A literatura tem demonstrado a importância dos minerais traço na manutenção da qualidade óssea, através de seu papel no metabolismo de metaloenzimas, na síntese de colágeno e de outras proteínas que formam a estrutura dos ossos. Dentre estes minerais, destaca-se o zinco. Sabendo que indivíduos idosos apresentam um estado nutricional deficiente em relação a este mineral; que a expectativa de vida geral da população está aumentando, contribuindo para uma elevada incidência de fraturas, principalmente devido à osteoporose; e que cada vez mais é recomendado suplementação com cálcio e vitamina D para esses pacientes, foi realizado um estudo longitudinal, aleatório, que teve como objetivo avaliar se essa suplementação altera o estado nutricional dos idosos em relação ao zinco. Para tanto, foram selecionados 28 idosos, com fratura do quadril, com idade de 60 anos ou mais, distribuídos em dois grupos: um recebendo suplementação com cálcio e vitamina D, e outro sem suplementação. Não houveram diferenças estatisticamente significativas em relação ao gênero, à média da idade e do IMC entre os dois grupos. A avaliação do consumo alimentar foi realizada por meio do software Nutwin. O zinco foi analisado pelo método de espectrofotometria de absorção atômica por chama. A determinação da 25(OH)D foi realizada por Cromatografia Líquida de Alta Eficiência (CLAE). A maioria dos participantes apresentou IMC de acordo com os valores de referência considerados normais para idosos e adequação energética inferior ao recomendado. A porcentagem dos macronutrientes da dieta analisada estava dentro dos limites de normalidade. O consumo de zinco e cálcio alimentares foi inferior ao recomendado segundo as DRIs para a maioria dos idosos dos dois grupos avaliados. A média das concentrações de zinco plasmático foi menor que o valor de referência nos dois grupos, sem diferença estatística significativa entre estes (p>0,05). Em relação ao zinco eritrocitário, embora o grupo suplementado tenha apresentado a média das concentrações dentro da normalidade, o grupo não suplementado apresentou concentrações superiores ao valor de referência, sendo esta diferença estatisticamente significativa (p<0,05). Foi observado que todos os idosos com fratura do quadril encontravam-se em hipovitaminose D. Portanto, os resultados nos permitem concluir que a suplementação não teve influência no estado nutricional relativo ao zinco nos pacientes estudados. / The literature has demonstrated the importance of trace minerals in maintaining bone quality through its role in the metabolism of metaloenzyme, the synthesis of collagen and other proteins that form the structure of bones. Among these minerals is zinc. Knowing that the elderly have a poor nutritional status in relation to this mineral, that the life expectancy of the general population is increasing, contributing to a high incidence of fractures mainly due to osteoporosis, and that is increasingly recommended supplementation with calcium and vitamin D for these patients, a study was conducted longitudinal, randomized, which aimed to assess whether this supplementation alters the nutritional status of elderly in relation to zinc. Thus, we selected 28 elderly patients with hip fracture aged 60 years or more, divided into two groups: one receiving calcium and vitamin D supplementation and the other one without supplementation. There were no statistically meaningful differences in relation to gender, the average age and BMI between the two groups. The assessment of food consumption was done using the software Nutwin. Zinc was analyzed by the method of flame atomic absorption spectrophotometry. The determination of 25(OH)D was performed by High Performance Liquid Chromatography (HPLC). Most participants showed BMI according to the reference values considered normal for the aged and lower energy adequacy than recommended. The percentage of macronutrients of the analyzed diet was considered within the normal range. The consumption of dietary zinc and calcium was lower than recommended by the DRIs for most elderly of the two groups evaluated. The average concentrations of plasma zinc was lower than the reference value in both groups without important statistical difference between them (p>0,05). Regarding erythrocyte zinc, whereas the supplemented group has presented the average concentrations within the normal range, the non-supplemented group showed concentrations above the reference value, the difference being statistically significant (p<0,05). It was observed that all elderly patients with hip fracture were in hypovitaminosis D. Therefore, the results allow us to conclude that supplementation had no influence on nutritional status for zinc in tested patients.

Abstract There are no definitive laboratory tests for osteoporosis, and little is known of their age-related variation. Furthermore, the knowledge of factors contributing to the occurrence of hip fracture, the most important complication of osteoporosis, during the fall is insufficient. Hip fracture is known to impair the function of elderly patients considerably at short term, but here is only limited information of the potential permanence of this impairment. The goal of treatment is to restore the patient's pre-fracture lifestyle. In this respect, intensive rehabilitation has been recommended and applied in many institutions. However, the number of critical reports on this topic is limited, and the results are heterogeneous. An assessment of the effects of age on some commonly used parameters of bone metabolism in females was performed on 238 healthy Caucasian women aged 40–86 years. It was observed that the markers of bone formation, alkaline phosphatase and osteocalcin, and the marker of bone resorption, tartrate-resistant acid phosphatase (TRACP) as well as parathyroid hormone (PTH), phosphorus and creatinine increased with age, whereas 25-hydroxyvitamin D [25(OH)D] and oestradiol decreased. All these parameters except calcium showed a significant age relation. An evaluation of the factors contributing to the occurrence of hip fracture during a fall on the hip was performed by comparing 123 hip fracture patients to 132 persons who had experienced a fall that caused a visible soft tissue injury in the hip or gluteal region without a fracture. The hip fracture patients more commonly than the fallers were women, lived in long-term institutional care, had had previous stroke with hemiparesis, had Parkinsonism, used neuroleptics, were dependent in ADL and had lower body mass indexes. According to the logistic regression model, institutional residence, low body mass index and a history of stroke with hemiplegic status differed between the fracture cases and controls. The long-term effects (mean follow-up 7 years) of trochanteric hip fracture on outcome were studied by comparing 200 consecutive patients (mean age 77 years) and age- and sex-matched controls representing the average population from the same area. Mortality increased gradually, being 4.5% above the control level at one month and 9% at six years after the fracture. 48% the surviving patients and 90% of the surviving controls were still living in their own homes or service apartments ,whereas 48% of the patients and 5% of the controls were instutionalized. The ambulatory capacity of the patients was significantly worse than controls. The patients managed their ADL activities significantly less well, required more home help and had fewer social contacts and outdoor hobbies than the controls. An assessment of the effect of intensive rehabilitation on the coping of hip fracture patients was done in a prospective randomised study on 154 patients, half of whom were treated postoperatively in a rehabilitation clinic and the other half at health care centre hospitals. Seven of the 70 survival patients of the rehabilitation group 5 of the 71 respective controls were institutionalized at one year. No difference was either observed in the walking ability or ADL functions between the groups.

Prostate cancer is frequently diagnosed in elderly men and, despite the largely unproven survival benefits of treatment, the majority receive treatment. Treatment options include surgery, radiation, and/or androgen deprivation therapy (ADT). Risks associated with treatment include hip fracture. Current understanding suggests that hip fracture is a frequent cause of morbidity and mortality in the elderly, and both radiation treatment and ADT can increase the risk of hip fracture. It is important to understand these risks so they can be minimized and the morbidity of treatment reduced. The objectives of this study were to estimate the risk of hip fracture as a major adverse outcome of treatment for prostate cancer among elderly men. The specific objectives include estimating: 1) the risk of hip fracture and the dose-risk relationship among patients receiving curative radiation treatment, and 2) the risk of hip fracture associated with palliative ADT and relapsed ADT compared to curative ADT. The cancer diagnosis and treatment records of 32,673 men were linked to their hospital discharge abstracts. The risk of hip fracture was estimated using Cox regression and the estimates were adjusted for age, comorbidity, income, and year of diagnosis. The risk of hip fracture was 59% higher among men who received curative radiation when compared to men who received curative surgery. The risk of hip fracture fell by 6% with each one Gy increase in radiation dose between 55 and 81 Gy Biological Equivalent Dose to the hip-bone. The risk of hip fracture for subjects in the palliative ADT and relapsed ADT categories was 5.98 and 5.77 times the risk in comparison to men who received curative ADT treatment. Curative radiation treatment is associated with an increased risk of hip fracture when compared to curative surgery. The risk of hip fracture is greater with ADT for palliation and relapsed cancer than with curative treatment. Current treatments for prostate cancer contain significant risk of hip fracture for elderly men and these risks should be considered as part of the treatment decision. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Orientador: Djalma de Carvalho Moreira Filho / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T11:38:57Z (GMT). No. of bitstreams: 1 Vidal_EdisonIglesiasdeOliveira_M.pdf: 1778837 bytes, checksum: d1969cdf36d980491cc004d14fb05459 (MD5) Previous issue date: 2006 / Resumo: Dentre as fraturas associadas à osteoporose, as Fraturas de Quadril (FQ) são consideradas como as mais graves e com maior impacto em termos de morbi-mortalidade para a população idosa e para os sistemas de saúde. Um dos fatores de risco para a mortalidade de idosos pós-FQ mais debatidos na literatura médica corresponde ao tempo decorrido entre a FQ e a cirurgia reparadora. Uma limitação importante de muitos dos estudos que avaliaram esta temática previamente reside na aferição apenas do intervalo de tempo entre a internação hospitalar e a cirurgia, ao invés do intervalo entre o momento da fratura propriamente dita e o procedimento cirúrgico. Outro ponto de debate interessante dentro da temática dos idosos com FQ reside na diferença de mortalidade entre os sexos, sendo poucas as investigações sobre as causas óbito em relação a esta variável. Deste modo, com o objetivo de avaliar a relação entre a mortalidade intra-hospitalar de idosos que sofreram FQ osteoporótica e o intervalo de tempo da FQ à cirurgia e explorar as diferenças de mortalidade entre os sexos, propõe-se um estudo observacional tipo coorte retrospectivo, baseado na análise de banco de dados de internação hospitalar relativo ao período de 1° de abril de 2003 a 31 de março de 2004 na província do Québec no Canadá. Os dados foram estudados por meio de análises univariadas e por regressão logística múltipla, tendo como variável resposta a presença de óbito intra-hospitalar. Foram incluídas no modelo da regressão logística múltipla para controle de confundimento sobre o efeito do intervalo da fratura à cirurgia na mortalidade intra-hospitalar as variáveis que haviam demonstrado significância nas análises de regressão logística univariada. Resultados: o intervalo de tempo da fratura à cirurgia alcançou significância estatística como preditor do óbito intra-hospitalar apenas na análise univariada (p < 0,001, OR = 1,08, IC95% 1,03-1,12). Após o controle para confundimento pelas demais variáveis no modelo de regressão múltipla, o período de tempo da fratura à cirurgia deixou de apresentar qualquer capacidade preditora sobre a mortalidade intra-hospitalar (p = 0,36, OR = 1,02, IC95% 0,97-1,07). O sexo masculino mostrou-se associado significativamente ao óbito hospitalar (p < 0,001, OR = 1,9, IC95% 1,45 ¿ 2,5) e, no que concerne às três principais causas de óbito, houve maior freqüência de mortes entre homens para as causas infecciosas e respiratórias, representando razões de chance de 2,92 (p < 0,001, IC95% 1,93 ¿ 4,42) e 2,23 (p = 0,002, IC95% 1,35 ¿ 3,69), respectivamente. Conclusão: Após controle para sexo, idade, número de diagnósticos secundários, comorbidades, tipo de fratura, modalidade cirúrgica e anestésica, não foi observada correlação entre o intervalo de tempo do momento da FQ à cirurgia e a mortalidade hospitalar de pacientes idosos submetidos a cirurgia reparadora de FQ no Québec entre 1° de abril de 2003 e 31 de março de 2004 com base na análise de dados administrativos. Neste mesmo grupo de pacientes, os homens apresentaram maior chance de morte intra-hospitalar que as mulheres. No que diz respeito às três principais causas de óbito, os homens morreram mais que as mulheres por causas infecciosas e respiratórias, não havendo diferença detectável neste estudo quanto à mortalidade cardiovascular entre os sexos / Abstract: Hip fractures (HF) are considered the most severe of the osteoporótica fractures as well as the ones with greater impact in morbidity and mortality for the elderly population and health care systems. The role of the delay between the HF and its operative treatment on the post-HF mortality of elderly patients is certainly one of the most controversial issues on HF epidemiology in the medical literature. One striking limitation of most previous studies on this theme abides in records regarding only the time between hospital admission and the surgical procedure, instead of the time between the fracture itself and the operative treatment. Another interesting point of debate in the subject of elderly with HF encompasses the differences in mortality between men and women, with few investigations on the causes of death according to gender. Therefore, targeting to evaluate the relationship between the inhospital mortality of elderly with osteoporotic HF and the span of time from fracture to surgery as well as to explore the differences in mortality amid sexes, it was designed an observational retrospective cohort study based on database analysis of hospital admissions relative to the period from April 1st 2003 to March 31st 2004 in the province of Québec, Canada. The data were studied through univariate analysis and multiple logistic regression modeling, assigning as response variable the presence of inhospital death. The variables which attained significance in the univariate analysis were included in the logistic regression model to control for confounding in the relationship between the time from fracture to surgery and the inhospital mortality. Results: The time between HF and surgery reached statistical significance as a predictor of inhospital mortality only in the univariate analysis (p < 0.001, OR = 1.08, IC95% 1.03-1.12). After controlling for confounding in the multiple logistic regression model, the delay from HF to operative repair no longer displayed any predictive ability over inhospital mortality (p = 0.36, OR = 1.02, IC95% 0.97-1.07). Male sex was significantly associated to inhospital death (p < 0.001, OR = 1.9, IC95% 1.45 ¿ 2,5). In regard to the three principal causes of death, there was a higher frequency of death for men among infectious and respiratory causes, accounting for odds ratios of 2.92 (p < 0.001, IC95% 1.93 ¿ 4.42) and 2.23 (p = 0.002, IC95% 1.35 ¿ 3.69), respectively. Conclusion: Based on administrative data, after controlling for sex, age, number of secondary diagnosis, comorbidities, type of fracture, surgical and anesthesiologic procedures, it was not observed any relationship between the time gap from HF to surgery and inhospital mortality of elderly patients submitted to HF surgical repair in Québec from April 12003 to March 312004. In this cohort of patients men displayed higher inhospital mortality odds than women. With regard to the three main causes of death, men died more often than women from infectious and respiratory causes and there was no detectable difference between genders concerning cardiovascular mortality / Mestrado / Epidemiologia / Mestre em Saude Coletiva

Bakgrund: Varje år drabbas 18 000 personer av höftfraktur, den vanligaste orsaken är fall. Behandlingen av höftfraktur har utvecklats från att patienter ligger i sträck under flera veckor till operation med mobilisering direkt efter. Ålderdom leder till att kroppen blir mer sårbar och att patienten har svårare att hantera återhämtningen både fysiskt och psykiskt efter en höftfraktur. Syfte: Att beskriva den äldre patientens upplevelse av återhämtningen från en höftfraktur efter utskrivning från sjukhuset. Metod: En litteraturöversikt innehållande 15 vetenskapliga artiklar, artiklarna söktes i databaserna PubMed och CINAHL. De inkluderade artiklarna är av kvalitativ och mixed-metod ansats. I analysen sammanställdes artiklarnas resultat, sammanställningen presenteras i litteraturöversiktens resultat under tre huvudkategorier. Resultat: Resultatet visar att patienterna upplever ensamhet och isolering då de upplever sig fångade i sitt eget hem, de har svårt att komma ut och röra på sig på grund av begränsad rörlighet och smärta. Patienterna upplevde att deras egen attityd och inställning återspeglades i återhämtningen. Stunder när patienterna upplevde livet som innan höftfrakturen gav styrka och motivation. Slutsats: Resultatet visar att de flesta äldre upplever återhämtningen på liknande sätt, begränsad rörlighet leder till ensamhet och isolering och behov av hjälp från andra upplevs som frustrerande av vissa och motiverande av andra. De äldre som haft tillgång till information kring operation och återhämtning samt möjlighet att utnyttja fysioterapeut har upplevt återhämtningen som lättare än de som upplever en brist på information. / Background: Each year 18 000 people suffer from hip fracture, the most common cause is fall. The treatment of hip fracture has evolved from patients were on stretch for several weeks to surgery with mobilization immediately after. Aging causes the body to become more vulnerable and the patient has a harder time to handle the recovery both physically and mentally following a hip fracture. Aim: To describe the older patient's experience of the recovery from a hip fracture after discharge from the hospital. Method: A literature review containing 15 scientific articles, the articles were searched in the PubMed and CINAHL databases. The included articles are of qualitative and mixed method. In the analysis, the results of the articles were compiled, the compilation is presented in the results of the literature review under three main categories. Result: The results show that patients experience loneliness and isolation when they feel trapped in their own home, they have difficulty getting out and moving due to limited mobility and pain. The patients felt that their own attitude and mindset were reflected in the recovery. Moments when patients experienced life as before the hip fracture provided strength and motivation. Conclusion: The results shows that most elderly people experience recovery in similar ways, limited mobility leads to loneliness and isolation and the need for help from others is perceived as frustrating by some and motivating others. The elderly who have had access to information around surgery and recovery as well as the ability to exploit physiotherapist have experienced the recovery as easier than those who experience a lack of information.

Prior studies have unequivocally established a consistent association between osteoporotic hip fracture risk and type 2 diabetes mellitus. One reason this association still remains unclear is primarily due to the limited amount of research conducted in this area. The Utah Study of Nutrition and Bone Health (USNBH) is a case-control study conducted in Utah during the period of 1997-2001 to determine risk factors for osteoporotic hip fracture. All study participants (n = 2590) were determined from Utah residents 50-90 years of age. Cases were determined from 18 Utah hospitals during 1997-2001. Age and gender-matched controls were randomly selected from the Utah Drivers License pool if less than 65 years of age and the Medicare databases if greater than 65 years of age. Logistic regression models were used to determine the association between type 2 diabetes and hip fracture risk. Logistic regression modeling controlled for gender, body mass index, smoking status, alcohol use, physical activity, education level, and estrogen use in women. The risk of hip fracture was associated with type 2 diabetes. The significant correlation was primarily found in females in which the risk of hip fracture increased accompanying diagnosis of type 2 diabetes. Estrogen usage in females decreased (p < 0.0001) hip fracture risk in both former or current users. Physical activity significantly decreased the risk of hip fracture for females (p < 0.0001) and for males (p = 0.001). Smoking and alcohol use may increase the risk of hip fracture, especially in women. This study substantiates the hypothesis that type 2 diabetes mellitus increases the risk of hip fracture.

Change in body weight is an important determinant of risk of osteoporotic hip fracture in aging adults. Weight loss has been associated with an increased risk of hip fracture and weight gain has been associated with a decreased risk of hip fracture . . Weight gain cannot be recommended as appropriate prevention against hip fracture, however, because it is associated with such adverse health outcomes as cardiovascular disease and diabetes, and weight loss is commonly recommended in the treatment of these types of diseases. Clarification of how weight loss is related to risk of hip fracture is needed to resolve this issue. An extensive review of published literature was completed to assess the relationships between hip fracture and body weight, weight change, and involuntary and voluntary weight loss. Change in body weight and weight lll loss that was either intentional or unintentional were then assessed for their effects on risk of hip fracture in a population-based case-control study of risk factors for osteoporotic hip fracture in aging Utah residents. Analyses of risk of hip fracture by quintile of weight change since age 18 and according to weight loss intention were performed through logistic regression modeling. Weight loss after age 18 was associated with an increased risk of hip fracture in men and women, and above average weight gain after age 18 was protective against hip fracture in women. Involuntary weight loss of more than 20 pounds was associated with an increased risk of hip fracture in men and women aged 50 to 69 years, but was not related to risk of hip fracture in participants aged 70 to 89. Voluntary weight loss of more than 20 pounds did not significantly increase risk of hip fracture in either age group. It was concluded that involuntary weight loss may be an important predictor of risk of hip fracture in aging adults and that voluntary weight loss may be safely recommended to aging adults without increasing their risk of hip fracture

There are 18 000 cases of hip fracture in Sweden every year. Dementia is the strongest risk factor for hip fractures in the age of 60 to 90-year. According to current research, the most common method to assess pain is VAS (Visual Analogue). However, VAS is unreliable in assessing pain in patients with dementia or impaired communication disorders. The elderly experience pain in the same way as younger people. Inadequate pain relief is a risk factor for general health. An important cause of misinterpretation and/or underestimation of pain among the elderly is cognitive impairment and cognitive loss, which is relatively common in this age group. The work of an ambulance nurse is complex with ever shifting environments and situations. At the same time, the ambulance personnel have to make several independent decisions and carry them out. The aim of this study was to describe the treatment of pain in patients with suspected hip fracture within the ambulance care context. The method used was retrospective case control study with record analysis. Data were collected from a quality record regarding the “Hip track” in a midswede County. Two groups were created, the study group included patients with suspected dementia/ confusion and known dementia. The control group were patients where the record stating fully aware. The data were analyzed, accordance with quantitative descriptive and analytic design to answer the study questions. The study questions were how pain relief varied in relation to the patient's mental status and how the assessment of VAS differs in relation to the patient's mental status. The results showed that patients with suspected or known dementia received pain relief equally to cognitively intact patients. Likewise did the dosing of pain medication not differ significantly between the two groups. The usage of VAS in assessment and monitoring of pain was significantly lower in patients with suspected/known dementia compared to patients with intact cognition. The administration of pain relief to patients undergoing Xrays was limited in both groups, even though these patients rated high on VAS. In particular, the patients in the control group received small amounts of pain relief in relation to their assessed VAS.
 In conclusion, for patients with hip fractures the first medical contact is often the ambulance nurse. In patients with dementia/suspected dementia/confusion, the assessment using VAS occurs to a lesser extent compared to cognitively intact patients. There is room for improvement in the assessment of pain in patients with dementia due to difficulties in assessing VAS. Partly to confirm that pain is present, but also to assess its intensity in order to provide satisfying analgesia through the continuum of care, where the ambulance nurse is responsible for the patient. To the same extent, patients with hip fracture receive analgesia in the ambulance regardless of their mental status or whether pain assessment is performed in accordance with VAS. This might indicate that the ambulance nurse has the knowledge and skills to foresee the pain that the hip fractured patient is exposed to.

Osteoarthritis (OA) is a chronic, painful, and currently incurable disease characterized by structural deterioration and loss of function of synovial joints. OA is known to involve profound changes in bone density and microstructure near to, and even distal to, the joint. The prevailing view is that these changes in density and microstructure serve to stiffen the subchondral region thereby altering the mechanical environment (stresses and strains) within the epiphyseal and metaphyseal bone, and that these alterations trigger the aberrant cellular signaling and tissue damage characteristic of the progression of OA. Critically, however, these alterations in mechanical environment have never been well documented in a quantitative fashion in hip OA. Separately, although OA is generally thought to be inversely associated with fragility fracture, recent data challenge this idea and suggest that OA may actually modulate which regions of the proximal femur are at risk of fracture. Therefore, the goal of this work was to provide a spatial assessment of bone density and microstructure in hip OA and then examine the mechanical consequences of these OA-related abnormalities throughout the proximal femur. First, micro-computed tomography and data-driven computational anatomy were used to examine 3-D maps of the distribution of bone density and microstructure in human femoral neck samples with increasing severity of radiographic OA, providing evidence of the heterogeneous and multi-faceted changes in hip OA and discussion of the implications for OA progression and fracture risk. Second, the feasibility of proton density-weighted MRI in image-based finite element (FE) modeling, to examine stress, strain, and risk of failure in the proximal femur under sideways fall, was assessed by comparison to the current standard of CT-based FE modeling. Third, phantom-less calibration for CT-based FE modeling was used with clinically available pre-operative patient scans to assess bone strength and failure risk of the proximal femur in hip OA. Overall, the results of this work provide a rich, quantitative definition of the ways in which the bone mechanical environment under traumatic loading differ in association with hip OA, and then highlight the potential for clinical image-based FE methods to be used opportunistically to assess bone strength and failure risk at the hip. This work is significant because it directly tests the long-standing premise that OA is associated with changes in the mechanical environment of the bone tissue in ways that are impactful for OA progression; further, this work examines how these changes may influence risk of hip fracture. The results can be used to identify mechanistic predictors of OA progression, to inform development of bone-targeting treatments for OA, and to more broadly understand bone damage and fracture in this population.

Trycksår är en komplikation hos patienter med höftfraktur som ofta tillskrivs sängläge men som kan uppstå vid olika långvariga inaktivitet och belastningstillstånd. Syftet med denna litteraturstudie var att undersöka eventuellt sambandet mellan nutrition och förebyggandet av trycksår hos patienter över 65 år med genomgången höftfraktur. En systematisk databassökning har skett i Pubmed och Cinahl. Denna studie genomfördes för att söka relevanta vetenskapliga artiklar och sju artiklar selekterades. Författarna fann att olika näringsämnen framförallt serumalbumin, arginin, zink, vitamin C kan påverka sårläkningsprocessen. Det visade att lågt serumalbumin och arginin kan leda till viktminskning, detta är en viktig riskfaktor som kan öka komplikationer hos äldre patienter. Serumalbumins betydelse hos patienter med trycksår är viktigt. / Pressure ulcers are a complication in patients with hip fracture often attributed to bed rest, but that can arise in various long-standing idle and load conditions. The purpose of this study was to investigate the possible relationship between nutrition and the prevention of pressure ulcers in patients over 65 with a hip fracture. A systematic database search has taken place in Pubmed and Cinahl. This study was conducted to find relevant scientific papers and seven articles were selected. The authors found that certain nutrients, particularly serum albumin, arginine, zinc, vitamin C can affect the wound healing process. It showed that low serum albumin and arginine are can lead to weight loss, this is an important risk factor that may increase complications in elderly patients. Serumalbumins significance in patients with pressure ulcers is important.