Individuals who develop one of these outcomes are at risk for developing the other, with a resulting spiraling risk of falls, fear of falling, and functional decline. Because falls and fear of falling share predictors, individuals who are at a high risk of developing these endpoints can be identified.

Comanagement by geriatricians and orthopedic surgeons, combined with standardized care, leads to improved processes and outcomes for patients with hip fractures.

Hip fractures in older adults are a common event, leading to substantial morbidity and mortality. Hip fractures have been previously described as a “geriatric, rather than orthopedic disease.” Patients with this condition have a high prevalence of comorbidity and a high risk of complications from surgery, and for this reason, geriatricians may be well suited to improve outcomes of care. Co‐management of hip fracture patients by orthopedic surgeons and geriatricians has led to better outcomes in other countries but has rarely been described in the United States. This article describes a co‐managed Geriatric Fracture Center program that has resulted in lower‐than‐predicted length of stay and readmission rates, with short time to surgery, low complication rates, and low mortality. This program is based on the principles of early evaluation of patients, ongoing co‐management, protocol‐driven geriatric‐focused care, and early discharge planning. This is a potentially replicable model of care that uses the expertise of geriatricians to optimize the management of a common and serious condition.

Comanagement of geriatric hip fracture patients with standardized protocols has been shown to improve short-term outcomes after surgery. A standardized, patient-centered, comanaged Hip Fracture Program for Elders is examined for 1-year mortality. Patients 60 years of age who were treated in the Hip Fracture Program for Elders were comanaged by orthopaedic surgeons and geriatricians. Data including age, place of origin, procedure, length of stay, 1-year mortality, Charlson score, and activities of daily living (ADLs) were retrospectively collected. A total of 758 patients 60 years of age with hip fractures between April 15, 2005, and March 1, 2009, were included. Their data were analyzed, and the Social Security Death Index and the hospital data system were searched for mortality data. Seventy-eight percent were female, with a mean age of 84.8 years. The mean Charlson score was 3. Fifty percent were admitted from an institutional setting. The overall 1-year mortality was 21.2%. Age (odds ratio [OR] ¼ 1.03, 95% confidence interval [CI] ¼ 1.00-1.05; P ¼ .02), male gender (OR ¼ 1.55, 95% CI ¼ 1.01-2.36; P ¼ .04), low Parker mobility score (OR ¼ 2.94, 95% CI ¼ 1.31-6.57; P ¼ .01), and a Charlson score of 4 or greater (OR ¼ 2.15, 95% CI ¼ 1.30-3.55; P ¼ .002) were predictive of 1-year mortality. ADL dependence was a borderline predictor, as was medium Parker mobility score. Prefracture residence and moderate comorbidity (Charlson score of 2-3) were not independently predictive of mortality at 1 year after adjusting for other characteristics. A comprehensive comanaged hip fracture program for elders not only improves the short-term outcomes but also demonstrates a low 1-year mortality rate, particularly in patients from nursing facilities.Keywords geriatric trauma, systems of care, fragility fractures, hip, fractures, mortality Hip fractures in older adults are a leading public health concern. The incidence of hip fractures has been declining over the past decade; however, the total number of fractures has grown exponentially. 1 The number of hip fractures in the United States could total 840 000 by the year 2040.2,3 Older adults are the fastest growing segment of the US population. The population aged 65 years and older is predicted to more than double by 2050, increasing from 39 million today to 89 million. 4 It has been estimated that 1 in 3 women and 1 in 12 men will sustain a hip fracture in their lifetime.5 It has been reported that 86% of hip fractures occur in individuals aged 65 years and older. Hip fractures are associated with significant morbidity, mortality, loss of independence, and financial burden. [6][7][8][9][10][11][12] In usual care, the reported 1-year mortality after sustaining a hip fracture has been estimated to be 14% to 58% (Table 1). 1,7,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The relative risk of mortality in the elderly patient population increases 4% per year. 30 The first year after a hip fracture appears to be the most critical time. A recent meta-ana...

In the fast-growing geriatric population, we are confronted with both osteoporosis, which makes fixation of fractures more and more challenging, and several comorbidities, which are most likely to cause postoperative complications. Several models of shared care for these patients are described, and the goal of our systematic literature research was to point out the differences of the individual models. A systematic electronic database search was performed, identifying articles that evaluate in a multidisciplinary approach the elderly hip fracture patients, including at least a geriatrician and an orthopedic surgeon focused on in-hospital treatment. The different investigations were categorized into four groups defined by the type of intervention. The main outcome parameters were pooled across the studies and weighted by sample size. Out of 656 potentially relevant citations, 21 could be extracted and categorized into four groups. Regarding the main outcome parameters, the group with integrated care could show the lowest in-hospital mortality rate (1.14%), the lowest length of stay (7.39 days), and the lowest mean time to surgery (1.43 days). No clear statement could be found for the medical complication rates and the activities of daily living due to their inhomogeneity when comparing the models. The review of these investigations cannot tell us the best model, but there is a trend toward more recent models using an integrated approach. Integrated care summarizes all the positive features reported in the various investigations like integration of a Geriatrician in the trauma unit, having a multidisciplinary team, prioritizing the geriatric fracture patients, and developing guidelines for the patients' treatment. Each hospital implementing a special model for geriatric hip fracture patients should collect detailed data about the patients, process of care, and outcomes to be able to participate in audit processes and avoid peerlessness.