Orthogeriatric and Fragility Fracture Care in the Future

Abstract

AbstractThis chapter aims to outline some of the future goals for fragility fracture care and to offer some thoughts on how some of the more significant challenges need to be approached. The increase in the prevalence of fragility fractures is a growing challenge. Globally, fragility fractures have a varied impact. In resource-rich nations, approximately 10–20% of patients move to residential care after a hip fracture, with accompanying financial and socioeconomic costs. Where healthcare services are less well resourced, much fragility fracture care takes place in the patient’s place of residence or that of their family; placing significant stress on their ability to cope. There is also a chronic worldwide shortage of nurses and, in specialties such as orthogeriatrics and fragility fracture management, there is also high patient acuity and high demand for expert care, often resulting in failure to meet patient and community needs. Care is complex and time and staff intensive, demanding staffing flexibility. Nursing care is likely to be missed when staffing ratios are low and when staffing flexibility is lacking. Inordinate energy must be spent in trying to provide care that meets constantly changing patient needs. Clinicians must also engage with governments, policy makers, leaders, employers, and communities to present evidence, lobby and negotiate for their own working conditions, and the care priorities of those for whom they provide care.This chapter focuses on several aspects of the future development of fragility fracture and orthogeriatric care. This includes highlighting the need for new ways of working and nursing role development along with ensuring that care is provided by nurses who not only understand the injury and the acute care needs related to the fracture, but who also recognise the specific and complex needs relating to the frail older person with multiple comorbidities. Clinicians must also be skilled in chronic condition management, especially concerning osteoporosis and other comorbidities.The evidence base for orthogeriatric and fragility fracture nursing is considered throughout this book. Expert care needs a specific and broad body of evidence that identifies exactly what its actions are and what its value is. Hence, the development, conduct, translation, and application of nursing research for the care of patients with fragility fractures is essential and needs to be developed with a global perspective.Education is the foundation of transforming care and services so that patient outcomes following fragility fracture can be optimised and future fractures prevented. Even though nursing education is paramount in achieving optimum patient care, acknowledging that orthogeriatric and fragility fracture care is, by necessity, interdisciplinary is essential. The benefits of multidisciplinary approaches to care, supported by interdisciplinary education are considered here.