Injury, Int. J. Care Injured 45 (2014) 1513–1515
Contents lists available at ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
Editorial
Development of geriatric trauma centers – An effort by the German Society for Trauma and Orthopaedics
Keywords: Orthogeriatrics Comanaged care Factures in the elderly Certified geriatric trauma centers Fractures in the elderly
Background: Trauma networks Throughout Europe there has been a wave of certifications for trauma networks over the last 15 years or so. These initiatives have been very helpful in England, The Netherlands, Germany, and other countries. The advantages achieved through these innovations might be helpful for the management of another epidemic, the geriatric patient. Current status of geriatric fracture center development Today we are facing a rapidly ageing population along with associated traumatic events [1]. A recent survey describes that almost 130,000 hip fractures are treated annually in Germany alone [2]. In order to improve the general knowledge about these injuries, a fragility network has been developed [2]. It is actively undertakes data acquisition and evaluated treatment outcomes that were presented in national and international meetings [3]. One of the most important aspects in current treatment principles is a close cooperation between trauma surgery and geriatrics [4]. As will be demonstrated below, this cooperation has been
integrated in the certification process for geriatric trauma centers. In most locations, this has occurred just within the last five years (Fig. 1). Prevention In general, many programs have focused on fracture prevention through specialized training. Among these are offers by physical therapists to train with walking aids. These should be performed on a regular basis and as a result, many places offer ‘‘drivers licenses for walkers’’. These programs have to be managed by health care professionals in order to cover safety issues. Other programs offer self assessment tools: The Aachen group has developed a falls prevention scale that allows elderly citizens to assess themselves. The aim is to improve the ability to estimate the individual falls risk on a longitudinal basis and possibly trigger the necessity for a doctor’s visit (Table 1). If there has been a fall that requires hospitalization, the comanaged care concept foresees that initial patient assessment by a geriatrician along with multiple other common decisions. Among them is a common treatment plan both for the fracture treatment and the comorbidities, common ward rounds between geriatricians, Orthopaedic trauma surgeons, social workers and specialized nurses [5]. In some areas even hospitals were built that focused on co-managed care [6]. Some studies document that the implementation of a standardized care plan improves the outcome of the geriatric proximal femur fractures [7]. However, Buecking et al. recently reviewed the current literature about prospective studies regarding hip fractures. He
Fig. 1. Long-term mortality: forest plot of the effect of orthogeriatric treatment. 95% CI, 95% confidence interval. Ref. [1]. http://dx.doi.org/10.1016/j.injury.2014.08.006 0020–1383/ß 2014 Elsevier Ltd. All rights reserved.
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Editorial / Injury, Int. J. Care Injured 45 (2014) 1513–1515
Table 1 Aachen falls prevention scale.
Table 2 Criteria for certification as a geriatric trauma center. Full time Geriatrician, must have the right to educate Proof of specialized nursing abilities by certified courses (e.g.>>>) SOP’s for geriatric conditions Quality management program for geriatric conditions Proof of common patient care 1. Assessment
Contents lists available at ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
Editorial
Development of geriatric trauma centers – An effort by the German Society for Trauma and Orthopaedics
Keywords: Orthogeriatrics Comanaged care Factures in the elderly Certified geriatric trauma centers Fractures in the elderly
Background: Trauma networks Throughout Europe there has been a wave of certifications for trauma networks over the last 15 years or so. These initiatives have been very helpful in England, The Netherlands, Germany, and other countries. The advantages achieved through these innovations might be helpful for the management of another epidemic, the geriatric patient. Current status of geriatric fracture center development Today we are facing a rapidly ageing population along with associated traumatic events [1]. A recent survey describes that almost 130,000 hip fractures are treated annually in Germany alone [2]. In order to improve the general knowledge about these injuries, a fragility network has been developed [2]. It is actively undertakes data acquisition and evaluated treatment outcomes that were presented in national and international meetings [3]. One of the most important aspects in current treatment principles is a close cooperation between trauma surgery and geriatrics [4]. As will be demonstrated below, this cooperation has been
integrated in the certification process for geriatric trauma centers. In most locations, this has occurred just within the last five years (Fig. 1). Prevention In general, many programs have focused on fracture prevention through specialized training. Among these are offers by physical therapists to train with walking aids. These should be performed on a regular basis and as a result, many places offer ‘‘drivers licenses for walkers’’. These programs have to be managed by health care professionals in order to cover safety issues. Other programs offer self assessment tools: The Aachen group has developed a falls prevention scale that allows elderly citizens to assess themselves. The aim is to improve the ability to estimate the individual falls risk on a longitudinal basis and possibly trigger the necessity for a doctor’s visit (Table 1). If there has been a fall that requires hospitalization, the comanaged care concept foresees that initial patient assessment by a geriatrician along with multiple other common decisions. Among them is a common treatment plan both for the fracture treatment and the comorbidities, common ward rounds between geriatricians, Orthopaedic trauma surgeons, social workers and specialized nurses [5]. In some areas even hospitals were built that focused on co-managed care [6]. Some studies document that the implementation of a standardized care plan improves the outcome of the geriatric proximal femur fractures [7]. However, Buecking et al. recently reviewed the current literature about prospective studies regarding hip fractures. He
Fig. 1. Long-term mortality: forest plot of the effect of orthogeriatric treatment. 95% CI, 95% confidence interval. Ref. [1]. http://dx.doi.org/10.1016/j.injury.2014.08.006 0020–1383/ß 2014 Elsevier Ltd. All rights reserved.
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Editorial / Injury, Int. J. Care Injured 45 (2014) 1513–1515
Table 1 Aachen falls prevention scale.
Table 2 Criteria for certification as a geriatric trauma center. Full time Geriatrician, must have the right to educate Proof of specialized nursing abilities by certified courses (e.g.>>>) SOP’s for geriatric conditions Quality management program for geriatric conditions Proof of common patient care 1. Assessment
