Learning disabilities and hip fractures: are we getting it right? Experience from a major trauma centre
Abstract
Background:
Patients with a learning disability (LD) are classified as vulnerable. This group of patients are reported to have a significantly younger median age of death (61 years), and receive poorer quality acute care. The Royal College of Physicians (RCP) acute care toolkit (2022) was developed to support doctors in prioritising specific aspects of care in hospital for these individuals. The national hip fracture database (NHFD) includes patients with a hip fracture over the age of 60 years old, meaning those with a LD who develop frailty younger are excluded. Our aim is to assess whether the care of LD patients aligns with these standards and recommendations.
Methods:
Data were collected from patient presenting with a hip fracture and diagnosed LD between 2017 - 2025. 83 patients were identified and 57 met inclusion criteria. We audited data against the standards and recommendations set in the NHFD and from the RCP acute care toolkit.
Results
Of these, 26 were male, 31 were female, and 21% were under 60 years. There were discrepancies relating to number receiving post-operative medical assessment (78.9% LD group vs 92.3% Trust average), mobilising day 1 post-surgery (59.3% vs 83.7%), and receiving bone health treatment (63.0% vs 99.6%). No patients had a specialist pain assessment tool used. Only 59.6% of LD patients received a fascia iliaca block in the emergency department. Documentation of mental capacity assessments was poor was surrounding consent forms and resuscitation decisions.
Conclusions
This study identifies barriers in managing LD patients who present with hip fractures. It is particularly important to ensure they are fully supported in making decisions about their care and optimising communication. Educating care providers about the complexities surrounding LD patients, inclusion within NHFD regardless of age, and signposting to RCP guidelines may facilitate improvement in management.