The subspecialty of orthogeriatrics frequently incorporates falls prevention and bone health. It is the system of care for older people who have suffered a fracture, often the neck of the femur, and describes the collaboration between geriatricians and orthopaedic surgeons to ensure that both medical and surgical needs of the patient are appropriately met.
Models of care are outlined in the British Geriatrics Society (BGS) best practice guidelines and range from a single preoperative liaison visit to full care delivered by geriatricians and their team (with surgical involvement limited to the operation). The BGS recommends that patients receive joint multidisciplinary care on a dedicated orthogeriatrics ward to ensure holistic care, and reduce the risk of common complications of hip fracture surgery such as delirium.
The ‘Blue Book’ is a joint publication between the British Orthopaedic Association (BOA) and the BGS and gives detailed recommendations for the care of this group of patients. In England, their management attracts a best practice tariff incentive. Standards are monitored through the National Hip Fracture Database.
Older people who have suffered a fall, with or without a fracture, can be assessed in a falls clinic by a geriatrician with access to a multidisciplinary team. Assessment takes the form of targeted comprehensive assessment to review risk factors such as medications, vision and gait problems and to put in place a management plan. NICE has published guidelines on the management of falls.