Evaluation and Implementation of Geriatric Co-Management Models for Hospitalized Frail Older Patients

status: publishe

Geriatric trauma: there is more to it than just the implant!

Abstract. Geriatric trauma continues to rise, corresponding with the continuing growth of the older population. These fractures continue to expand, demonstrated by the incidence of hip fractures having grown to 1.5 million adults worldwide per year. This patient population and their associated fracture patterns present unique challenges to the surgeon, as well as having a profound economic impact on the health care system. Pharmacologic treatment has focused on prevention, with aging adults having impaired fracture healing in addition to diminished bone mineral density. Intraoperatively, novel ideas to assess fracture reduction to facilitate decreased fracture collapse have recently been explored. Postoperatively, pharmacologic avenues have focused on future fracture prevention, while shared care models between geriatrics and orthopaedics have shown promise regarding decreasing mortality and length of stay. As geriatric trauma continues to grow, it is imperative that we look to optimize all phases of care, from preoperative to postoperative

From research to bedside: Incorporation of a CGA‐based frailty index among multiple comanagement services

The comprehensive geriatric assessment (CGA) is the core tool used by geriatricians across diverse clinical settings to identify vulnerabilities and estimate physiologic reserve in older adults. In this paper, we demonstrate the iterative process at our institution to identify and develop a feasible, acceptable, and sustainable bedside CGA‐based frailty index tool (FI‐CGA) that not only quantifies and grades frailty but also provides a uniform way to efficiently communicate complex geriatric concepts such as reserve and vulnerability with other teams. We describe our incorporation of the FI‐CGA into the electronic health record (EHR) and dissemination among clinical services. We demonstrate that an increasing number of patients have documented FI‐CGA in their initial assessment from 2018 to 2020, while additional comanagement services were established (Figure 2). The acceptability and sustainability of the FI‐CGA, and its routine use by geriatricians in our division, were demonstrated by a survey where the majority of clinicians report using the FI‐CGA when assessing a new patient and that the FI‐CGA informs their clinical management. Finally, we demonstrate how we refined and updated the FI‐CGA, we provide examples of applications of the FI‐CGA across the institution and describe areas of ongoing process improvement and challenges for the use of this tailored yet standardized tool across diverse inpatient and outpatient services. The process outlined can be used by other geriatric departments to introduce and incorporate an FI‐CGA.See related editorial by Callahan in this issue.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/171594/1/jgs17446_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/171594/2/jgs17446.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/171594/3/jgs17446-sup-0001-supinfo.pd