The Orthogeriatrics Model of Care: Systematic Review of Predictors of Institutionalization and Mortality in Post-Hip Fracture Patients and Evidence for Interventions

Abstract

Hip fracture is a common serious complication of osteoporosis, which is associated with high morbidity and mortality. In nursing home residents, incidence rates of hip fractures are at least twice to three times higher than in community-dwellers of the same age and sex. Older adults with hip fracture have a 5- to 8-fold increased risk for all-cause mortality and much higher risk of institutionalization. Therefore, interventions to prevent institutionalization, prevent a second fracture in institutionalized patients, and decrease mortality after a hip fracture are highly needed. The orthogeriatrics model of care is a shared-care approach to patients after suffering a hip fracture. This program, which has been studied in models run by geriatricians with the assistance of a multidisciplinary team, includes a comprehensive medical and nursing admission assessment focusing on the patient's premorbid function, cognition, comorbidities, and risks is followed by a comprehensive care plan design. This systematic review describes and analyzes the interrelation between hip fracture and nursing home placement taking into consideration those evidence-based interventions to prevent later complications and future institutionalization.