Prevention after a hip fracture. "The value of interdisciplinary intervention"

Falls with their severe and frequent consequence of proximal femoral fracture in the elderly population, constitute a major health problem. The frequency of falls increases with age, and the characteristics of elderly people living in the community who fall are different.

They constitute one of the great geriatric syndromes, usually of multifactorial origin, with "extrinsic factors", external to the patient (environment, lighting, carpets, furniture, architectural barriers, etc.), and intrinsic, due to conditions or diseases of the patient himself, such as gait disturbances (due to neurological, muscular, skeletal diseases, immobilism syndromes, weakness of lower limbs), vertigo, orthostatic hypotension, syncope, vision or hearing disturbances and drugs, especially psycho-pharmaceuticals and cardiovascular drugs. This event generates excessive morbimortality, dependence, institutionalization and increased socio-health costs, being necessary to prevent them, more effective interventions that include modification of risk factors by a multidisciplinary team.

In the Orthogeriatric Unit of the Ricardo Bermingham Hospital, an intervention plan has been initiated at the time of admission, aimed at reducing falls in patients who have previously suffered a hip fracture, as well as reducing the incidence of refractures in this population. To this end

1) the causes and characteristics of the falls in each patient are evaluated,

2) an individual care plan is drawn up and proposed, aimed at minimising risk factors for new falls and preventing and treating osteoporosis/sarcopenia and

3) patients and families are involved in the adherence to this plan, supported at discharge by primary care doctors and nurses.

This plan is based on:

• The comprehensive geriatric assessment and the action of a multidisciplinary team which includes medical and nursing assessment with the detection of precipitating or risk factors that affect the fall, diagnosis of sarcopenia, nutritional assessment etc.
• Initiation in the re-education of walking and handling of technical aids (physiotherapists and assistants) during admission, with an individualised exercise plan for each patient on discharge.
• Interview with the occupational therapist for recommendations on adaptations at home, training of the patient and/or carers in exercises adapted to the psycho-physical condition of each patient.

In short, a multidisciplinary approach whose common objective is to promote maximum independence and a good quality of life for our patients.