What Is Orthogeriatric Service?

Orthogeriatric Service (OGS) is a collaborative work between orthopaedic and geriatric medicine department. The main goal is to provide a specialised care to elderly patients who have suffered from a fragility fracture in particular hip fracture or other types of orthopaedic problems. Fragility hip fractures can be particularly devastating for older patients, who may already have co-morbidities that can make recovery more difficult. 

The multidisciplinary team, comprised of orthopaedic surgeons, nurses, dieticians, pharmacists, geriatricians, physiotherapists, rehabilitation specialists, and occupational therapists, works together to provide patients with the best possible combined care. This collaborative effort aims to minimize surgical risks and support patients in achieving their optimal recovery.

Practical Applications of Orthogeriatric Care

Orthogeriatric service utilizes a multidisciplinary approach to address orthopaedic issues in the geriatric population such as fragility fractures, arthritis, and degenerative spinal problems. Concurrent or underlying medical conditions like hypertension and diabetes need to be assessed and managed before any surgical procedure to optimize the patient’s conditions and minimize risks related to surgery or anaesthesia. Orthogeriatric service is suitable to treat the following conditions:

Osteoarthritis

This condition affects many older people especially over their knees and hips. Patients present with severe knee and hip osteoarthritis often need total knee or total hip replacement surgery. Before surgery, they need to be assessed by physician/geriatrician for their underlying medical problems to optimize their condition before they are admitted for surgery as well as inpatient care when they are admitted for surgery.

Diabetic foot infection

A common condition affecting patient with diabetes mellitus. If diabetes is not well controlled and at the same time patient has minor skin injury or abrasion, bacteria infection sets in and leading on to diabetic foot infection. Many might need surgical intervention or regular wound management to remove the infection before it becomes worse. However, diabetes needs to be controlled well and they need to be in the most optimized condition to allow wound healing.

Osteoporosis

It’s a silent epidemic, characterised by deterioration of bone density and quality predisposes an individual to fragility fractures. It is often neglected as it is often considered as a natural ageing process. Osteoporosis can be prevented and treated if diagnosed early. This helps to reduce the risk of fragility fracture which can occur with minimal injury or spontaneously.

Age related degenerative lumbar spinal problems

This condition is very common among older people. Many develop lumbar spondylosis, lumbar spinal stenosis (narrowing of the canal where the nerve passes through), spondylolisthesis (instability of lumbar spine that might require combined care of orthogeriatric services especially if they need to go for surgical intervention.

Fragility fracture

A fragility fracture occurs in individuals aged 50 or older due to a fall from standing height or less. Many patients are unaware of their underlying osteoporosis. 1 in 3 women and 1 in 5 men will experience osteoporosis-related fractures. Fragility fracture, in particular, hip fractures, in particular, have the highest morbidity and mortality. Timely attention from an orthogeriatric team is crucial for hip fractures. Worldwide, optimizing underlying medical conditions and preparing patients for surgery within 24 to 48 hours is recommended. Immediate post-surgery rehabilitation to facilitate patient ambulation and mobility is vital for minimizing complications. Fall prevention, muscle strengthening, coordination, and balance exercises, integral to the orthogeriatric care model, are essential.

Multidisciplinary Specialists Approach

Orthogeriatric care combines both orthopaedic and geriatric medicine approach, providing comprehensive and specialised treatment for older adults who have suffered orthopaedic conditions and fragility fractures. Orthogeriatric care also include rehabilitation, dietetic advice, nursing care, fall prevention, treatment of underlying osteoporosis and sarcopenia (loss of muscle bulk, strength and muscle function).

This multidisciplinary approach aims to address the clinical needs and challenges faced by older people, considering their age-related physiological changes, medical conditions, and functional limitations. The ultimate objectives are to ensure the older people receiving the best care possible, to reduce any possible risks that may arise from surgery and anaesthesia.

Comprehensive assessment will be performed to evaluate the patient’s:

Medical History

Cognitive Function

Mobility

Social Support

This assessment helps to identify any underlying medical conditions, bone fragility or frailty that may impact the patient’s recovery and rehabilitation. Once the assessment is complete, a personalised treatment plan is developed, considering the patient’s specific needs and goals. This may involve:

Surgical/non-Surgical Intervention

Pain Management

Medication Review

Rehabilitation Strategies

Fall Prevention

Dietetic Advice

Throughout the treatment process, co-management between orthopaedic surgeons, geriatricians and other specialists are maintained to ensure a smooth recovery.

This collaboration helps address not only the orthopaedic injury but also the patient’s overall well-being, including the management of:

    • other medical conditions,
    • prevention of complications,
    • optimisation of functional recovery.

Team of Orthopaedic and Geriatric Experts

The world’s population is ageing, but with higher expectations for quality of life. It is especially crucial to provide integrated and holistic care to the ageing population. Chronic and degenerative musculoskeletal conditions are becoming more common in industrialised countries, substantially impacting the quality of life of the elderly population. This integrated approach addresses issues related to both medical and orthopaedics conditions with best functional outcomes possible.

In older people with musculoskeletal diseases, orthogeriatric care can improve timely diagnosis, optimal pre- and postoperative care and functional recovery. Recognising the complex issues of ageing physiology, treating physicians should be aware of effective alternatives to analgesics, procedural sedation, and definitive imaging in order to facilitate early surgical management and postoperative recovery.

In order to provide a systematic approach and best care possible to our patients at the older age group, Beacon Hospital focuses on providing expert acute care treatment for patients with orthopaedic issues, appropriate discharge planning, osteoporosis, sarcopenia and fall prevention strategies.

Seamless FLS Integration

As the pioneer of Fracture Liaison Service (FLS) in Malaysia, Beacon Hospital integrate our internationally certified FLS programme into our orthogeriatric services. FLS provides secondary fracture prevention program for individuals above fifty years of age, presenting with an index fragility fractures related to osteoporosis. Orthogeriatric team provides the acute care for the fracture, proper rehabilitation post fracture treatment and treatment of the underlying osteoporosis and fall prevention. It is meant to reduce the risk of further fractures which carry a higher morbidity and mortality.

Fracture-Liaison-Service-FLS-Programme-Beacon-Hospital-Malaysia

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