Caring for elderly people with orthopaedic problems

CARING FOR ELDERLY PEOPLE WITH ORTHOPAEDIC PROBLEMS

FEB 7, 2019 7.12 PM

Orthogeriatric is defined as the care of elderly patients with orthopaedic problems; where "ortho" refers to the bones, joints, muscles, ligaments, tendons while "geriatric" refers to elderly care.

Orthogeriatric was developed as a subspecialty in order to address the suboptimal outcomes of hip fractures in elderly patients following surgery or medical intervention and the importance of improving the prognosis (the next course of action). This increases the chance of functional recovery with the support of a specialist inter-disciplinary team.

Rehabilitation: A targeted treatment plan
Elderly patients are more susceptible to such conditions due to various health or physical impairments in their advanced age - most commonly broken bones from joint, knee, hip fractures after suffering a fall, weakness in their limbs and muscles from fragility, osteoporosis in both men and women and many others.

The lack of targeted medical attention and poor practices in post-acute care is the main culprit for poor recovery. Recent studies have shown that fragility fractures carry significant mortality rate of 10% that dies within one month of the injury, and a third within a year. Almost half of the patients experience a decrease in mobility after the fracture.

"Pre-hab" or pre-operation rehabilitation
All patients should have a comprehensive medical and admission assessment identifying their pre-incident function, cognition and risks in order to provide end-to-end support ahead of the surgical or medical intervention. Goals for pre-hab include the following:

1. Physical preparation: Light traction and mobilisation exercises to normalise movement patterns prior to surgery which helps to reduce pain and inflammation.
2. Mental preparation: Managing expectations of movement post-surgery including understanding rehabilitation exercises which can be done immediately after surgery.

Post-operation or post-acute rehabilitation
Rehabilitation can start anywhere from a few hours to a few days post-surgery; in some cases, there may need to be a period of rest/immobilisation following a surgery. It is one of the main factors in supporting the patient's ability to regain motion and strength and ultimately return to their daily activities.

After a thorough evaluation by the rehabilitation physician and therapists, goals will be set; from minimizing the adverse effects of surgery towards restoring normal flexibility, function and energy. These will form part of the targeted treatmentplan tailored for patient's specific needs.