Loyola University Hospital is launching an interdisciplinary Geriatric Fracture Program to reduce hospital stays and complications from broken hips and other age-related fractures.
Many elderly patients who break bones have underlying health conditions such as heart failure, diabetes and chronic obstructive pulmonary disease that can delay surgery. But the longer surgery is put off, the greater the risk of complications such as pneumonia and blood clots.
Moreover, elderly patients who are bedridden while awaiting surgery rapidly lose muscle strength. The longer surgery is delayed, the longer the hospitalization and rehab, and the less likely a patient will fully recover.
At Loyola, the goal is to begin surgery to repair a fracture within 24 hours whenever possible, and within 48 hours in all cases, said orthopaedic surgeon Dr. Erika Mitchell, who initiated Loyola's Geriatric Fracture Program.
The Geriatric Fracture Program is developing protocols to assess surgical risks and address underlying health conditions, so that surgery can be performed as safely and as soon as possible, said hospitalist Dr. Theresa Kristopaitis. (A hospitalist is a physician who specializes in the care of hospital patients.)
As more and more baby boomers reach retirement age, there will be a sudden and dramatic increase in the number of patients who experience fragility fractures due to age and osteoporosis.
"I think the health-care system is under-prepared for this," Mitchell said.
A fragility fracture, such as slipping on the ice and breaking a hip, typically is caused by a fall from a standing height or less. Fragility fractures also can be caused by ordinary activities such as sneezing or even rolling over in bed.
Fragility fractures occur in bones weakened by osteoporosis. Common fragility fractures include broken hips, wrists and vertebrae. Fragility fractures affect up to one half of women and one-third of men over age 50.
Loyola's program puts it at the forefront of treating fractures in the elderly, said Dr. Pauline Camacho, director of Loyola's Osteoporosis and Metabolic Bone Disease Center.
The geriatric fracture program will address osteoporosis and fractures from a multidisciplinary perspective. The program will attempt to lower re-fracture rates, which are very high in untreated patients. Initial workups will be started in the hospital, and osteoporosis therapy started as soon as possible after surgery.
"Osteoporotic fractures are a huge and costly burden to the health care system," Camacho said. "Programs such as ours will have an impact on reducing this burden. We are hoping other hospitals will follow our lead."
Treating fragility fractures is challenging. Plates, screws and other hardware that surgeons use to hold bones in place can come loose in bones softened by osteoporosis. And elderly patients are at higher risk for complications from surgery.
But Mitchell finds the work rewarding. "Older patients just want to stay independent and get back to their lives," she said. "When we can help them do that, they are the most thankful patients."
Source: Loyola University Hospital