Elderly care: the hip fracture journey

Question 1

what does the term fragility fracture encompass?

Answer 1

Include neck of femur, neck of humerous, wrist, vertebral and pelvic fractures

Question 2

What is the hip fracture care pathway report 12 standards patients should receive ?

Answer 2

1. Be transferred from the ED (emergency dept) to the orthopaedic ward within 4 hours
2. Have the ‘Big Six’ interventions in the ED
3. Receive the ‘Inpatient Bundle of Care’ within 24h
4. Undergo surgery with 36h of admission
5. Not be fasted repeatedly and should be given fluids up to 2 hours before surgery
6. Not be pre-operatively catheterised without medical reason
7. Have a cemented hemiarthoplasty unless otherwise indicated
8. Receive geriatric assessment within 3 days of admission if frail
9. Receive early mobilisation by end of first day after surgery and physiotherapy assessment by end of day 2.
10. Receive occupational therapy assessment by end of day 3 post operatively
11. Receive assessment of bone health prior to leaving acute orthopaedic ward
12. Have recovery optimised by MDT so can be discharged within 30 days of admission

Question 3

What are the ‘big six interventions’?

Answer 3

• Analgesia (esp for Xrays)
• Early Warning Score
• Pressure Area Inspection
• Bloods tests
• Fluid therapy
• Delirium screening

Question 4

What is geriatric assessment ?

Answer 4

Geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological, and functional capabilities of a frail elderly person in order to develop a coordinated and integrated plan for treatment and long-term follow-up.

Question 5

Delirium (Acute Confusion), how is it recognised?

Answer 5

Confusion Assessment Method (CAM):

• Acute change/ Fluctuating cognitive level
• Inattention
• Altered conscious level or disorganised thinking

Question 6

What is this and how does it develop?

Answer 6

It is a pressure ulcer and can start to develop within 30 mins of lying on hard surface eg A&E trolley or floor at home

Question 7

What is the WHO pain ladder?

Answer 7

Question 8

In relation to bone health assessment and fracture prevention what is done?

Answer 8

• Basic assessment should be done whilst inpatient (with follow up arrangements)
• Calcium/ Vitamin D intake should be assessed (most get supplemented)
• Dual X-ray Bone Densitometry (DeXA) if required as outpatient
• Antiresorportive therapy:

1. Oral (eg alendronic acid) once weekly
2. Second line treatments include intravenous bisphosphates or denosumab (monoclonal antibody)