Alterstraumatologie – die geriatrische Perspektive

Zusammenfassung

Die Alterstraumatologie befasst sich mit der Behandlung von Verletzungen älterer Menschen, die durch physiologische Veränderungen und chronische Erkrankungen besonders gefährdet sind. Häufige Verletzungen wie Hüftfrakturen treten oft infolge von Stürzen auf und führen zu schwerwiegenden gesundheitlichen Folgen, einschließlich erhöhter Morbidität und Mortalität. Besondere geriatrische Syndrome wie Frailty (Gebrechlichkeit), Delir und Polypharmazie stellen zusätzliche Herausforderungen dar. Frailty erhöht das Risiko für Komplikationen nach Verletzungen, während Delir, oft durch Krankenhausaufenthalte oder Medikamente ausgelöst, die Genesung erheblich beeinträchtigen kann. Eine gezielte Delirprävention ist daher essenziell, ebenso wie die frühzeitige Mobilisation, die Komplikationen reduziert und die Rehabilitation unterstützt. Die geriatrische Komplexbehandlung bietet einen interdisziplinären Ansatz, um die vielfältigen gesundheitlichen Probleme älterer Patienten umfassend zu behandeln. Dabei spielen Präventionsmaßnahmen wie Sturzabklärung und Osteoporosebehandlung eine zentrale Rolle, um das Risiko weiterer Verletzungen zu minimieren. Nach der Entlassung aus dem Krankenhaus ist eine strukturierte poststationäre Versorgung entscheidend, um eine erfolgreiche Rehabilitation und die Rückkehr in ein selbstständiges Leben zu ermöglichen. Hierbei sind Rehabilitationsprogramme, Pflegekoordination und Unterstützung durch Angehörige von großer Bedeutung.

Abstract

Geriatric traumatology deals with the treatment of injuries in older people who are particularly at risk due to physiological changes and chronic diseases. Common injuries such as hip fractures often occur as a result of falls and lead to serious health consequences, including increased morbidity and mortality. Specific geriatric syndromes such as frailty, delirium and polypharmacy pose additional challenges. Frailty increases the risk of complications following injury, while delirium, often triggered by hospitalisation or medication, can significantly impair recovery. Targeted delirium prevention is therefore essential, as is early mobilisation, which reduces complications and supports rehabilitation. Complex geriatric treatment offers an interdisciplinary approach to comprehensively treat the diverse health problems of older patients. Preventive measures such as fall assessment and osteoporosis treatment play a central role in minimising the risk of further injuries. After discharge from hospital, structured post-inpatient care is crucial to enable successful rehabilitation and a return to independent living. Rehabilitation programmes, care coordination and support from relatives are of great importance here.

Schlüsselwörter

Alterstraumatologie - Orthogeriatrie - Geriatrische Komplexbehandlung

Keywords

geriatric traumatology - orthogeriatrics - geriatric complex treatment

Publication History

Received: 19 September 2024

Accepted: 04 November 2024

Article published online:
10 December 2024

• Literatur

• 1 Hernlund E, Svedbom A, Ivergard M. et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2013; 8: 136
• 2 Rupp M, Walter N, Pfeifer C. et al. The Incidence of Fractures Among the Adult Population of Germany-an Analysis From 2009 through 2019. Dtsch Arztebl Int 2021; 118: 665-669
• 3 Hussain MA, Qaisar R, Karim A. et al. Predictors of hip fracture in 15 European countries: a longitudinal study of 48,533 geriatric adults using SHARE dataset. Arch Osteoporos 2024; 19: 60
• 4 Tran T, Bliuc D, Abrahamsen B. et al. Multimorbidity clusters potentially superior to individual diseases for stratifying fracture risk in older people: a nationwide cohort study. Age Ageing 2024; 53
• 5 Rapp K, Becker C, Todd C. et al. The Association Between Orthogeriatric Co-Management and Mortality Following Hip Fracture. Dtsch Arztebl Int 2020; 117: 53-59
• 6 Prestmo A, Saltvedt I, Helbostad JL. et al. Who benefits from orthogeriatric treatment? Results from the Trondheim hip-fracture trial. BMC Geriatr 2016; 16: 49
• 7 Baroni M, Serra R, Boccardi V. et al. The orthogeriatric comanagement improves clinical outcomes of hip fracture in older adults. Osteoporos Int 2019; 30: 907-916
• 8 Sieber CC. [The elderly patient--who is that?]. Internist (Berl) 2007; 48: 1192-1194
• 9 Schulz C, Konig HH, Rapp K. et al. Analysis of mortality after hip fracture on patient, hospital, and regional level in Germany. Osteoporos Int 2020; 31: 897-904
• 10 Kappenschneider T, Maderbacher G, Meyer M. et al Risk and complication profiles of orthogeriatric patients in elective hip and knee joint replacement. Z Gerontol Geriatr 2024; doi:10.1007/s00391-024-02295-3
• 11 Heinimann NB, Kressig RW. Accidental falls in the elderly. Praxis (Bern 1994) 2014; 103: 767-773
• 12 World Health Organization. Ageing and Life Course Unit. WHO global report on falls prevention in older age. In. Geneva, Switzerland: World Health Organization; 2008. 1 electronic resource (iv, 47 pages)
• 13 Dreinhofer K. Hip Fracture in the Elderly: Time to Act. Dtsch Arztebl Int 2020; 117: 51-52
• 14 Ulrich C., Liener CB. Kilian Rapp. Weissbuch_Alterstraumatologie_. 2018
• 15 Veronese N, Fazzari A, Armata M. et al. Clinical prognostic factors for older people: A systematic review and meta-analysis. Ageing Res Rev 2024; 98: 102345
• 16 Rahn A. Delirium – management in the hospital: diagnosis and treatment. Z Gerontol Geriatr 2008; 41: 440-446
• 17 Neuerburg C, Gosch M, Bocker W. et al [Proximal femoral fractures in the elderly]. Z Gerontol Geriatr 2015; 48: 647-659 quiz 660-641
• 18 Roigk P, Becker C, Pfeiffer K. et al [Cooperation of geriatrics and trauma surgery in certified geriatric trauma centers: Insights into different care models and the implementation of requirements resulting from certification]. Z Gerontol Geriatr 2024; doi:10.1007/s00391-023-02271-3
• 19 Meyer M, Michalk K, Greimel F. et al. SOG-Special Orthopedic Geriatrics: First interim results of a randomized controlled study on integrated orthogeriatric care in elective hip and knee arthroplasty. Orthopadie (Heidelb) 2024; 53: 127-135
• 20 Mant SJ, Amadi-Livingstone C, Ahmed MH. et al. Orthogeriatric Care Following Hip Fracture: Improving Post-Operative Outcomes in an Aged Population. Life (Basel) 2024; 14
• 21 Gao F, Liu G, Ge Y. et al. Orthogeriatric co-managements lower early mortality in long-lived elderly hip fracture: a post-hoc analysis of a prospective study. BMC Geriatr 2023; 23: 571
• 22 Alves M, Duque S. Improving the Care of Hip Fracture Patients Through Orthogeriatrics. Acta Med Port 2024; 37: 405-406
• 23 Kammerlander C, Roth T, Friedman SM. et al. Ortho-geriatric service – a literature review comparing different models. Osteoporos Int 2010; 21: S637-646
• 24 McCusker J, Bellavance F, Cardin S. et al. Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc 1999; 47: 1229-1237
• 25 Thiem U, Greuel HW, Reingraber A. et al. [Consensus for the identification of geriatric patients in the emergency care setting in Germany]. Z Gerontol Geriatr 2012; 45: 310-314
• 26 Feist B, Feindt B, Kasprick L. et al. Trial of the GeriNOT screening tool: Identification of geriatric risk potentials on admission to hospital care from the age of 70 years. Z Gerontol Geriatr 2023; 56: 201-208
• 27 Gerhard T, Mayer K, Braisch U. et al. Validation of the geriatrie-check for identification of geriatric patients in emergency departments. Z Gerontol Geriatr 2021; 54: 106-112
• 28 Krohn JN, Habboub B, Gosch M. Fragility Fractures: Preoperative assessment and optimisation. Z Gerontol Geriatr 2024; 57: 235-243
• 29 Bergau L. Atrial fibrillation and heart failure. Inn Med (Heidelb) 2024; 65: 755-761
• 30 Gogol M. [Delirium in the elderly]. Z Gerontol Geriatr 2008; 41: 431-439
• 31 Balas MC, Deutschman CS, Sullivan-Marx EM. et al. Delirium in older patients in surgical intensive care units. J Nurs Scholarsh 2007; 39: 147-154
• 32 Chen Y, Feng F, Li Q. et al. Frailty index and risk of delirium in hospitalized patients: a two-sample Mendelian randomization study. Front Med (Lausanne) 2024; 11: 1361437
• 33 Peng Z, Wu J, Wang Z. et al. Incidence and related risk factors for postoperative delirium following revision total knee arthroplasty: a retrospective nationwide inpatient sample database study. BMC Musculoskelet Disord 2024; 25: 633
• 34 Gurlit S, Mollmann M. How to prevent perioperative delirium in the elderly?. Z Gerontol Geriatr 2008; 41: 447-452
• 35 Savino T, Vergara FH, Ramos MD. et al. Bringing Delirium to Light: Impact of CAM-ICU Tool to Improve Care Coordination. Prof Case Manag 2024; 29: 149-157
• 36 Fruhwald T, Weissenberger-Leduc M, Jagsch C. et al. [Delirium: an interdisciplinary challenge]. Z Gerontol Geriatr 2014; 47: 425-438 quiz 439 440
• 37 Mao W, Chang SM, Hong CC. Early mobilisation and weight-bearing as tolerated after hip fracture surgery among older adults in China and similar countries: barriers and strategies. Age Ageing 2024; 53
• 38 Siminiuc D, Gumuskaya O, Mitchell R. et al. Rehabilitation after surgery for hip fracture – the impact of prompt, frequent and mobilisation-focused physiotherapy on discharge outcomes: an observational cohort study. BMC Geriatr 2024; 24: 629
• 39 Gray R, Lacey K, Whitehouse C. et al. What factors affect early mobilisation following hip fracture surgery: a scoping review. BMJ Open Qual 2024; 12
• 40 Krupp S, Freiberger E, Renner C. et al. [Assessment of mobility/motor skills in old age: Based on the S1 guideline "Geriatric assessment level 2, living guideline"]. Z Gerontol Geriatr 2022; 55: 239-248
• 41 Schippinger W. Comprehensive geriatric assessment. Wien Med Wochenschr 2022; 172: 122-125
• 42 Kolb G, Breuninger K, Gronemeyer S. et al. [Ten years of early complex geriatric rehabilitation therapy in the DRG system]. Z Gerontol Geriatr 2014; 47: 6-12
• 43 Homagk L, Hellweger A, Hofmann GO. [Hybrid stabilization and geriatric complex treatment of type A spinal fractures]. Chirurg 2020; 91: 878-885
• 44 Palzer M, Meyer U, Abderhalden LA. et al. [Acute geriatric treatment of older trauma patients: Influence on mobility, autonomy and postdischarge destination]. Z Gerontol Geriatr 2021; 54: 816-822
• 45 Dadwal G, Schulte-Huxel T, Kolb G. Geriatric traumatology (e. g. „Alterstraumatologie“) is more than orthogeriatrics-Experiences of a physician in advanced training. Z Gerontol Geriatr 2022; 55: 513-518
• 46 Barcelo M, Casademont J, Mascaro J. et al. Indoor falls and number of previous falls are independent risk factors for long-term mortality after a hip fracture. Aging Clin Exp Res 2023; 35: 2483-2490
• 47 Cai Y, Leveille SG, Andreeva O. et al. Characterizing Fall Circumstances in Community-Dwelling Older Adults: A Mixed Methods Approach. J Gerontol A Biol Sci Med Sci 2023; 78: 1683-1691
• 48 Jahn K, Freiberger E, Eskofier BM. et al. Balance and mobility in geriatric patients: Assessment and treatment of neurological aspects. Z Gerontol Geriatr 2019; 52: 316-323
• 49 Jahn K, Zwergal A, Schniepp R. Gait disturbances in old age: classification, diagnosis, and treatment from a neurological perspective. Dtsch Arztebl Int 2010; 107: 306-315 quiz 316
• 50 Runge M. Diagnosis of the risk of accidental falls in the elderly. Ther Umsch 2002; 59: 351-358
• 51 Runge M, Rittweger J, Russo CR. et al. Is muscle power output a key factor in the age-related decline in physical performance? A comparison of muscle cross section, chair-rising test and jumping power. Clin Physiol Funct Imaging 2004; 24: 335-340
• 52 Brodin E, Ljungman S, Sunnerhagen KS. Rising from a chair: a simple screening test for physical function in predialysis patients. Scand J Urol Nephrol 2008; 42: 293-300
• 53 Mayhew AJ, So HY, Ma J. et al. Normative values for grip strength, gait speed, timed up and go, single leg balance, and chair rise derived from the Canadian longitudinal study on ageing. Age Ageing 2023; 52
• 54 Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986; 34: 119-126
• 55 Carey BJ, Potter JF. Cardiovascular causes of falls. Age Ageing 2001; 30: 19-24 doi:
• 56 Hewitt JA. Balancing the Evidence on Exercise for Falls Prevention in Long-term Care. J Am Med Dir Assoc 2024; 25: 653-654
• 57 Lazo Green K, Yang Y, Abaraogu U. et al. Effectiveness of dance interventions for falls prevention in older adults: systematic review and meta-analysis. Age Ageing 2024; 53
• 58 Oberholster CK, Taylor CJ, Huynh M. et al. The immediate and lasting balance outcomes of clinical falls-prevention programs: A non-randomised study. PLoS One 2024; 19: e0299146
• 59 Sadaqa M, Debes WA, Nemeth Z. et al. Multicomponent Exercise Intervention for Preventing Falls and Improving Physical Functioning in Older Nursing Home Residents: A Single-Blinded Pilot Randomised Controlled Trial. J Clin Med 2024; 13
• 60 Modreker MK, von Renteln-Kruse W. Medication and falls in old age. Internist (Berl) 2009; 50: 493-500
• 61 Ramos KA, Colosimo EA, Duarte YAO. et al. Effect of polypharmacy and Fall-Risk-Increasing Drugs (FRIDs) on falls among Brazilian older adults: The SABE cohort study. Arch Gerontol Geriatr 2023; 115: 105127
• 62 Seppala LJ, Wermelink A, de Vries M. et al. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: II. Psychotropics. J Am Med Dir Assoc 2018; 19 (371) e311-371
• 63 Hoogendijk EO, Afilalo J, Ensrud KE. et al. Frailty: implications for clinical practice and public health. Lancet 2019; 394: 1365-1375
• 64 Fried LP, Tangen CM, Walston J. et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146-156
• 65 Bernabei R, Landi F, Calvani R. et al. Multicomponent intervention to prevent mobility disability in frail older adults: randomised controlled trial (SPRINTT project. BMJ 2022; 377: e068788
• 66 Celaya Cifuentes S, Botella Romero F, Sanchez Saez P. et al. [Nutritional status in older adults admitted to an acute geriatric unit. Nutr Hosp 2020; 37: 260-266
• 67 Chen B, Zhang JH, Duckworth AD. et al. Effect of oral nutritional supplementation on outcomes in older adults with hip fractures and factors influencing compliance. Bone Joint J 2023; 105-B: 1149-1158
• 68 Reider L, Owen EC, Dreyer HC. et al. Loss of Muscle Mass and Strength After Hip Fracture: an Intervention Target for Nutrition Supplementation. Curr Osteoporos Rep 2023; 21: 710-718
• 69 Cianferotti L, Bifolco G, Caffarelli C. et al. Nutrition, Vitamin D, and Calcium in Elderly Patients before and after a Hip Fracture and Their Impact on the Musculoskeletal System: A Narrative Review. Nutrients 2024; 16
• 70 Siggelkow H, Thomasius F. [Osteoporosis – implications of the new guidelines in practice]. Dtsch Med Wochenschr 2024; 149: 684-689
• 71 Stumpf U, Schmidmaier R. [Secondary fracture prevention/Update osteoporosis guidelines 2023 of the Umbrella Organization Osteology]. Unfallchirurgie (Heidelb) 2024; 127: 283-289
• 72 DVO Ld. DVO-Leitlinie Osteoporose 2023. In; 2023
• 73 Sieber CC. [Patient-oriented medicine in the elderly]. Internist (Berl) 2017; 58: 354-358
• 74 Authors/Task Force M McDonagh TA, Metra M. et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2024; 26: 5-17
• 75 Falke C, Karapinar F, Bouvy M. et al The association between medication use and health-related quality of life in multimorbid older patients with polypharmacy. Eur Geriatr Med 2024; doi:10.1007/s41999-024-01036-4
• 76 de Agustin Sierra L, Rodriguez Salazar J, Jimenez-Munoz AB. et al. Potentially inappropriate medication in acute hospitalized elderly patients with polypharmacy: an observational study comparing PRISCUS, STOPP, and Beers criteria. Eur J Clin Pharmacol 2021; 77: 757-766
• 77 Hudhra K, Garcia-Caballos M, Casado-Fernandez E. et al. Polypharmacy and potentially inappropriate prescriptions identified by Beers and STOPP criteria in co-morbid older patients at hospital discharge. J Eval Clin Pract 2016; 22: 189-193
• 78 Levy HB. Polypharmacy Reduction Strategies: Tips on Incorporating American Geriatrics Society Beers and Screening Tool of Older People's Prescriptions Criteria. Clin Geriatr Med 2017; 33: 177-187
• 79 Tang J, Wang K, Yang K. et al. A combination of Beers and STOPP criteria better detects potentially inappropriate medications use among older hospitalized patients with chronic diseases and polypharmacy: a multicenter cross-sectional study. BMC Geriatr 2023; 23: 44
• 80 Wehling M, Throm C. Polypharmacy in the elderly – choosing wisely by using the FORTA list. Dtsch Med Wochenschr 2015; 140: 1378-1382