Orthogeriatrics and Hip Fractures

Sanford, Angela M.; Morley, John E.; McKee, Alexis M.

doi:10.1007/s12603-018-1007-7

Cited by 4 publications

(2 citation statements)

References 118 publications

(101 reference statements)

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“…The risk of mortality within the first 48 hours of hip fracture surgery has been estimated at 0.8%, erring close to the threshold where death can be considered a ‘common’ event [ 13 ]. Outside of the immediate post-operative period, estimates put the rate of mortality at 17%-38% at the end of the first year [ 14 ]. This is not to mention that patients with cognitive impairment are at a higher risk of mortality than those without [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Patients Lacking the Capacity to Consent to Hip Fracture Surgery May Be Undergoing Major Operations Without Their Next of Kin Being Involved in Best-Interests Decisions: A Quality Improvement Report

Zalmay¹,

Collis²,

Wilson³

2021

Cureus

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BackgroundCognitively impaired patients with a hip fracture may be undergoing major operations without attempts being made to involve their next of kin (NoK) in best-interest decisions. MethodsWe used the Plan-Do-Study-Act (PDSA) methodology to guide our quality improvement (QI) project. Cognitively impaired hip fracture patients were identified retrospectively by searching the hip fracture database of a medium-sized district general hospital (DGH). Their medical notes were reviewed for documented attempts at contacting their NoK prior to surgery as well as on completion of the NoK section of the Consent Form Four. InterventionA simple feedback intervention was delivered in the form of a mixed verbal and visual presentation to the orthopaedic registrars responsible for obtaining consent from these patients. ResultsPost-intervention, there were documented attempts at contacting the NoK before surgery for all patients, a significant improvement from only 80%. There was also a significant increase in completion of the NoK section of the consent form, from 30% to 64.3%. ConclusionsSimple audit and feedback interventions can produce significant positive changes in communication between clinicians and the NoK of cognitively impaired patients with hip fractures. Further interventions have been implemented to sustain these improvements.

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Section: Discussionmentioning

confidence: 99%

Patients Lacking the Capacity to Consent to Hip Fracture Surgery May Be Undergoing Major Operations Without Their Next of Kin Being Involved in Best-Interests Decisions: A Quality Improvement Report

Zalmay¹,

Collis²,

Wilson³

2021

Cureus

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“…Obviously, the exciting developments in the osteoporotic field from the DEXA and FRAX screens for the diagnosis (56) and the development of bisphosphonates and other drugs is an important component of modern geriatrics (57). Improved outcomes for persons with hip fracture is closely associated with the development of orthogeriatric units (58).…”

Section: Figurementioning

confidence: 99%

Geriatrics: Highlights of the Last 50 Years

Morley

2019

The Journal of nutrition, health and aging

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Old Bones

Morley

2020

The Journal of nutrition, health and aging

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Bone is a dynamic organ in which osteoblasts, under inhibitory control of sclerostin, creates new bone osteoblasts by releasing RANK-L to activate osteoclasts to remove bone. This dynamic network is under local control of miRNAs and long noncoding RNAs to balance the effect of bone stressors on bone formation (1). With aging there is an increase in fragility fractures. Fractures are a more common reason for older persons requiring interaction with medical professionals than any other disease and are one of the higher components of annual hospital costs (2). Over 20% of older persons with hip fractures die within a year and they are a major cause of disability (3). Vertebral fractures are a major cause of back pain, loss of height, reduced pulmonary function, dysphagia, deformity and a decline in quality of life. The need for collaboration between orthopedic surgeons and geriatricians to improve outcomes of older persons with fractures led to the forming of the first geriatric orthopaedic unit by Bobby Irvine and Michael Devas in 1963 (4). The motto of this unit was "Bedrest is rehabilitation for the grave." Richard Lefroy published the first positive effects of a geriatric orthopedic unit in Perth, Australia (5). A meta-analysis found that these combined programs resulted in a decrease in both in-hospital and long-term mortality (6). Two recent approaches improving hip fracture care are: (i) providing regional nerve blocks on arrival at hospital to reduce pain and improve function outcomes (7) and (ii) injection of a triphasic calcium based implant (AGN-1) into the contralateral proximal femur to reduce subsequent hip fracture in the other hip (8). There are three major bone diseases in older persons-Paget's disease of bone, osteomalacia, and osteoporosis.

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Orthogeriatrics and Hip Fractures

Cited by 4 publications

References 118 publications

Patients Lacking the Capacity to Consent to Hip Fracture Surgery May Be Undergoing Major Operations Without Their Next of Kin Being Involved in Best-Interests Decisions: A Quality Improvement Report

Patients Lacking the Capacity to Consent to Hip Fracture Surgery May Be Undergoing Major Operations Without Their Next of Kin Being Involved in Best-Interests Decisions: A Quality Improvement Report

Geriatrics: Highlights of the Last 50 Years

Old Bones

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