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

Abstract

This review article examines the role of orthogeriatric management for frail older patients with a fragility fracture. The history of orthogeriatrics and its application in clinical practice around the world is reported, and an evidence-based evaluation for the effect of orthogeriatric management on patient morbidity and mortality is also provided. It has been more than 50 years since the role of the geriatrician in the management of patients with a hip fracture was first described. The evidence that supports an orthogeriatric model of care has grown exponentially over the last decade. This evidence base is primarily related to hip fractures and demonstrates reduced morbidity and mortality rates amongst patients managed with a recognised model of orthogeriatric care. The societal and economic burden of hip fracture has led to health economic evaluations within this field, many of which have concluded that orthogeriatric management results in cost-effective clinical practice. Based on existing clinical and economic research, national clinical practice guidelines have been developed in several countries which recommend orthogeriatric participation in the management of older patients with a hip fracture. Compliance with such guidance has already demonstrated improved patient outcomes. Although the pathogenesis and prognosis of other types of fragility fracture may be as poor, there is a dearth of clinical research that evaluates the effect of orthogeriatric management on such injuries. Looking to the future, orthogeriatric management is likely to become more widespread, and the robust collection and reporting of patient outcomes from national registries will provide a greater understanding of the impact of orthogeriatric models in the care of all frail older patients with any type of fragility fracture.

Association between Cognitive Status before Surgery and Outcomes in Elderly Patients with Hip Fracture in a Dedicated Orthogeriatric Care Pathway

“…There is growing evidence from multiple studies that a similar benefit may be obtained elsewhere [2,39]. On these grounds, we anticipate that the deployment of new UPOG units in France as from 2014 will hopefully confirm these results, refine them and help find new ways to improve the outcome of patients facing HF surgery with or without cognitive disorders.…”

Hip Fracture in the Elderly

“…Several reports on orthogeriatric care in the management of frail patients with fragility fractures have described a positive effect on inpatient and long-term mortality, morbidity, and functional outcomes. 38 Cardiac evaluation should focus on allowing for early surgical treatment. Functional capacity, heart rate, and rhythm should be evaluated.…”

Time to Surgery Reduction in Hip Fracture Patients on an Integrated Orthogeriatric Unit: A Comparative Study of Three Healthcare Models

“…One relevant initiative has been the implementation of specific health care models, mainly the ones in which collaboration between surgeons and geriatricians or internists is established. These collaborative models of care can have a positive influence on the outcomes of hip fracture patients, since, in some cases, they are showing reduced mortality rates, reduced clinical complication rates, or being cost‐effective.…”

“…A key factor for the adequate treatment of this outstanding pathology seems to be the interdisciplinary collaboration. In fact, the care model used may have relevance to the clinical outcomes. Since the development of the Hastings care model, we have learned that collaboration between the trauma team and the geriatric team may improve the treatment of patients with hip fractures.…”

“…Since the development of the Hastings care model, we have learned that collaboration between the trauma team and the geriatric team may improve the treatment of patients with hip fractures. Several publications indicate that collaborative models between geriatricians and surgeons could improve the results of the treatment of this pathology.…”