Fragility Fracture and Orthogeriatric Nursing: Holistic Care and Management of the Fragility Fracture and Orthogeriatric Patient (Perspectives in Nursing Management and Care for Older Adults)

This second edition, in Open Access, aims to provide a comprehensive and practical overview of the knowledge required for the assessment and management of the older adult with or at risk of fragility fracture, with additional focus on those who are frail. It considers this from the perspectives of all the clinical and home care settings in which this group of patients receive care and is relevant to all global locations. The concept of orthogeriatric care is explored in detail. Global estimates suggest that there were 21 million men and 137 million women aged 50 years or more at high fracture risk in 2010. This incidence is expected to double by 2040, with the most significant increase in Asia. Fragility fracture is one of the foremost challenges for health care providers and thehe global demand for nursing care for patients with fragility fractures across the world is immense. Hip fracture is particularly challenging as these significant injuries often occur in frail older people requiring hospitalisation and orthopaedic surgery. Such injuries and associated surgery result in increased frailty, worsening health and wellbeing, pain, disability, reduced quality of life, loss of independence, and decreased life expectancy. Care providers need to understand the experience of fragility fracture from the perspective of patients and families so that direct improvements in care can be based on the perspectives of the users. Expert care of patients following fractures that require hospitalisation and orthopaedic surgery involves skill in the care and treatment of frail older people as we as individuals with an injury and undergoing surgery. Nurses have a significant role in interdisciplinary collaborative care provided through orthogeriatric models of care. There is increasing evidence that such models significantly improve patient outcomes. High quality, evidence-based orthogeriatric care is increasingly shown to have positive impact on outcomes for recovery, rehabilitation, and secondary prevention of further fracture. This book significantly supports the aims and values of the Fragility Fracture Network and, as such, supports the learning needs of nurses and other allied health professionals which will enable a comprehensive approach to nursing practice in orthogeriatric and fragility fracture care. Foreword Preface to the Second Edition Acknowledgements Contents 1: Orthogeriatric and Fragility Fracture Nursing: An Introduction 1.1 Introduction 1.2 Learning Outcomes 1.3 Fragility Fracture and Orthogeriatric Care 1.3.1 Pillar 1: Acute Care 1.3.1.1 Acute Orthogeriatric Care 1.3.2 Pillar 2: Rehabilitation 1.3.3 Pillar 3: Secondary Prevention 1.3.4 Pillar 4: Policy 1.4 Interdisciplinary Care 1.5 The Key Role of Nurses in Orthogeriatric and Fragility Fracture Care 1.6 Safe and Effective Clinical Care 1.7 Education for Orthogeriatric Care 1.8 Further Study References 2: Osteoporosis and the Nature of Fragility Fracture: An Overview 2.1 Introduction 2.2 Learning Outcomes 2.3 Bone Biology 2.4 Osteoporosis 2.4.1 Epidemiology 2.4.2 Fragility Fracture 2.4.3 Risk Factors 2.4.4 Diagnosis 2.4.4.1 Case Finding 2.4.4.2 Risk Evaluation and Diagnosis of Osteoporosis 2.4.4.3 Assessment Calculation Tools 2.4.4.4 Differential Diagnosis of Secondary Osteoporosis 2.4.5 Treatment 2.4.5.1 Medication to Reduce Fracture Risk 2.4.5.2 Follow-Up 2.5 The Role of Practitioners in Osteoporosis and Fracture Prevention, Case Finding, Risk Assessment, and Management and Education After Diagnosis 2.6 Suggested Further Study 2.7 How to Self-Assess Learning References 3: Frailty and Sarcopenia 3.1 Introduction 3.2 Learning Outcomes 3.3 Frailty 3.4 Assessment and Recognition of Frailty 3.4.1 The Clinical Frailty Scale (Rockwood et al. 2005) 3.4.2 FRAIL Scale 3.4.3 The Study of Osteoporotic Fractures (SOF) 3.5 Interventions for Frailty 3.6 Sarcopenia 3.6.1 Screening and Assessment for Sarcopenia 3.6.2 The Clinical Consequences of Sarcopenia 3.6.3 Interventions to Prevent Sarcopenia 3.7 Conclusion 3.8 Suggested Further Study 3.9 How to Self-Assess Learning References 4: Preventing Falls 4.1 Introduction 4.2 Learning Outcomes 4.3 Understanding the Risk Factors for Falling from an Individual Perspective 4.4 The Link Between Frailty, Sarcopenia, Falls and Fragility Fractures 4.5 Screening and Assessment 4.6 Evidence-Based Interventions for Fall Prevention 4.6.1 Fall Prevention in Hospital 4.6.2 Fall Prevention at Home/Community and Secondary Care 4.7 Incorporating the Individual Experience of Falls into Care: The Person’s Perspective 4.8 Working Collaboratively to Prevent Falls Within an Interdisciplinary Team 4.9 Suggested Further Study 4.10 How to Self-Assess Learning References 5: Secondary Fracture Prevention 5.1 Introduction 5.2 Learning Outcomes 5.3 Secondary Fracture Prevention 5.4 Development of Fracture Prevention Services and Best Practice 5.4.1 Models of Care 5.4.2 Value-Based Care 5.4.3 Patient-Centred Care 5.4.4 Behaviour Change Strategies 5.4.5 Fracture Liaison Services 5.4.6 Location of Service 5.4.7 The Multidisciplinary Team 5.4.7.1 Fracture Liaison Coordinator 5.4.7.2 Clinical Lead 5.4.7.3 Allied Health Professionals 5.4.7.4 Administrative Support 5.4.7.5 Team Members External to the FLS 5.5 Resources to Guide Best Practice Service Provision 5.6 The Patient and Family Journey 5.6.1 Identifying the Patient Cohort 5.6.2 First Contact with the Service 5.6.3 Patient Assessment 5.6.4 Health Education 5.6.5 Establishing a Personal Plan 5.6.6 Assessments Over Time 5.7 Evaluation of the FLS 5.8 Further Study References 6: The Nursing Role in Orthogeriatric Comprehensive Geriatric Assessment (CGA) 6.1 Introduction 6.2 Learning Outcomes 6.3 The Purpose of CGA 6.4 Dimensions of Comprehensive Geriatric Assessment 6.4.1 Functional Status 6.4.2 Falls 6.4.3 Cognition 6.4.4 Mood 6.4.5 Polypharmacy 6.4.6 Social and Financial Support 6.4.7 Spiritual Needs 6.5 Assessment Tools 6.6 Post-hospital Discharge CGA 6.7 Secondary Prevention 6.8 The Nursing and Interdisciplinary Team Role 6.9 Suggested Further Study 6.10 Self-Assessment References 7: Orthogeriatric Care in the Emergency and Perioperative Setting 7.1 Introduction 7.2 Learning Outcomes 7.3 Perioperative Care 7.3.1 Hip Fracture Diagnosis and Surgery 7.4 Emergency and Preoperative Care 7.4.1 Pain Management 7.5 Post-operative Care 7.5.1 Pain Management 7.5.2 Preparation for Discharge 7.6 Fundamentals of Perioperative Care 7.7 Suggested Further Study and Ideas for Reflections 7.7.1 General Suggestions for Further Reflection 7.7.2 Further Suggested Reading 7.8 How to Self-Assess Learning References 8: Early Mobilisation and Exercise After Fragility Fracture 8.1 Introduction 8.2 Learning Outcomes 8.3 Immobilisation in Fracture Management 8.4 Early Mobilisation After Fragility Fracture 8.5 Fragility Fracture-Related Pain and Other Factors Influencing Mobilisation 8.6 Surgical Procedure and Mobilisation After Lower Limb Fragility Fracture 8.7 Practical Suggestions for Facilitating Early Mobilisation 8.7.1 Selecting Walking Aids 8.8 Early Exercise After Hip Fracture 8.9 Nutrition, Mobilisation and Exercise After Hip Fracture 8.10 Suggested Further Study 8.11 How to Self-Assess Learning References 9: Pressure Ulcer Prevention 9.1 Introduction 9.2 Learning Outcomes 9.3 Introduction 9.4 Pathophysiology and Causes of Pressure Ulcers 9.5 Classification of Pressure Ulcers 9.6 Pressure Ulcer Prevention 9.6.1 Risk Factors and Risk Assessment 9.6.1.1 Skin Assessment 9.6.1.2 Moisture-Associated Skin Damage 9.6.1.3 Incontinence-Associated Dermatitis 9.6.1.4 Risk Assessment 9.6.2 Evidence-Based Preventive Interventions 9.7 Suggested Further Study References 10: Wound Management 10.1 Introduction 10.2 Learning Outcomes 10.3 Wound Healing Physiology 10.4 Surgical Wounds 10.4.1 Recognising and Preventing Surgical Site Wound Healing Problems 10.4.1.1 Optimum Nutrition 10.4.1.2 Stop Smoking 10.4.1.3 Chronic Health Conditions 10.4.1.4 Medication and Polypharmacy 10.4.2 Preventing Surgical Site Wound Infections 10.5 Assessing and Managing Skin Tears 10.6 Suggested Further Study 10.7 Suggested Further Reading References 11: Nutrition and Hydration 11.1 Introduction 11.2 Learning Outcomes 11.3 A Healthy Diet for Older Adults 11.3.1 Actioning a ‘Healthy’ Diet that Is Relevant to Age and Stage 11.3.2 Healthy Nutritional Guidelines for Healthy Older Adults 11.3.3 Energy, Protein, and Fluid Requirements 11.4 Calcium and Vitamin D 11.5 Definitions of Malnutrition and Dehydration 11.6 Prevalence, Determinants, and Symptoms of Malnutrition and Dehydration 11.7 Screening and Assessing for Malnutrition 11.8 Evidence-Based Interventions to Prevent and to Treat Malnutrition 11.8.1 Arrangements for Food and Meals 11.8.2 Dietary Supplementation 11.8.3 Interaction during Mealtimes 11.8.4 Environmental and Personal Requirements 11.8.5 Education, Support, and Guidance 11.8.6 Medication Review 11.8.7 Quality Management 11.9 Hydration and Dehydration 11.9.1 Screening and Assessing Patients with Dehydration 11.9.2 Assessment and Further Action 11.9.3 Evidence-Based Interventions to Prevent and Treat Dehydration 11.9.3.1 Availability of Drinks 11.9.3.2 Drinking Pleasure 11.9.3.3 Support and Help to Drink 11.9.3.4 Monitoring and Understanding of the Necessity to Drink 11.10 Suggested Further Study 11.11 How to Self-Assess Learning References 12: Delirium and Other Altered Cognitive States 12.1 Introduction 12.2 Learning Objectives 12.3 Delirium 12.4 The Experience of Delirium 12.4.1 Patient Experience 12.4.2 Loved Ones Experience 12.4.3 Healthcare Professionals Experience 12.5 Delirium Screening and Assessment 12.5.1 Screening for Risk Factors Predictive of Delirium 12.5.2 Assessment for the Presence of Delirium 12.6 Managing the Delirious Patient 12.6.1 Initial Actions and Investigations 12.6.1.1 Review of Medical Causes 12.6.1.2 Falls Assessment 12.6.1.3 Inform Family 12.7 Non-pharmacological Care Interventions 12.8 Medication 12.9 Dementia and Depression 12.10 COVID-19 and Delirium 12.11 Advocacy and Consent 12.11.1 Consent 12.11.2 Advocacy 12.12 Translating Knowledge into Action 12.13 Useful Resources for Further Study References 13: Psychological Wellbeing 13.1 Introduction 13.1.1 Why Is Psychological Status Important in the Management of Hip Fracture? 13.1.2 Why Is Psychological Status Important in the Outcome of Hip Fracture? 13.1.3 Why Is Psychological Status Important in the Rehabilitation from Hip Fracture? 13.2 Learning Outcomes 13.3 How Should the Psychological Status Be Assessed? 13.3.1 Psychological Evaluation 13.3.1.1 Quality of Life 13.3.1.2 Fear of Falling 13.3.1.3 Pain 13.3.1.4 Activities of Daily Living 13.3.1.5 Depression 13.3.1.6 Stress 13.3.1.7 Anxiety 13.3.1.8 Psychological Wellbeing 13.4 How Can Psychological Status Be Influenced Positively by the Orthogeriatric Team? 13.5 Suggested Further Study References 14: Rehabilitation 14.1 Introduction 14.2 Learning Outcomes 14.3 Long-Term Outcomes Following Significant Fragility Fracture 14.4 Post-acute Rehabilitation 14.5 Rehabilitation and Exercise 14.5.1 Functional Rehabilitation 14.6 Interprofessional Rehabilitation Following Fragility Fracture 14.7 Case Application 14.8 Suggested Further Study 14.9 How to Self-Assess Learning References 15: Family Partnerships, Patient and Carer Education and Support 15.1 Introduction 15.2 Learning Outcomes 15.3 The Value of Partnership Work and Empowerment 15.4 Educational Support to the Patient 15.5 Family Involvement in the Care Process 15.6 Caregiver Burden and Supporting Caregivers 15.7 Family Cares and Patient Education Using Technology 15.8 Suggested Further Study References 16: Discharge and Post-hospital Care 16.1 Introduction 16.2 Learning Outcomes 16.3 Patient and Carer Involvement in Discharge from Hospital 16.4 Preparing for Discharge 16.5 Discharge Readiness 16.6 Case Management Models: A Resource in the Discharge Process 16.6.1 The Brokerage Case Management Model 16.6.2 The Clinical Case Management Model 16.6.3 The Strengths-Based Clinical Case Management Model 16.6.4 The Intensive Case Management (ICM) Model 16.7 The Transition to Post-hospital Care 16.8 Post-hospital Care 16.9 Suggested Further Study References 17: Ethical Issues 17.1 Introduction 17.2 Learning Outcomes 17.3 Ethics in Providing Care for All Adults Following Fragility Fracture 17.4 Dignity 17.5 Vulnerability 17.6 Decision-Making Capacity 17.7 Safeguarding 17.8 Decision-Making, Capacity, and Consent 17.8.1 Decision-Making Capacity 17.9 End-of-Life Decisions 17.9.1 Do Not Attempt Resuscitation Decisions 17.9.2 Palliative Care 17.9.3 End of Life 17.10 Suggested Further Study 17.11 How to Self-Assess Learning References 18: Orthogeriatric and Fragility Fracture Care in the Future 18.1 Introduction 18.2 The Future Impact of the Fragility Fracture Epidemic 18.3 Workforce and Resource Challenges 18.4 New Ways of Working and Nursing Role Development 18.5 Chronic Condition Management 18.6 Dignity and Compassion in Care 18.7 Evidence-Based Orthogeriatric and Fragility Fracture Nursing 18.8 Orthogeriatric and Fragility Fracture Nursing Education 18.9 Conclusion References Index