Geriatric trauma care: improvement strategies

Abstract

Falls – and subsequent fractures – are the primary cause of accident-related death in the elderly. Due to the ageing population, the incidence of falls and fractures increases. This thesis aims to improve the care of geriatric patients (≥65 years) with a fracture. It focuses on three pillars: (i) multidisciplinary care pathways (MCPs), (ii) international comparisons, and (iii) patient-reported outcomes.

Chapter 2 focuses on the added value of an MCP in light of three clinical cases concerning geriatric hip fractures. An interhospital comparison to evaluate the differences between an MCP and extended standard care for geriatric hip fracture patients is made in Chapter 3. Chapter 4 evaluates the added value of a patient-based intervention to improve the screening and treatment of osteoporosis and prevent secondary fractures. In part II, the cultural-, and international differences in geriatric trauma care are evaluated. In Chapter 5, an intercultural comparison of geriatric hip fracture care is made between a Dutch hospital and a Swiss hospital to investigate differences in clinical outcomes such as complications, mortality, and hospital length of stay. Chapter 6 provides a global evaluation of geriatric hip fracture care. The last part (part III) of this thesis focuses on PROs. A fall-prevention intervention that assessed fear of falling is evaluated in Chapter 7. Quality of life, patient satisfaction, and rehabilitation of patients who sustained a low-energy fracture are studied in Chapter 8. A systematic review assessing how PRO are reported and the quality of reporting PRO is addressed in Chapter 9.