Is there a role for an orthogeriatric model of care for the management of vertebral fragility fractures in hospital?

Ong, Terence (2019) Is there a role for an orthogeriatric model of care for the management of vertebral fragility fractures in hospital? PhD thesis, University of Nottingham.

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Abstract

Introduction: Orthogeriatric care has led to improved outcomes in the management of patients admitted to hospital with hip fractures. Such an interprofessional multidisciplinary collaboration ensured that the complex needs of older people with hip fractures are met. This thesis considered the role of an orthogeriatric model of care for patients in hospital with vertebral fragility fractures. To support such a care model, certain conditions had to be met. The number of patients admitted to hospital warrant such a service, these patients have complex care needs, their outcomes poor and that hospital care had to be delivered by healthcare professionals with specific knowledge and skills.

Method: A multi-method study was conducted which synthesised findings from a systematic review of characteristics and outcomes of patients admitted to hospital with vertebral fragility fractures, an observational study of patients requiring hospital treatment, and a modified-Delphi consensus study to determine how these patients should be managed in hospital.

Results: The annual incidence of hospital admission for the UK was estimated at 6 per 10,000/year in patients over the age of 50 years. Those admitted were in severe pain, especially during mobilisation which restricted their daily living. These patients were older, mostly in their ninth decade of life, reported a high prevalence of frailty, multimorbidity and cognitive impairment. In addition to treating the acute fracture, their care in hospital involved managing their concomitant medical diagnosis, falls risk, bone health and rehabilitation requirements. This required input from healthcare professionals with medical, surgical, nursing and therapy background. After an average of 2 weeks in hospital, up to half did not return to their usual residence but required an increase in care, either temporary or permanent. One-third at 6 months after hospital discharge remained in pain. Many do not return to their pre-fracture level of function. One-year mortality can be as high as 27%. Worse outcomes were associated with increasing age and comorbidities. Clinicians with responsibility for managing patients with vertebral fragility fractures in hospital agreed that a coordinated multidisciplinary approach was required.

Discussion: Those admitted to hospital with vertebral fragility fractures are vulnerable to the adverse effects of their fracture and hospitalisation. A systematic organised service, i.e. orthogeriatric care for these patients can address their care needs.

Conclusion: There is a role for an orthogeriatric model of care for patients admitted to hospital with vertebral fragility fractures. The next phase is to evaluate the feasibility in delivering such a service and gauge the resources required for it.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Gladman, John
Sahota, Opinder
Keywords: Vertebral fracture, Spinal fracture, Orthogeriatric, Aged, Fragility fracture, Multidisciplinary, Hospital
Subjects: W Medicine and related subjects (NLM Classification) > WE Muscoskeletal system
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 56724
Depositing User: Ong, Terence
Date Deposited: 21 Aug 2019 13:38
Last Modified: 07 May 2020 10:16
URI: http://eprints.nottingham.ac.uk/id/eprint/56724

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