An orthogeriatric collaborative intervention program for fragility fractures: a retrospective cohort study.

BACKGROUND: This retrospective cohort study aims to investigate the impact of regular pre- and postoperative geriatric input into the management of geriatric patients with hip fracture, with specific interests in morbidity and mortality. METHODS: Patients with hip fracture (n = 548) older than 60 years were identified within a 2-year period. In the first year, the patients (n = 270) were managed mainly by orthopedics and this group constituted the control group. In the second year, this group of patients (orthogeriatric group, n = 278) had reviews by orthopedic surgeons and geriatricians (physicians specializing in medicine for the elderly), within 48 hours of admission and regularly thereafter. The main outcomes measured included demographics, length of hospital stay, postoperative complications, mortality, and functional outcomes. Data were collected from records of acute and rehabilitation admissions, and outpatient consultations. RESULTS: The admission to operation time for those in the orthogeriatric group was shorter by 17% (p = 0.02). The percentage of patients deceased at 12 months postoperative was 11.5% for the orthogeriatric group and 20.4% for the conventional group (p = 0.02). A higher percentage of patients in the orthogeriatric group remained independent for daily living activities (24.5%) when compared with the conventional group (23.7%; p = 0.02). CONCLUSION: In addition to existing evidence that postoperative orthogeriatric collaboration improves mortality and functional outcomes in older patients with hip fractures, this study suggests that allowing preoperative geriatric input in this model of care can produce even more superior results.

The efficacy of a multidisciplinary falls prevention clinic with an extended step-down community program.

OBJECTIVE: To investigate the efficacy of a falls prevention clinic and a community step-down program in reducing the number of falls among community-dwelling elderly at high risk of fall. DESIGN: Prospective cohort. SETTING: Community. PARTICIPANTS: Community-dwelling elderly (N=200) were screened for risk of fall; 60 were identified as being at high risk and were referred to the intervention program. INTERVENTION: Twelve sessions of a once-a-week falls prevention clinic, including fall evaluation, balance training, home hazard management program, and medical referrals, were provided in the first 3 months. The community step-down program, including falls prevention education, a weekly exercise class, and 2 home visitations, was provided in the following 9 months. MAIN OUTCOME MEASURES: Fall rate, injurious fall, and its associated medical consultation were recorded during the intervention period and the year before intervention. Balance tests included the Berg Balance Scale (BBS), Sensory Organization Test, and limits of stability test; fear of falling, as evaluated using the Activities-specific Balance Confidence (ABC) scale, was measured at baseline and after the training in the falls prevention clinic. RESULTS: Significant reductions in fall rate (74%), injurious falls (43%), and fall-associated medical consultation (47%) were noted. Significant improvement in balance scores (BBS, P<.001; endpoint excursion in limits of stability test, P=.004) and fear of falling (ABC scale, P=.001) was shown. CONCLUSIONS: The programs in the falls prevention clinic were effective in reducing the number of falls and injurious falls. The community step-down programs were crucial in maintaining the intervention effects of the falls prevention clinic.

A primary falls prevention programme for older people in Hong Kong.

This study describes the development and implementation of a large-scale primary fall and fracture prevention programme in Hong Kong and its effect on increasing the awareness and knowledge of fall and fracture prevention among older people. The effect of promotion of community participation is also investigated in the implementation of this primary prevention programme. The programme includes educational seminars, a train-the-trainers programme and a staff training programme. The effect of the educational seminars is shown by the increase in the knowledge and awareness of fall and fracture prevention among these participants (p < 0.01), while that of the train-the-trainers programme and staff-training programme is confirmed by the continuous expansion and continuation of the fall and fracture prevention programme in the community. The experience from this primary prevention programme has given us direction for future implementation of a more comprehensive prevention programme in our community.

Biomechanical study of an anthropometrically designed hip protector for older chinese women.

Biomechanical properties and compliance are 2 essential properties of hip protectors (HPs) that determine their clinical efficacy. This study describes the development of a HP that was anthropometrically designed according to anthropometric data from 68 older Chinese women and with attention paid to the biomechanical properties of the device. A simulated mechanical fall test using a drop weight and a force plate were set up to test the force attenuation properties of the HP. The HP attenuated up to 93% of the impact force, and the remaining force was 2 standard deviations below the mean fracture threshold of the proximal femur. The HP was effective in force attenuation, and the anthropometric data obtained provides important information for the development of HPs adapted for a Chinese population. Further study on the compliance and clinical efficacy of this HP is underway.

High-frequency whole-body vibration improves balancing ability in elderly women.

OBJECTIVE: To investigate the efficacy of high-frequency whole-body vibration (WBV) on balancing ability in elderly women. DESIGN: Randomized controlled trial. Subjects were randomized to either the WBV intervention or the no-treatment control group. SETTING: Community-living elderly women. PARTICIPANTS: Sixty-nine elderly women aged 60 or above without habitual exercise. INTERVENTION: Side alternating WBV at 20Hz with 3 minutes a day and 3 days a week for 3 months in the WBV intervention group. Those in control group remained sedentary with normal daily life for the whole study period. MAIN OUTCOME MEASURES: Limits of stability in terms of reaction time, movement velocity, directional control, endpoint excursion, maximum excursion, and the functional reach test were performed at baseline and endpoint. RESULTS: Significant enhancement of stability was detected in movement velocity (P<.01), maximum point excursion (P<.01), in directional control (P<.05). CONCLUSIONS: WBV was effective in improving the balancing ability in elderly women. This also provides evidence to support our user-friendly WBV treatment protocol of 3 minutes a day for the elderly to maintain their balancing ability and reduce risks of fall.