Hip fractures are a debilitating disease in the elderly. The number of hip fractures worldwide is expected to increase from 1.26 million in 1990 to 4.5 million in 2050,1 and the number of hip fractures in Taiwan is expected to increase from 18,338 in 2010 to 50,421 in 2035, a 2.7-fold increase.2 The annual cost of hospitalization for hip fractures in the elderly is 1.3 billion, accounting for one-fifth of all fractures3 and long-term hospitalization and rehabilitation are required. This situation is directly related to ballooning medical costs. In addition, hip fractures are associated with a progression of complications, such as disability, depression, and cardiovascular disease, which carry additional costs to society.1

Hip fractures are an important cause of morbidity and mortality in elderly patients, and the one-year mortality rate after hip fractures in the elderly is as high as 8.4 to 36 %, an increase of at least 14% or more.4 The chronic diseases of the elderly and the comorbidities caused by fractures or surgical complications result in prolonged length of hospital stays, decreased quality of life, increased readmission rates, and even increased mortality and medical costs.5

Most patients with hip fractures have varying degrees of fracture comorbidity and show some degree of dependence on basic or more complex daily activities.6 Functions of daily living, walking or instrumental activities of daily living, quality of life, a decline from pre-fracture physical capacity, and the number or severity of cognitive status and comorbidities have all been shown to be associated with post-fracture mortality and the recovery of mobility. With high fragility following hip fracture surgery, integrated care including geriatrics improves short-term and long-term outcomes after hip fractures.6,7

In our study, integrated care refers to the cooperation of a multidisciplinary team including an orthopedic surgeon and geriatrician focused on elderly patients with hip fractures. Hip fracture patients receive consultation “as needed” from specialists in various fields, receiving complete care in a comprehensive collaboration.8 Among elderly patients with hip fractures receiving integrated care, the mortality rate during admission decreased from 10% in 2012 to 3.6% in 2017, which is a significant difference, and the 30-day and one-year mortality rates were lower than that of usual care. Length of hospital stays, surgical delays, and postoperative hospital admissions also decreased. In a single hospital from a study conducted in France, the estimated savings resulting from providing integrated care amounted to roughly EUR 1,000,000 in one year.9

In Taiwan, the proportion of hospitalized patients with hip fractures is quite high. The complication rate was 53.7% in the original hospitalization and the complication severity index that affected mortality within one year after the operation was 7.96 times that of the no comorbidities group (Charlson Comorbidity Index, CCI≧3 points).10 Providing care for and controlling the comorbidities of patients before, during, and after surgery will greatly help reduce the mortality rate. In the usual care model, the one-year mortality rate was 14%, and one-year mortality was 4.7% in the hip specialist care model.11 Compared with usual care, there is a significant difference of approximately 12% in 1-year mortality after hip fractures in older adults with integrated care.12

Based on the abovementioned literature, it can be seen that the implementation of integrated care has received more and more attention. It has been implemented in medical care all over the world for many years with positive outcomes. In the medical system in Taiwan, it has been used in the care of chronic diseases, such as kidney and liver diseases in the elderly in recent years. Its use has gradually increased in the postoperative care of elderly hip fracture patients. Insurance coverage for hospital stays may be informed by this observation. In Taiwan, the number of hospital days is limited by the national health insurance system. If the number of hospital days were to be extended, it may result in an ability to better observe and treat comorbidities and deliver improvements in rehabilitation implementation, pain, and daily life quality and function of patients.

The care content and guidelines for integrated care vary from hospital to hospital, but through detailed planning, implementation, and evaluation, an effective elderly hip fracture care plan can be developed to reduce pain and improve quality of life after returning home. Through integrated care, quality of daily life and function can be improved, thereby reducing post-morbidity and mortality. In this study, a literature review and meta-analysis was conducted of the postoperative situation of elderly patients with hip fractures, and "Integrated Care Programs" examined as the intervention. After searching the literature, only randomized clinical trials (RCT) were included for in-depth discussion. Examining “Integrated Care Programs” as the intervention in the postoperative research results of elderly patients with hip fractures can facilitate the planning and implementation of future “Integrated Care Programs,” and facilitate further follow-up research, as well as the implementation and promotion of more postoperative care for elderly patients with hip fractures.