Role of comprehensive geriatric assessment in the management of osteoporotic hip fracture in the elderly: an overview

• Published in: Disability and rehabilitation 2013-05, Vol.35 (9), p.758-765
• Main Authors: De Rui, Marina, Veronese, Nicola, Manzato, Enzo, Sergi, Giuseppe
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Comprehensive geriatric assessment; Comprehensive Health Care - methods; Disability; elderly; Elderly people; Fractured hips; Geriatric assessment; Geriatric Assessment - methods; Health Services for the Aged - organization & administration; hip fracture; Hip Fractures - rehabilitation; Hip Fractures - surgery; Humans; Length of Stay; Mortality; Osteoporosis - complications; Osteoporotic Fractures - rehabilitation; Osteoporotic Fractures - surgery; Patient Care Planning; Patient Care Team - organization & administration; Recovery of Function; Secondary prevention
• ISSN: 0963-8288; 1464-5165
• DOI: 10.3109/09638288.2012.707747

Purpose: To highlight the advantages of comprehensive geriatric assessment (CGA) over usual care in the management of elderly patients with fragility hip fractures in terms of reducing the related mortality and disability. Method: An overview of publications on the topic was conducted using the MEDLINE and EMBASE databases. Results: Several models of geriatric and orthopedic comanagement have been developed in recent years, all characterized by a variable degree of integration, and they have been shown to reduce complications, disability and mortality in elderly hip-fracture patients. Preoperatively, CGA should identify the comorbidities that need to be treated in view of surgery, so as to reduce the related risks. After surgery, CGA should deal with medical complications and assure patients an early mobilization in order to reduce short-term mortality and contain functional decline. Before discharge, the orthogeriatric team should draw up a tailored program to promote the patient's functional recovery and satisfactory quality of life, also covering the secondary prevention of fragility fractures by improving bone quality and reducing the risk of falls. Conclusions: Fragility hip fractures in the elderly people need to be managed by different professionals working in close cooperation and adopting a CGA. Implications for Rehabilitation Orthogeriatric management Fragility hip fracture in older people is burdened by an elevated incidence of complications, mortality and disability. The global complexity of elderly people with hip fracture requires an orthopedic and geriatric comanagement. The application of the comprehensive geriatric assessment during hospital stay is the best approach for the management of the elderly people with hip fracture. Before discharge the multidisciplinary team should design a tailored rehabilitation plan and should also consider the secondary prevention of hip fracture.