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Geriatric orthopedics

Corey S Scher
PURPOSE OF REVIEW: The percentage of people over the age of 65 is growing rapidly and anesthesiologists must develop a medical understanding that is comprehensive to meet the unique medical needs of this population. The changing physiology of an elderly population makes them extremely vulnerable to trauma and the administration of blood products. Although most of these cases involve orthopedic attention, it is not less dangerous as a blunt trauma case. RECENT FINDINGS: This article addresses some of the main concerns for the anesthesiologists of providing a hemostatic resuscitation in the geriatric population...
April 2018: Current Opinion in Anaesthesiology
Nirav H Amin, Jacob A West, Travis Farmer, Hrayr G Basmajian
Introduction: Hip fracture is a common occurrence in the elderly population with high morbidity and mortality due to postoperative pain and opioid use. The goal of this article is to review the current literature on the neuroanatomy of the hip and the use of localized nerve block in controlling hip fracture pain. Methods: A thorough search of MEDLINE/PubMed, Embase, and the Cochrane Database of Systematic Reviews was conducted using the search terms "hip fracture" and "fascia iliaca block (FICB)...
December 2017: Geriatric Orthopaedic Surgery & Rehabilitation
Sanjit R Konda, Ariana Lott, Hesham Saleh, Sebastian Schubl, Jeffrey Chan, Kenneth A Egol
Introduction: Frailty in elderly trauma populations has been correlated with an increased risk of morbidity and mortality. The Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) is a validated mortality risk score that evaluates 4 major physiologic criteria: age, comorbidities, vital signs, and anatomic injuries. The aim of this study was to investigate whether the addition of additional frailty variables to the STTGMA tool would improve risk stratification of a middle-aged and elderly trauma population...
December 2017: Geriatric Orthopaedic Surgery & Rehabilitation
Leyanna Susan George, Sanjay Deshpande, M K Krishna Kumar, Ramesh S Patil
Context: India is an "aging nation" with 7.7% of its population being above 60 years of age. It has resulted in a rise of both physical and mental health morbidities. Aims: This study aimed to gather information regarding the morbidity pattern and its sociodemographic determinants among the elderly residing in the rural villages of Raichur, to understand the need for geriatric health-care facilities. Settings and Design: This community-based cross-sectional study was carried out in six rural villages of Raichur District, of which 230 elderly were selected randomly...
April 2017: Journal of Family Medicine and Primary Care
Daniel I McIsaac, Tim Jen, Nikhile Mookerji, Abhilasha Patel, Manoj M Lalu
BACKGROUND: Frailty is an important prognostic factor for adverse outcomes and increased resource use in the growing population of older surgical patients. We identified and appraised studies that tested interventions in populations of frail surgical patients to improve perioperative outcomes. METHODS: We systematically searched Cochrane, CINAHL, EMBASE and Medline to identify studies that tested interventions in populations of frail patients having surgery. All phases of study selection, data extraction, and risk of bias assessment were done in duplicate...
2017: PloS One
Yasuharu Nakashima, Ken Okazak, Koichiet Nakayama, Seiji Okada, Hideki Mizu-uchi
With the increase of elderly population, orthopaedic surgeons need to deal with the diseases related to aging, such as joint disorders and fragility fractures. The number of total joint replacements, for example, is two times more than it was 10 years ago. With these backgrounds, the Japanese Orthopaedic Association (JOA) has proposed the concept of locomotive syndrome; conditions under which the elderly have been receiving care services due to problems of the locomotive organs. To prevent geriatric or disuse syndrome, JOA is currently providing the care‒prevention programs such as the loco-check and loco-training...
January 2017: Fukuoka Igaku Zasshi, Hukuoka Acta Medica
P Merloz
Proximal femoral fracture in elderly subjects is a major event that is life-threatening in the medium-to-long term. Advanced age, male gender and number of comorbidities largely account for high mortality and require geriatric expertise. Protein-energy malnutrition and bone demineralization increase mortality. Mortality can, on the other hand, be reduced by acting on two variables accessible to medical intervention: daily activities and nutritional status. Functional and neurocognitive assessment allow the risk of dependency to be evaluated, and global geriatric work-up can prevent sudden breakdown of homeostasis...
February 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Mateusz Klukowski, Rafał Kowalczyk, Grzegorz Górniewski, Paweł Łęgosz, Marek Janiak, Janusz Trzebicki
BACKGROUND: Fractures of the proximal femur in elderly patients are a challenge for orthopedics, anesthe-sio-logy and geriatrics. Early mobilization reduces postoperative mortality among these patients. Effective anal-gesia is necessary to achieve this goal. MATERIAL AND METHODS: A retrospective analysis of perioperative medical records of 78. patients undergoing surgical treatment of proximal femur fractures was performed. Group 1 (n=35)consisted of patients who were treated with pharmacologic analgesia only (systemic analgesics) and Group 2 (n=43) involved patients who re-ceived a preoperative fascia iliaca compartment block (FICB) and pharmacologic analgesia...
October 31, 2017: Ortopedia, Traumatologia, Rehabilitacja
Mary E Wims, Shayla M McIntyre, Ann York, Laura G Covill
How physical therapists (PTs) in the United States currently use yoga in their clinical practices is unknown. The purpose of this study was to determine how PTs in the United States view yoga as a physical therapy (PT) tool and how PTs use yoga therapeutically. The authors conducted a 24-item survey via electronic communications of the Geriatric, Orthopedic, Pediatric, and Women's Health Sections of the American Physical Therapy Association. Participants (n = 333) from 47 states and the District of Columbia replied...
November 2017: International Journal of Yoga Therapy
Janine Gronewold, Christian Dahlmann, Marcus Jäger, Dirk M Hermann
BACKGROUND: As a consequence of demographic changes, hospitals are confronted with increasing numbers of elderly patients, who are at high risk of adverse events during hospitalization. Geriatric risk screening followed by comprehensive geriatric assessment (CGA) and treatment has been requested by geriatric societies and task forces to identify patients at risk. Since empirical evidence on factors predisposing to adverse hospital events is scarce, we now prospectively evaluated implications of geriatric risk screening followed by CGA in a university hospital department of orthopedics and trauma surgery...
2017: PloS One
Markus Muhm, Matthias Amann, Alexander Hofmann, Thomas Ruffing
BACKGROUND: Over the last decade, the percentage of people >65 years has increased from 16.6% to 20.7%. In industrialized countries, the annual incidence in people >65 years with a proximal femur fracture is about 600-900 per 100,000 population. The incidence will increase by 3-5% per year. Guidelines advocate early surgery as soon as possible but within 24 h. External quality control requires surgical treatment within 48 h. In this study, the changes in the patient population with proximal femur fractures and their treatment during the last decade were investigated...
October 20, 2017: Der Unfallchirurg
Manabu Akahane, Shingo Yoshihara, Akie Maeyashiki, Yasuhito Tanaka, Tomoaki Imamura
BACKGROUND: The Japanese Orthopedic Association first proposed the concept of "locomotive syndrome" in 2007. It refers to circumstances in which elderly people need nursing care services or are at high risk of requiring such services within a short time. Recently, the public health burden of providing nursing care for elderly individuals has increased. Therefore, locomotive syndrome, and the means of preventing it, are a major public health focus in Japan. The purpose of this study was to investigate the relationships of lifestyle factors, such as smoking, alcohol consumption, sleep duration, and dental health, with locomotive syndrome...
October 18, 2017: BMC Geriatrics
Gilgamesh Eamer, Bianka Saravana-Bawan, Brenden van der Westhuizen, Thane Chambers, Arto Ohinmaa, Rachel G Khadaroo
BACKGROUND: Seniors presenting with surgical disease face increased risk of postoperative morbidity and mortality and have increased treatment costs. Comprehensive Geriatric Assessment (CGA) is proposed to reduce morbidity, mortality, and the cost after surgery. METHODS: A systematic review of CGA in emergency surgical patients was conducted. The primary outcome was cost-effectiveness; secondary outcomes were length of stay, return of function, and mortality. Inclusion and exclusion criteria were predefined...
October 2017: Journal of Surgical Research
Hanru Ren, Lianghao Wu, Wankun Hu, Xiuzhang Ye, Baoqing Yu
BACKGROUND: More and more older patients receive the surgery after hip fracture. However, the mortality rate is high. Prognostic nutritional index (PNI) is associated with prognosis in hip fracture patients. In the current study, we proposed a novel prognostic score, named c-reactive protein/PNI ratio (CRP/PNI ratio), for predicting the prognosis for geriatric orthopedic population. METHODS: This is a prospective study. Eighty cases of hip fracture surgery in the elderly population were studied to reveal the relationship between the CRP/PNI ratio and the clinicopathological characteristics of the elderly patients...
September 22, 2017: Oncotarget
Kiyoshi Kita, Yoshihiro Fukumoto, Yukihide Nishimura, Akihiko Kasuya, Tsuyoshi Asai
BACKGROUND: Step-up ability is considered to be associated with lower limb dysfunction. The objective of this research was to assess the height of the tallest step that could be mounted and to investigate its association with lower limb dysfunction. METHODS: We previously conducted a two-year follow-up prospective cohort study. The study subjects were 119 patients receiving physiotherapy or exercise therapy at an orthopedic surgery clinic. The items evaluated were step-up ability (maximum step height), the timed up and go test, one-leg standing time and the 5-question Geriatric Locomotive Function Scale...
January 2018: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Deborah J Culley, Devon Flaherty, Margaret C Fahey, James L Rudolph, Houman Javedan, Chuan-Chin Huang, John Wright, Angela M Bader, Bradley T Hyman, Deborah Blacker, Gregory Crosby
BACKGROUND: The American College of Surgeons and the American Geriatrics Society have suggested that preoperative cognitive screening should be performed in older surgical patients. We hypothesized that unrecognized cognitive impairment in patients without a history of dementia is a risk factor for development of postoperative complications. METHODS: We enrolled 211 patients 65 yr of age or older without a diagnosis of dementia who were scheduled for an elective hip or knee replacement...
November 2017: Anesthesiology
Silvana X Choo, Paul Stratford, Julie Richardson, Jackie Bosch, Susan M Pettit, Barbara J Ansley, Jocelyn E Harris
PURPOSE: To determine whether there was a difference in the sensitivity to change of the subscales of the Functional Independence Measure and the Assessment of Motor and Process Skills within three different post-acute inpatient rehabilitation populations. MATERIAL AND METHODS: We conducted retrospective chart review of patients consecutively admitted to inpatient rehabilitation units, with both admission and discharge Functional Independence Measure and Assessment of Motor and Process Skills scores...
September 10, 2017: Disability and Rehabilitation
Lauren Jan Gleason, Emily A Benton, M Loreto Alvarez-Nebreda, Michael J Weaver, Mitchel B Harris, Houman Javedan
OBJECTIVES: There are limited screening tools to predict adverse postoperative outcomes for the geriatric surgical fracture population. Frailty is increasingly recognized as a risk assessment to capture complexity. The goal of this study was to use a short screening tool, the FRAIL scale, to categorize the level of frailty of older adults admitted with a fracture to determine the association of each frailty category with postoperative and 30-day outcomes. DESIGN: Retrospective cohort study...
December 1, 2017: Journal of the American Medical Directors Association
Tsutomu Iwaya, Tokuhide Doi, Atsushi Seichi, Yuichi Hoshino, Toru Ogata, Masami Akai
BACKGROUND: Ageing is associated with a decline of motor function and ability to perform daily activities. Locomotive disorders are one of the major disorders resulting in adverse health condition in elderly people. Concept of Locomotive syndrome (LoS) was proposed to tackle the problems and prolong healthy life expectancy of people with locomotive disorders. To develop intervention strategy for LoS it is mandatory to investigate impairments, functional disabilities which people with locomotive disorder experience and to examine relationships among these parameters...
July 26, 2017: BMC Geriatrics
Julia R Berian, Lynn Zhou, Marcia M Russell, Melissa A Hornor, Mark E Cohen, Emily Finlayson, Clifford Y Ko, Ronnie A Rosenthal, Thomas N Robinson
OBJECTIVE: To explore hospital-level variation in postoperative delirium using a multi-institutional data source. BACKGROUND: Postoperative delirium is closely related to serious morbidity, disability, and death in older adults. Yet, surgeons and hospitals rarely measure delirium rates, which limits quality improvement efforts. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Geriatric Surgery Pilot (2014 to 2015) collects geriatric-specific variables, including postoperative delirium using a standardized definition...
July 24, 2017: Annals of Surgery
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