Management of Older People with Hip Fractures in China and India: A Systems Approach to Bridge Evidence-Practice Gaps

Abstract

Protocol-based ‘Integrated Care Pathways’ for the management of older adults with hip fractures in high-income countries has resulted in decreased mortality rates, early hospital discharge, improved quality of life and significant reduction in healthcare costs. An epidemic of fragility hip fracture looms on the horizon, primarily due to ageing populations and increased life expectancy in China and India, such that by 2050, nearly half the projected 6.5 million hip fractures globally will occur in Asia. Health policy makers and care workers in China and India have the potential to prevent the looming social and financial burden of hip fractures in the burgeoning older population by learning from the experience of ICP based care in the UK. This chapter analyses present evidence–practice gaps in the management of fragility hip fractures in China and India; the barriers and facilitators to implementation of ICP and summarises the hurdles for knowledge translation of best practices. The authors draw upon current care-seeking behaviour studies, implementation and health systems research to determine appropriateness, acceptability and feasibility of adopting best practice and protocol-based care of hip fractures among older adults. Early findings from studies on knowledge diffusion and ICP for hip fractures have underlined the need for a systems approach and contextually relevant ICP to improve management of hip fractures in India and China. Finally, the importance of generating political priority for fragility hip fractures and global collaboration to support health systems strengthening is emphasised as a prerequisite to enable an environment to adopt ICP.