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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2929_Библиотеки_им_академика_М_И_Перельмана
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K. Hertz and J. Santy-Tomlinson
the ultimate purpose of delivering optimum care as well as consideration of how this
reects the patient/carer/family perspective and how it can include the patients’
experience of their condition. Such a strategy would need consideration of different
cultural aspects globally.
18.9 Conclusion
This concluding chapter has explored some of the considerations for the future of
orthogeriatric and fragility fracture care from the perspective of nurses and other
practitioners. The demand for care in some parts of the world will continue to escalate in the coming decades. This means that the right resources and skills need to be
in place for fracture prevention to ameliorate as much of the rise in incidence as
possible, and for post-fracture care to be optimised. Without such a focus, services
will be overwhelmed. Orthogeriatric and Fragility Fracture Care teams need to
work collaboratively with leaders and policy makers to ensure the best evidencebased care can be implemented.
The agenda that supports this important goal includes attention to workforce
resources as well as the development of the roles of practitioners with particular
attention to the skills needed to care for older people following acute injury as well
as in health improvement and prevention of future fractures. Signicant effort is
also needed in the research agenda that can support future optimum practice and
education of the workforce to provide this optimised care that is compassionate and
person centred.
Summary of Main Points for Learning
• The role of nurses and other practitioners in orthogeriatric care and fragil-
ity fracture management and care (denitions are provided in Chap. 1) is
broad and complex.
• The rising incidence of fractures, particularly fragility fractures, is a global
public health issue placing unprecedented pressure on service.
• Care of patients with fragility fractures is best provided practitioners who
recognise the specic and complex needs of frail older people with multiple comorbidities.
• In some places care is enhanced by nurses working in advanced practice
roles that encompass advanced/specialist clinical practice, leadership, and
education.
• All members of the interdisciplinary team need skills in chronic disease
management.
• Care provided for patients with fragility fractures needs to be compassion-
ate and patient centred.
18 Orthogeriatric andFragility Fracture Care intheFuture
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301
• Interdisciplinary research in orthogeriatrics and fragility fracture care must
involve all members of the team with nurses more involved in the conduct
of research.
• The task of facilitating learning of individuals and teams of fragility frac-
ture practitioners at a global level requires careful consideration of how
learning might be delivered in a manner that accommodates different cultures, learning needs and styles, and available resources.
References
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K. Hertz and J. Santy-Tomlinson
Open Access This chapter is licensed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing,
adaptation, distribution and reproduction in any medium or format, as long as you give appropriate
credit to the original author(s) and the source, provide a link to the Creative Commons license and
indicate if changes were made.
The images or other third party material in this chapter are included in the chapter's Creative
Commons license, unless indicated otherwise in a credit line to the material. If material is not
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statutory regulation or exceeds the permitted use, you will need to obtain permission directly from
the copyright holder.
Index
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A
ABCDE approach, 116
Activehip+ programme, 243
Activities of daily living (ADLs), 215
Acute delirium, 122
Acute orthogeriatric care, 6, 8
Administrative support, 84, 85
Advanced activities of daily living
(AADLs), 102
Aerobic exercise, 47
Allied health professionals (AHPs), 84
Antimicrobial prophylaxis, 164
B
Balance exercises, 47, 229
Basic activities of daily living (BADLs), 102
Behaviour change strategies, 81
Blanching erythema, 150
Bone biology, 18, 19
Bone densitometry, 8, 88
Bone mineral density (BMD), 24
C
Calcium, 175, 176
Case management model
brokerage, 260
clinical, 260, 261
intensive case management model, 261, 262
strengths-based clinical, 261
Clinical frailty scale (CFS), 40
Clinical lead, 84
Cognitive impairment, 122
Comprehensive (ortho)geriatric assessment
(CGA), 7
assessment tools, 105
cognition, 103
falls, 102, 103
functional status, 102
mood, 103
nursing and interdisciplinary team role,
106, 107
patient needs, 100
polypharmacy, 103, 104
post-hospital discharge, 106
purpose of, 98, 100
secondary fracture prevention, 106
social and nancial support, 104
spirituality needs, 104, 105
Constipation, 122
Cumulated ambulation score (CAS), 132
D
Decision-making capacity (DMC), 276
consent, 279, 281
Dehydration
denitions of, 176
symptoms of, 177, 179
Delirium, 192, 193
advocacy, 205, 206
assessment for presence, 196, 198
assessment tools, 197
consent, 204, 205
COVID-19 and, 204
dementia and depression, 202, 204
healthcare professionals, 194
loved-ones, 194
medication management, 201, 202
non-pharmacological care interventions,
200, 201
patient experience, 193, 194
patient management, 198, 200
predisposing and precipitating factors for, 195
screening and assessment, 194, 195
screening for risk factors, 196
subtypes of, 198
© The Editor(s) (if applicable) and The Author(s) 2024
K. Hertz, J. Santy-Tomlinson (eds.), Fragility Fracture and Orthogeriatric
Nursing, Perspectives in Nursing Management and Care for Older Adults,
https://doi.org/10.1007/978-3-031-33484-9
303
304
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Index
Delirium elderly at risk screening tool
(DEAR), 196
Depression, 215, 216
Dignity, health care, 274, 275
Discharge instructions, 254
Disorganized discharge, 256
Distal forearm fractures, 20
Do not attempt resuscitation (DNAR)
decisions, 281, 282
Dual-energy x-ray absorptiometry (DXA), 24
Dynamic pain, 133
E
Early mobilisation
after fragility fracture, 131, 132
practical suggestions for, 136, 139
Empowerment value, 241, 242
End-of-life care, 283, 284
Evidence-based preventive, 152, 154
Exercise and rehabilitation, 227, 228
F
Fall prevention, 60, 63
at home/community and secondary
care, 64, 65
in hospital, 63, 64
interdisciplinary team, 69, 70
programs, 69
Falling, fear of, 215
Falls
case study, 56, 70
dened, 53
frailty, sarcopenia and fragility frac-
tures, 57
individual experience of, 68, 69
risk assessment tools/scales, 59
risk factors, 55
screening and assessment, 57, 60
Femoral neck fracture, 113
Flexibility exercise, 47
Fracture liaison coordinator (FLC), 83, 84
Fracture liaison services (FLS), 9, 81, 82
Fracture prevention services
assessments over time, 89
behaviour change strategies, 81
best practice service provision, 85, 86
evaluation of, 90
rst contact with service, 87
fracture liaison service, 81, 82
health education, 88, 89
identifying patient, 86, 87
models of care, 79
multidisciplinary team, 83, 85
patient assessment, 87, 88
patient centred care, 80, 81
personal plan, 89
service location, 83
value based care, 80
Fracture risk assessment, 21
Fragility fracture, 21
acute care, 5, 8
chronic condition management, 295, 296
dened, 4
dignity and compassion in care, 296, 297
early mobilisation after, 131, 132
future impact of, 290
mobilisation after lower limb, 134, 135
nursing, 297, 298
orthogeriatric, 297, 298
other factors inuencing mobilisation,
132, 134
policy, 9, 10
rehabilitation, 8
secondary prevention, 8, 9, 77, 78
workforce and resource challenges,
291, 293
Fragility Fracture Network (FFN), 4
Fragility Fracture Network (FFN) Call to
Action (CtA), 11
FRAIL scale, 41
Frailty, 36, 39
assessment and recognition of, 39, 40
case study, 42
clinical frailty scale, 40
FRAIL scale, 41
interventions for, 42, 43
study of osteoporotic fractures, 41, 42
Functional mobility training, 229
G
Geriatric syndrome, 96
Glasgow model, 82
Glycaemic control, 164
H
Haemostasis, 160
Healthcare ethics, 273
Healthcare-associated infection, 122
Healthy bone, 19
Healthy diet
age and stage, 173, 174
energy, protein, and uid requirements,
174, 175
for older adults, 173
Index
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305
nutritional guidelines, 174
Hip fracture, 21
diagnosis and surgery, 113, 116
early exercise after, 139, 140
mobilisation and exercise after, 140
nutrition, 140
wards/units, 6
Home hazards assessment, 58
Hospital discharge
case management model, 259, 262
patient and carer involvement in, 254
preparing, 256, 257
readiness, 257
Hydration and dehydration
assessment and further action, 183, 184
evidence-based interventions, 184, 185
screening and assessing patients, 182, 183
Hydration and nutrition, 122
I
Immobilisation, effects of, 131
Incontinence-associated dermatitis (IAD), 152
Injury mechanism, 53
Instrumental/intermediate activities of daily
living (IADLs), 102
Intensive case management (ICM) model,
261, 262
Interdisciplinary care, 10, 11
Interdisciplinary orthogeriatric care, 7
International Skin Tear Advisory Panel
(ISTAP), 166
Interprofessional rehabilitation, 230
Intertrochanteric hip fracture, 113
L
Low bone mineral density, 23
M
Malnutrition
arrangements for food and meals, 180
denitions of, 176
dietary supplementation, 181
education, support, and guidance, 182
environmental and personal require-
ments, 181
interaction during mealtimes, 181
medication review, 182
quality management, 182
screening and assessing for, 179, 180
symptoms of, 177, 179
Maturation phase, 161
Mechanical loading, 130
Medication review, 58
Moisture-associated skin damage
(MASD), 152
Mood, CGA, 103
Multidisciplinary team
administrative support, 84, 85
allied health professionals, 84
clinical lead, 84
fracture liaison coordinator, 83, 84
team members external, 85
Muscle failure, 44
N
Non-pharmacological therapies, 120
Nonsteroidal anti-inammatory drugs, 120
Normothermia, 164
Numeric Rating Scale (NRS), 133
Nurses, role of, 12
Nursing
education, 298, 300
and interdisciplinary team role, 106, 107
safe and effective clinical care, 12, 13
Nursing care programmes, 139
Nursing role development, 293, 295
Nursing shortage, 291
O
Orthogeriatric care, 4, 14, 297, 298
Orthogeriatric team approach, 99
Orthogeriatric units, 6
Osteoporosis
assessment calculation tools, 25, 26
case nding, 24
differential diagnosis of, 26
epidemiology, 19, 20
fragility fracture, 21
medication to reduce fracture risk, 27, 28
risk evaluation and diagnosis, 24, 25
risk factors, 22, 24
role of practitioners in osteoporosis, 29, 30
treatment follow-up, 28, 29
Oxygenation, 164
P
Pain management
postoperative care, 119, 120
preoperative care, 117, 118
Palliative care, 282, 283
Paracetamol, 120
Parenteral antimicrobial prophylaxis, 164
306
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Index
Partnership work, 241, 242
Patient assessment
bone and general health status, 88
patient reported outcomes, 87, 88
risk factors, 88
timing of, 87
using tool, 88
Patient centred care, 80, 81, 239
Patient education, 242, 245
using technology, 248
Patient reported outcomes (PROMS), 87, 88
Perioperative care
fundamentals of, 121, 122
intraoperative phase, 113
postoperative phase, 113
preoperative phase, 113
Polypharmacy, 103, 104, 163
Post-acute rehabilitation, 227
Post hospital care, 263, 266
Transition to, 262, 263
Postoperative care
discharge preparation, 120, 121
pain management, 119, 120
Preoperative care
emergency and, 116, 117
pain management, 117, 118
Pressure injuries, 148
Pressure ulcers, 148
causes of, 149, 150
classication of, 150
evidence-based preventive interventions,
152, 154
incontinence-associated dermatitis, 152
injury prevention, 122
moisture-associated skin damage, 152
pathophysiology of, 149, 150
risk assessment, 152
skin assessment, 151, 152
Primary prevention, fracture, 24
Progressive resistance exercise, 47
Progressive resistive exercise, 228
Proliferative phase, 160
Protein supplementation, 43
Proximal femur fracture, 5
Psychological support therapy (PST)
intervention, 218
programme, 219
Psychological wellbeing
activities of daily living, 215
anxiety, 216
depression, 215, 216
fear of falling, 215
hip fractures, management of, 212
hip fractures, outcome of, 212
hip fractures, rehabilitation of, 212, 213
orthogeriatric team, 216, 220
pain assessment, 215
quality of life, 214, 215
R
Rehabilitation
case application, 233, 235
and exercise, 227, 228
functional, 230
interprofessional, 230
post-acute, 227
and recovery, 232
task of caregiving, 246
Remodelling phase, 161
Residential care facilities (RCF), 265
Risk assessment, pressure ulcers, 152
S
Safeguarding, 277, 279
SARC-F tool, 59
Sarcopenia, 44, 45
clinical consequences of, 46
diagnosis of, 45
malnutrition and, 58, 59
nutrition, 47
prevent progressive loss, 46, 47
screening and assessment for, 45, 46
Secondary fracture prevention, 24, 78, 79, 122
Secondary fragility fracture, 9
Sit-to-stand, 137
Skin assessment, 151, 152
Skin tears, 165, 167
Strength-based clinical case management, 261
Study of osteoporotic fractures (SOF), 41, 42
Subtrochanteric hip fracture, 114
Supporting caregivers, 246, 247
Surgical site infections, 165
Surgical wounds
chronic health conditions, 163
medication and polypharmacy, 163
optimum nutrition, 162
preventing infections, 164, 165
stop smoking, 162
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307
T
Transitional care model (TCM), 263
V
Value based care (VBC), 80
Verbal Rating Scale (VRS), 133
Vertebral fractures, 5, 21
Vision assessment and referral, 58
Visual Analogue Scale (VAS), 133
Vitamin D, 43, 175, 176
Vulnerability, 275, 276, 279
W
Walker/walking frames, 138
Walking aids, 137, 138
Weight bearing exercises, 229
Wound healing
haemostasis, 160
inammation phase, 160
proliferative phase, 160
remodelling phase, 161
Wrist or distal forearm fractures, 20
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