Orthopaedic surgeons\u2019 perceptions of frailty and frailty screening

Mandy M Archibald,Tiffany K Gill,Michael Lawless,Mellick J Chehade

doi:10.1186/s12877-019-1404-8

Abstract

BackgroundOver the past decade, there has been significant growth in the awareness and understanding of fragility among orthopaedic surgeons in the context of osteoporotic fractures and with it, improvements in the recognition and management of fragility fractures. Emerging as a major clinical and research focus in aged care is the concept of frailty and its associations with fragility, sarcopenia, falls and rehabilitation. Currently, research is lacking on how orthopaedic surgeons perceive frailty and the role of frailty screening. A baseline understanding of these perceptions is needed to inform integration of frailty identification and management for patient optimization in orthopaedic practices, as well as research and education efforts of patients and healthcare professionals in orthopaedic contexts.MethodsWe used an exploratory design guided by qualitative description to conduct 15 semi-structured telephone and in-person interviews across three orthopaedic surgeon subgroups (Registrars, Junior Consultants, and Senior Consultants). Data collection and analysis occurred iteratively and was guided by thematic saturation.ResultsOrthopaedic surgeons have a disparate understanding of frailty. Between colleagues, frailty is often referred to non-specifically to suggest a general state of risk to the patient. Frailty screening is regarded positively but its specific utility in orthopaedic environments is questioned. Easy-to-administer frailty screening tools that are not exclusive assessments of functional status are viewed most satisfactorily. However these tools are rarely used.ConclusionsThere is little understanding among orthopaedic surgeons of frailty as a phenotype. Beliefs around modifiability of frailty were dissimilar as were the impact of related risk factors, such a cognitive status, chronic disease, social isolation, and environmental influences. This in turn may significantly impact on the occurrence and treatment outcomes of fragility fracture, a common orthopaedic problem in older populations. This study highlights need for knowledge translation efforts (e.g. education) to achieve cohesive understanding of frailty among health professionals.

Highlights

Over the past decade, there has been significant growth in the awareness and understanding of fragility among orthopaedic surgeons in the context of osteoporotic fractures and with it, improvements in the recognition and management of fragility fractures
A critical component to optimizing frailty identification and management in clinical practice is generating a baseline understanding of how acute care providers perceive frailty and frailty screening, considerations that to date have received insufficient attention in the literature [11,12,13]
We explored the perceptions of South Australian orthopaedic surgeons towards frailty and frailty screening

Summary

Introduction

There has been significant growth in the awareness and understanding of fragility among orthopaedic surgeons in the context of osteoporotic fractures and with it, improvements in the recognition and management of fragility fractures. A baseline understanding of these perceptions is needed to inform integration of frailty identification and management for patient optimization in orthopaedic practices, as well as research and education efforts of patients and healthcare professionals in orthopaedic contexts. Growing numbers of frail older adults are being admitted to hospital with complex health problems and acute care needs. Support for the clinical operationalization of frailty is growing, including policy and practice recommendations to screen older adults for frailty using validated measurement tools. A critical component to optimizing frailty identification and management in clinical practice is generating a baseline understanding of how acute care providers perceive frailty and frailty screening, considerations that to date have received insufficient attention in the literature [11,12,13]

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