Orthogeriatric co-management – managing frailty as well as fragility

Pioli, Giulio; Bendini, Chiara; Pignedoli, Paolo; Giusti, Andrea; Marsh, David

doi:10.1016/j.injury.2018.04.014

Cited by 60 publications

(50 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Managing frailty, fragility, and multi-morbidity in older patients who at a higher risk of poor outcomes such as falls, fracture, perioperative complications, and readmission is an increasingly critical aspect of orthopaedic practice [19][20][21][26][27][28][29][30][31][32]. Yet, how frailty is understood and how the use of validated frailty screening tools could aid identification and augment integrated care in this context is markedly limited.…”

Section: Discussionmentioning

confidence: 99%

Orthopaedic surgeons’ perceptions of frailty and frailty screening

2020

View full text Add to dashboard Cite

Background: Over the past decade, there has been significant growth in the awareness and understanding of fragility among orthopaedic surgeons in the context of osteoporotic fractures and with it, improvements in the recognition and management of fragility fractures. Emerging as a major clinical and research focus in aged care is the concept of frailty and its associations with fragility, sarcopenia, falls and rehabilitation. Currently, research is lacking on how orthopaedic surgeons perceive frailty and the role of frailty screening. A baseline understanding of these perceptions is needed to inform integration of frailty identification and management for patient optimization in orthopaedic practices, as well as research and education efforts of patients and healthcare professionals in orthopaedic contexts. Methods:We used an exploratory design guided by qualitative description to conduct 15 semi-structured telephone and in-person interviews across three orthopaedic surgeon subgroups (Registrars, Junior Consultants, and Senior Consultants). Data collection and analysis occurred iteratively and was guided by thematic saturation.Results: Orthopaedic surgeons have a disparate understanding of frailty. Between colleagues, frailty is often referred to non-specifically to suggest a general state of risk to the patient. Frailty screening is regarded positively but its specific utility in orthopaedic environments is questioned. Easy-to-administer frailty screening tools that are not exclusive assessments of functional status are viewed most satisfactorily. However these tools are rarely used. Conclusions: There is little understanding among orthopaedic surgeons of frailty as a phenotype. Beliefs around modifiability of frailty were dissimilar as were the impact of related risk factors, such a cognitive status, chronic disease, social isolation, and environmental influences. This in turn may significantly impact on the occurrence and treatment outcomes of fragility fracture, a common orthopaedic problem in older populations. This study highlights need for knowledge translation efforts (e.g. education) to achieve cohesive understanding of frailty among health professionals.

show abstract

Section: Discussionmentioning

confidence: 99%

Orthopaedic surgeons’ perceptions of frailty and frailty screening

2020

View full text Add to dashboard Cite

show abstract

“…Managing frailty, fragility, and multi-morbidity in older patients who at a higher risk of poor outcomes such as falls, fracture, perioperative complications, readmission is an increasingly critical aspect of orthopaedic practice [23][24][25][26][27][28][29]. Yet, how frailty is understood and how the use of validated frailty screening tools could aid identification and augment integrated care in this context is markedly limited.…”

Section: Discussionmentioning

confidence: 99%

“…These findings pointed to a discrepancy between how declaratively participants-particularly Registrars-defined frailty and how this knowledge was displayed and operationalised in the remainder of the interviews. This suggests fundamental differences between the participants' propositional (information, knowledge-that) and operational knowledge (abilities and skills, knowledge-how-to; [32,33]) about frailty, and suggests that education emphasizing integrated orthogeriatric management and comprehensive geriatric competencies (e.g., knowledge of frailty and related conditions with reduced physiologic reserve, such as sarcopenia; operational knowledge of psycho-social assessment; [28]) may be beneficial to optimizing the care of older persons in orthopaedic contexts.…”

Section: Discussionmentioning

confidence: 99%

“…Relative to other complex geriatric conditions and considerations such as sarcopenia, falls, and fragility fracture, awareness about frailty is only recently growing and has not formally been included in medical school education or advanced orthopaedic curricula in many countries. Education that attends to the biological, psychological and social components of frailty in diverse orthopaedic practice contexts would likely better equip practitioners to consider the holistic needs of patients during pre and post surgical optimization, and may provide a foundation for integrated and personcentered care of frail older persons [28,38]. Collaborative, interdisciplinary and multi-level education regarding the merits of frailty screening pertinent to orthopaedic practice and linking with fragility, with an explicit emphasis on the contextual nuances relevant to diverse orthopaedic practice contexts, could therefore be of benefit, if supported by compelling evidence.…”

Section: Discussionmentioning

confidence: 99%

“…Although changing current orthopaedic practice would represent a major translational challenge, support from accrediting bodies by way of continuing professional development and education activities and incentives would be a necessary facilitator. General training education that reflects the collaborative necessities and ideals of management (e.g., orthogeriatric collaboration and fracture liason services; [28]) with general community understandings may be well placed to attend to challenges of frailty identification and management within and beyond orthopaedic practices. Ideally, such education would be positioned within accepted models of care, particularly those that integrate frailty recognition and defined care responsibilities within orthopaedic practice as part of preoperative assessment, perioperative management, and rehabilitation [39].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Orthopaedic Surgeons Perceptions of Frailty and Frailty Screening

Archibald

Lawless

Gill

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

Investigation and analysis of frailty and nutrition status in older adult patients with hip fracture

Liu

Xie

et al. 2023

Nut in Clin Prac

View full text Add to dashboard Cite

BackgroundTo analyze the current situation of frailty and the main influencing factors of frailty of older patients with hip fracture.MethodsUsing a fixed‐point consecutive sampling method, we investigated older adult patients with hip fracture aged ≥60 years who were hospitalized in an orthopedic ward of a tertiary hospital from January 2021 to March 2022. We also assessed the prevalence of frailty and malnutrition by trial of the fatigue, resistance, aerobic capacity, illnesses, and loss of weight (FRAIL) scale and the Global Leadership Initiative on Malnutrition criteria to analyze the factors influencing frailty.ResultsA total of 216 older adult patients with hip fracture were collected, 106 (49.08%) were frail, 72 (33.33%) were prefrail, 38 (17.59%) were nonfrail, 103 (47.69%) were at overall nutrition risk, and 76 (35.19%) were malnourished. The results of bivariate correlation analysis showed that frailty score was correlated with age, the Activity of Daily Living Scale (ADL) score, body mass index (BMI), C‐reactive protein, hemoglobin (Hb), serum albumin (ALB), and serum prealbumin, and was negatively correlated with ADL score, BMI, Hb, and ALB (r = −0.399, −0.420, −0.195, −0.283, respectively; P < 0.05). The results of multiple linear regression analysis showed that age, number of underlying diseases, ADL score, BMI score, and nutrition status were important influencing factors of frailty (P < 0.05).ConclusionOlder adult patients with hip fracture are frail and prefrail, with a high prevalence of malnutrition. Advanced age, combined underlying diseases, and a low BMI score were risk factors for preoperative frailty.

show abstract

Orthogeriatric co-management – managing frailty as well as fragility

Cited by 60 publications

References 52 publications

Orthopaedic surgeons’ perceptions of frailty and frailty screening

Orthopaedic surgeons’ perceptions of frailty and frailty screening

Orthopaedic Surgeons Perceptions of Frailty and Frailty Screening

Investigation and analysis of frailty and nutrition status in older adult patients with hip fracture

Contact Info

Product

Resources

About