Improved outcome in hip fracture patients in the aging population following co-managed care compared to conventional surgical treatment: a retrospective, dual-center cohort study

Background: Hip fracture patients in the aging population frequently present with various comorbidities, whilst preservation of independency and activities of daily living can be challenging. Thus, an interdisciplinary orthogeriatric treatment of these patients has recognized a growing acceptance in the last years. As there is still limited data on the impact of this approach, the present study aimed to evaluate the long-term outcome in elderly hip fracture patients, by comparing the treatment of a hospital with integrated orthogeriatric care (OGC) with a conventional trauma care (CTC). Methods: We conducted a retrospective, two-center, cohort study. In two maximum care hospitals all patients presenting with a hip fracture at the age of ≥ 70 years were consecutively assigned within a 1 year period and underwent follow-up examination 12 months after surgery. Patients treated in hospital site A were treated with an interdisciplinary orthogeriatric approach (co-managed care), patients treated in hospital B underwent conventional trauma care. Main outcome parameters were 1 year mortality, readmission rate, requirement of care (RC) and personal activities of daily living (ADL). Results: A total of 436 patients were included (219 with OGC / 217 with CTC). The mean age was 83.55 (66-99) years for OGC and 83.50 (70-103) years for CTC (76.7 and 75.6% of the patients respectively were female). One year mortality rates were 22.8% (OGC) and 28.1% (CTC; p = 0.029), readmission rates were 25.7% for OGC compared to 39.7% for CTC (p = 0.014). Inconsistent data were found for activities of daily living. After 1 year, 7.8% (OGC) and 13.8% (CTC) of the patients were lost to follow-up. Conclusions: Interdisciplinary orthogeriatric management revealed encouraging impact on the long-term outcome of hip fracture patients in the aging population. The observed reduction of mortality, requirements of care and readmission rates to hospital clearly support the health-economic impact of an interdisciplinary orthogeriatric care on specialized wards

Development and initial evaluation of a point-of-care educational app on medical topics in orthogeriatrics

INTRODUCTION: Research by AOTrauma's orthogeriatrics education taskforce identified ongoing educational needs for surgeons and trainees worldwide regarding the medical management of older adults with a fracture. To address practicing surgeons' preference for increased use of mobile learning, a point-of-care educational app was planned by a committee of experienced faculty. The goals were to deliver the app to surgeons, trainees, and other healthcare professionals, to measure usage, and to evaluate the impact on patient care. MATERIALS AND METHODS: The committee of geriatricians and surgeons designed and developed four modules on osteoporosis, delirium, anticoagulation, and pain based on published evidence and the content was programmed into mobile app formats. A registration form was integrated and a 14-question online evaluation survey was administered to users. RESULTS: The AOTrauma Orthogeriatrics app was installed by 17,839 users worldwide between September 2014 and October 2015: Android smartphones (44%), iPhones (32%), iPads (15%), Android tablets (9%). 920 users registered and 100 completed the online evaluation: orthopedic/trauma surgeons (67%), residents/fellows (20%), and other professionals (13%). Ratings for all aspects were 4 or higher on a 1-5 Likert scale (5 = Excellent). 80% of evaluation respondents found the answer to their question or educational need on their last visit, and 26 of 55 respondents (47%) reported making a change in an aspect of their management of patients as a result of their learning from the app. CONCLUSION: The orthogeriatrics app reached its intended audiences and was rated highly as a method of providing education to help improve patient care. Content input by experienced faculty and app improvements based on user feedback were key contributors to successful implementation

Multidisciplinary inpatient rehabilitation improves the long-term functional status of geriatric hip-fracture patients

Background As the world population ages, the number of hip-related fractures in the elderly is steadily increasing. These fractures generate a major worldwide healthcare problem and frequently lead to deterioration of life quality, mobility and independence in activity of daily life of geriatric patients. At present, many studies have investigated and proved benefits of multidisciplinary orthogeriatric care for elderly hip-fracture patients. Only few studies however, have analyzed treatment concepts for those patients directly following discharge from hospital in specialized rehabilitation centers. The aim of this study was to evaluate effects of a multidisciplinary inpatient rehabilitation on the short- and long-term functional status of geriatric patients who suffered from hip fracture. Methods A total of 161 hip-fracture patients aged 80 years and above, or additionally 70 years and above suffering from age-typical multimorbidity were included in this study. Patients who had an initial Barthel Index lower than 30 points were excluded from this study, as most of these patients were not able to attend a therapy at the rehabilitation center due to a poor functional status. The patients were separated into two subgroups dependent on the availability of treatment spots at the rehabilitation center. No other item was used to discriminate between the groups. Group A (n = 95) stayed an average of 21 days at an inpatient rehabilitation center that specialized in geriatric patients. Group B (n = 66) underwent the standard postoperative treatment and were sent home with further treatment by their general practitioner, nursing staff and physiotherapists. To evaluate the patients’ functional status over the course of time we used the Barthel Index, which was evaluated for every patient on the day of discharge, as well as during checkups after 3, 6 and 12 months. Results The average Barthel Index at the day of discharge was 57.79 ± 14.92 points for Group A and 56.82 ± 18.76 points for Group B (p = 0.431). After 3 months, the average Barthel Index was 82.43 points for Group A and 73.11 points for group B (p = 0.005). In the 6-month checkup Group A’s average Barthel Index was 83.95 points and Group B’s was 74.02 points (p = 0.002). After 12 months, patients from Group A had an average Barthel Index of 81.21 while patients from Group B had an average Barthel Index of 69.85 (p = 0.005). Conclusion The results of this study reveal a significantly better outcome concerning both, short-term and long-term functional status after 3, 6 and 12 months for geriatric hip-fracture patients, who underwent an inpatient treatment in a rehabilitation center following the initial therapy

COVID-19 pandemic and mortality in nursing homes across USA and Europe up to October 2021

Purpose We compared the prevalence of COVID-19 and related mortality in nursing homes (NHs) in 14 countries until October 2021. We explored the relationship between COVID-19 mortality in NHs with the average size of NHs and with the COVID-19 deaths at a population level. Methods The total number of COVID-19 cases and COVID-19-related deaths in all NHs as well as the total number of NHs and NH beds were provided by representatives of 14 countries. The population level respective figures in each country were provided up to October 2021. Results There was a wide variation in prevalence of COVID-19 cases and deaths between countries. We observed a significant correlation between COVID-19 deaths in NHs and that of the total population and between the mean size of NHs and COVID-19 deaths. Conclusion Side-by-side comparisons between countries allow international sharing of good practice to better enable future pandemic preparedness.Peer reviewe

COVID-19 pandemic and mortality in nursing homes across USA and Europe up to October 2021

Purpose We compared the prevalence of COVID-19 and related mortality in nursing homes (NHs) in 14 countries until October 2021. We explored the relationship between COVID-19 mortality in NHs with the average size of NHs and with the COVID-19 deaths at a population level. Methods The total number of COVID-19 cases and COVID-19-related deaths in all NHs as well as the total number of NHs and NH beds were provided by representatives of 14 countries. The population level respective figures in each country were provided up to October 2021. Results There was a wide variation in prevalence of COVID-19 cases and deaths between countries. We observed a significant correlation between COVID-19 deaths in NHs and that of the total population and between the mean size of NHs and COVID-19 deaths. Conclusion Side-by-side comparisons between countries allow international sharing of good practice to better enable future pandemic preparedness.Peer reviewe

PAINT I: the effect of art therapy in preventing and managing delirium among hospitalized older adults in the PAINT I study: a proof of concept trial

Background: delirium is common among older hospitalized patients and is regarded as a negative outcome parameter. Non-pharmacological strategies have been shown to be effective in the prevention and management of delirium. This study aimed to determine the effectiveness of art therapy as part of a multicomponent intervention in preventing and managing delirium in hospitalized older patients.Methods: 138 patients at risk of developing delirium were included and received art therapy twice daily for 25 min using a mobile atelier. 107 participants were included in the final analysis (N = 53 intervention, N = 54 control). The primary outcome was the effectiveness of art therapy in preventing delirium. The secondary outcome was to determine its impact on duration of delirium in patients with existing delirium. Delirium was assessed using the Nursing delirium Screening Scale (Nu-DESC).Results: 8 patients (7.5%) developed new onset delirium after admission, equally distributed among control and intervention group. Therefore, no valid statistical analysis could be performed. There was a statistically non-significant decrease in the duration of delirium in the intervention group (4 days, IQR 2.25–8.75) compared to the control group (7 days, IQR 5-10), Mann-Whitney-U-Test p-value = 0.26. After stratifying by dementia diagnosis on admission, the non-significant decrease in duration of delirium in the intervention group was more apparent in patients without dementia.Conclusion: findings from this study showed that the integration of art therapy as part of a multicomponent intervention in delirium management is feasible, and can reduce duration of delirium among hospitalized older adults

Differential Diagnosis of MCI, Dementia and Depression—A Comparison of Different Cognitive Profiles

Three-hundred-and-thirty-four cognitive profiles from neuropsychological examinations assessed during a 5-year period (2015 to 2020) from geriatric patients of a day clinic in the south of Germany were analyzed. For this purpose, the profiles were divided into the following subgroups: (1) Mild Cognitive Impairment, no depression (2) Onset or mild dementia, no depression (3) No cognitive deficit, depression (4) cognitively impaired (MCI, dementia) and depression. Subgroups were be compared using analysis of variance (independent variable IV: diagnostic groups, dependent variable DV: cognitive functions) to reveal specific differences that will allow a differential diagnosis. Post-hoc comparisons and a graphical representation of the cognitive profiles were also investigated. All cognitive profiles with a Mini-Mental-State-Examination (MMSE) score of 25 or more points were selected for analysis if they had complete data from the following testing procedures: MMSE, clock drawing test, Geriatric Depression Scale (GDS), Syndrom-Kurztest (SKT), Nuremberg Aging Inventory (NAI) maze test, Wechsler Adult Intelligence Scale (WAIS) similarities, Rivermead Behavioral Memory Test (RBMT) story immediate and delayed. The results will help to improve the differential diagnostic examination of older depressed people with and without cognitive impairment: Depressed patients usually have no objectifiable memory impairment and inconspicuous scores in the logical structure of thought processes, while attention was usually impaired in both depressed and demented patients

Differential Diagnosis of MCI, Dementia and Depression—A Comparison of Different Cognitive Profiles

Three-hundred-and-thirty-four cognitive profiles from neuropsychological examinations assessed during a 5-year period (2015 to 2020) from geriatric patients of a day clinic in the south of Germany were analyzed. For this purpose, the profiles were divided into the following subgroups: (1) Mild Cognitive Impairment, no depression (2) Onset or mild dementia, no depression (3) No cognitive deficit, depression (4) cognitively impaired (MCI, dementia) and depression. Subgroups were be compared using analysis of variance (independent variable IV: diagnostic groups, dependent variable DV: cognitive functions) to reveal specific differences that will allow a differential diagnosis. Post-hoc comparisons and a graphical representation of the cognitive profiles were also investigated. All cognitive profiles with a Mini-Mental-State-Examination (MMSE) score of 25 or more points were selected for analysis if they had complete data from the following testing procedures: MMSE, clock drawing test, Geriatric Depression Scale (GDS), Syndrom-Kurztest (SKT), Nuremberg Aging Inventory (NAI) maze test, Wechsler Adult Intelligence Scale (WAIS) similarities, Rivermead Behavioral Memory Test (RBMT) story immediate and delayed. The results will help to improve the differential diagnostic examination of older depressed people with and without cognitive impairment: Depressed patients usually have no objectifiable memory impairment and inconspicuous scores in the logical structure of thought processes, while attention was usually impaired in both depressed and demented patients