could be over four million Americans reaching
age 100 or more by 2050. This growing number of centenarians has sparked
new research into health care for these elderly. A new study, for
example, looks at hip and knee replacement performed on centenarians.
Although approximately 40 percent of centenarians
are functionally independent, they are among those at the highest risk
for disabling arthritis and fractures due to osteoporosis.
With increasing age, the safety and desirability of
performing hip and knee replacements (arthroplasty) may be questioned
with the idea that health care resources should be spent on those who
can potentially benefit from them the most, and such procedures may be
too hazardous for elderly patients.
However, there have been few studies on joint
replacement among patients older than 90. A new study published in the
August issue of Arthritis Care & Research found that hip and knee
replacements are very infrequent among this age group, but that they
should not be denied to these patients solely because of short-term life
expectancy. The study was the largest to date of hip and knee
replacements among centenarians.
Led by Eswar Krishnan, MD, MPH, of the University
of Pittsburgh, in Pittsburgh, PA, researchers analyzed 10-year data
(1993-2002) from the Healthcare Cost and Utilization Project Nationwide
Inpatient Sample, the largest hospital discharge data set in the world.
Of the 57 million hospitalization records during this period, 41,335
were for centenarians.
The researchers identified 679 total hip
replacements and 7 total knee replacements in patients aged 100 or
older.
This relatively low frequency of elective surgery
might be due to physician and patient judgment that these individuals
are at high risk for poor outcomes and that the risk is not offset by
the perceived benefit in light of the relatively short life expectancy,
the authors state.
Centenarians who underwent hip replacement were at
a higher risk for in-hospital mortality than nonagenarians. Among
centenarians, however, hospitalization for hip replacement compared to
other causes of hospitalization was associated with a lower risk of
death.
Although frailty is known to increase with age,
some believe that with better medical care only the extremely elderly
are suffering its effects. The authors point out that centenarians live
to the century mark by delaying or even avoiding many age-related
diseases, and that among those suffering from such conditions, many
appear to do so with better functional status than younger patients. As
to the question of whether centenarians and nonagenarians are able to
reap the benefits of a new hip or knee, a previous study indicated that
one-quarter of the centenarian population are cognitively intact and
they appear to sustain their mental status over time. Another study
found that nonagenarians treated for hip fractures did not have an
increased risk of postoperative complications.
Given the increasing trend of joint replacements
over the last decade in the U.S. and the growing centenarian population,
such procedures are likely to become more commonplace in the elderly
population. The authors conclude, This study provides data that suggest
arthroplasty need not be denied to centenarians solely on account of age
and the concern of high in-hospital mortality risk.
Editor's Notes:
Arthritis Care & Research (http://www.interscience.wiley.com/journal/arthritiscare)
Article: Primary Knee and Hip Arthroplasty Among
Nonagenarians and Centenarians in the United States, Eswar Krishnan,
James F. Fries, C. Kent Kwoh, Arthritis Care & Research, August 2007; (DOI:
10.2002/art.22888).
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