Saltvedt Ingvild, Prestmo Anders, Einarsen Elin, Johnsen Lars Gunnar, Helbostad Jorunn L, Sletvold Olav
Department of Geriatrics, St, Olav Hospital, University Hospital of Trondheim, Trondheim, Norway.
BMC Res Notes. 2012 Jul 16;5:355. doi: 10.1186/1756-0500-5-355.
Hip fractures are common among frail elderly persons and often have serious consequences on function, mobility and mortality. Traditional treatment of these patients is performed in orthopedic departments without additional geriatric assessment. However, studies have shown that interdisciplinary geriatric treatment may be beneficial compared to traditional treatment. The aim of the present study is to investigate whether treatment of these patients in a Department of Geriatrics (DG) during the entire hospital stay gives additional benefits as compared to conventional treatment in a Department of Orthopaedic Surgery (DOS).
A new clinical pathway for in-hospital treatment of hip fracture patients was developed. In this pathway patients were treated pre-and postoperatively in DG. Comprehensive geriatric assessment was performed as an interdisciplinary, multidimensional, systematic assessment of all patients focusing on each patient's capabilities and limitations as recommended in guidelines and systematic reviews. Identification and treatment of co-morbidities, pain relief, hydration, oxygenation, nutrition, elimination, prevention and management of delirium, assessment of falls and osteoporosis were emphasized. Discharge planning started as early as possible. Initiation of rehabilitation with focus on early mobilisation and development of individual plans was initiated in hospital and continued after discharge from hospital. Fracture specific treatment was based upon standard treatment for the hospital, expert opinions and a review of the literature.
A new treatment program for old hip fracture patients was developed, introduced and run in the DG, the potential benefits of which being compared with traditional care of hip fracture patients in the DOS in a randomised clinical trial.
髋部骨折在体弱的老年人中很常见，并且常常对功能、活动能力和死亡率产生严重影响。这些患者的传统治疗在骨科进行，没有额外的老年医学评估。然而，研究表明，与传统治疗相比，跨学科的老年医学治疗可能有益。本研究的目的是调查在老年医学科（DG）对这些患者进行整个住院期间的治疗与在骨科（DOS）进行传统治疗相比是否能带来额外的益处。
制定了一种新的髋部骨折患者住院治疗临床路径。在该路径中，患者在DG进行术前和术后治疗。按照指南和系统评价中的建议，对所有患者进行全面的老年医学评估，这是一种跨学科、多维度、系统性的评估，重点关注每个患者的能力和局限性。强调识别和治疗合并症、缓解疼痛、补液、给氧、营养、排泄、谵妄的预防和管理、跌倒评估以及骨质疏松症评估。尽早开始出院计划。在住院期间开始以早期活动为重点的康复治疗并制定个人计划，出院后继续进行。骨折特异性治疗基于医院的标准治疗、专家意见和文献综述。
在DG制定、引入并实施了一种针对老年髋部骨折患者的新治疗方案，其潜在益处将在一项随机临床试验中与DOS中髋部骨折患者的传统治疗进行比较。
