Increased Geriatric Treatment Frequency Improves Mobility and Secondary Fracture Prevention in Older Adult Hip Fracture Patients—An Observational Cohort Study of 23,828 Patients from the Registry for Geriatric Trauma (ATR-DGU)

Abstract

Interdisciplinary orthogeriatric care of older adult hip fracture patients is of growing importance due to an ageing population, yet there is ongoing disagreement about the most effective model of care. This study aimed to compare different forms of orthogeriatric treatment, with focus on their impact on postoperative mobilization, mobility and secondary fracture prevention. In this observational cohort study, patients aged 70 years and older with a proximal femur fracture requiring surgery, were included from 1 January 2016 to 31 December 2019. Data were recorded from hospital stay to 120-day follow-up in the Registry for Geriatric Trauma (ATR-DGU), a specific designed registry for older adult hip fracture patients. Of 23,828 included patients from 95 different hospitals, 72% were female, median age was 85 (IQR 80–89) years. Increased involvement of geriatricians had a significant impact on mobilization on the first day (OR 1.1, CI 1.1–1.2) and mobility seven days after surgery (OR 1.1, CI 1.1–1.2), initiation of an osteoporosis treatment during in-hospital stay (OR 2.5, CI 2.4–2.7) and of an early complex geriatric rehabilitation treatment (OR 1.3, CI 1.2–1.4). These findings were persistent after 120 days of follow-up. Interdisciplinary treatment of orthogeriatric patients is beneficial and especially during in-patient stay increased involvement of geriatricians is decisive for early mobilization, mobility and initiation of osteoporosis treatment. Standardized treatment pathways in certified geriatric trauma departments with structured data collection in specific registries improve outcome monitoring and interpretation.

Prognostic Factors of the Inability to Bear Self-Weight at Discharge in Patients with Fragility Femoral Neck Fracture: A 5-Year Retrospective Cohort Study in Thailand

“…Thus, modern concepts concerning the application of multidisciplinary care teams and specific care programs (e.g., increasing the number of visits by geriatricians, early geriatric rehabilitation program (EGR)) are keys to improving the surgical outcomes and patients’ quality of life. Previous studies had reported the outcomes of implementing these programs, which results in a significant increase in walking ability, early initiation of anti-osteoporotic agents for preventing secondary hip fractures, and decreased patient mortality [ 49 , 50 ].…”

Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review

“…Indeed, pathways along specific care programmes which facilitate e.g., increased geriatrician input, may enhance the likelihood of weight bearing by mitigating modifiable risk factors such as delirium which may be more prevalent among those with non-modifiable risk factors (e.g., those who are older and present with poor cognitive and functional status) [110]. Previous studies revealed that adopting these programmes leads to a considerable gain in walking capacity [111].…”