Orthogeriatrics moving forward

Abstract

The role of the orthogeriatrician has grown over the last few years. Orthogeriatrics was primarily involved in the care and management of fragility hip fractures, but has recently been expanded to provide specialist care to patients admitted with other various fractures, the spine, pelvis, appendicular, and those suffered from major trauma. There is also an increasing role for the orthogeriatrician to optimise the pre-operative care of patients undergoing elective joint and spine surgery. Much of what we do incorporates comprehensive geriatric assessment of the frail older person, and research into new and innovative ways of managing various types of fragility fractures such as the use of enhanced recovery after surgery (ERAS) pathways, regional anaesthesia, vertebral augmentation in spinal fractures, sacral augmentation and anabolic treatment in pelvic fractures. Ultimately, this reduces post-operative complication rates, improves outcomes and leads to better patient care and recovery.

Orthogeriatrics in the management of frail older patients with a fragility fracture

“…The benefit of orthogeriatric care for patients with this injury is lacking in the scientific literature; however, perhaps owing to the experiences of key opinion leaders within the field, the Australian and New Zealand Society for Geriatric Medicine (ANZGSM) has endorsed orthogeriatric care for patients with vertebral fractures [1], and a recent review on the future of orthogeriatrics in the UK stated that the role of the orthogeriatrician in the management of these patients was critical [62]. The evidence base for orthogeriatric management of other fragility fractures including the wrist, pelvis, sacrum and ankle is also lacking; however, the ANZGSM's position statement on orthogeriatrics supports the role of an orthogeriatric model of care for all patients with such injuries [1].…”

Framing moving and handling as a complex healthcare intervention within the acute care of older people with osteoporosis: a qualitative study

“…Osteoporotic fractures are known to be a major cause of morbidity and mortality; hip fractures are potentially the most ominous type as they can cause acute pain and loss of function, invariably they lead to hospital admission, recovery can be protracted and rehabilitation may be incomplete with many unable to return to independent living (Kanis et al . , NHFD , Aw & Sahota ). Hip fractures were linked to up to 10% mortality in the first month after fracture and one‐third mortality within a year (Roche et al .…”

“…Whereas 90% of hip fractures are falls related (Geusens et al . , NOS ), only 25% of vertebral fractures are linked to falls and many occur during everyday activities such as bending over, twisting or lifting light objects (IOF , Aw & Sahota ). Despite being the most prevalent of the LTFs, vertebral fractures are under diagnosed and rates of hospital admission are low (Holroyd et al .…”

Translating Delirium Prevention Strategies for Elderly Adults with Hip Fracture into Routine Clinical Care: A Pragmatic Clinical Trial

“…[2][3][4][5][6] The strongest evidence is for nonpharmacological interventions, including educational interventions, [7][8][9] and multicomponent interventions performed by research personnel 10,11 or trained volunteers. 12,13 Access to specialized orthogeriatric services 14,15 is not routinely available. Multicomponent interventions target known delirium risk factors, including overuse of medications associated with delirium, 3,4,16 but given organizational and resource constraints, translating multicomponent strategies and best practice guidelines into routine clinical care can be a challenge, 3,4,6 and the benefits of educational interventions can wane with time and staffing turnover.…”