Orthogeriatric care: improving patient outcomes

Abstract

Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard.

The Effects of Comorbidities on Intensive Care Admission in Elderly Patients Undergoing Hip Surgerious

“…Some authors have reported that multidisciplinary geriatric care reduces hospital mortality and complications (17,18,19). We also believe that ICU monitoring of complicated cases reduces mortality.…”

“…Although orthogeriatric units have initiated improvements with respect to care of geriatric patients who are admitted to hospitals due to hip fractures since the 1950s, hip fractures are still a serious socio-economic problem in western countries (17).…”

Development of the Barthel Index 5 years after hip fracture: Results of a prospective study

“…Therefore, this relationship could be a possible explanation, even if it does not consider the osteosynthesis group. Other authors have already described increasing age, 7,8,12,13 poor mental status 7,12,14,15 and a higher degree of comorbidity 8 as risk factors for a worse functional outcome in shorter surveying periods (6-12 months). Discussing increased age as a significant factor for a lower Barthel Index score, especially in a long-term follow-up study, seems to be obvious because of the increasing frailty of the aging patients.…”

“…8,9 Pre-facture functional impairment seems to be associated with poor function and mobility in shortand mid-term follow up. 7,[10][11][12] Other factors that are associated with poor functional outcome after the different observation periods (6-12 months) are increasing age, 7,8,12,13 living in an institution, 13 poor mental status, 7,12,14,15 female sex, 12 trochanteric fractures, 7 a higher degree of comorbidity 8 and poor functional status after discharge. 13 There is only one retrospective cohort study with functional long-term follow up that reported the Barthel Index 4.9 years after hip fracture.…”

Effects of Geriatric Interdisciplinary Home Rehabilitation on Independence in Activities of Daily Living in Older People With Hip Fracture: A Randomized Controlled Trial

“…[1][2][3] In order to optimize recovery, the rehabilitation should include an orthogeriatric care model with an interdisciplinary team, using comprehensive geriatric assessment. 4,5 Length of stay (LOS) in the hospital has been reduced over the recent decades, which has contributed to the establishment of home rehabilitation (HR) teams for continuation of the rehabilitation after discharge. 6 The evidence for team-based rehabilitation after hip fracture in the home setting is still limited, but positive effects on ADL and mobility compared with usual inhospital care have been shown.…”