Broken bones in older people
About this PSP
There are approximately 5 million lower limb fragility fractures in the world each year. Many of these injuries are associated with long-term disability, and even death, because it is estimated that 25% of patients with a hip fracture will die within one year of their injury. Over 500,000 patients suffer a lower limb fragility fracture in the UK every year; a figure which is projected to rise rapidly as the population gets older.
Lower limb fragility fractures are also very expensive to treat. The cost is estimated at 2% of the total healthcare burden in established market economies such as the UK – that’s around £3 billion each year.
We would like to know from patients, their relatives and healthcare professionals the research questions they would like answered about broken bones in patients over 60 years of age.
The Broken Bones in Older people - Musculoskeletal Injury: fragility fractures of the lower limb and pelvis Top 10 was published in October 2018.
Impact of Top 10s
Top 10 priorities
- What is the best physiotherapy and/or occupational therapy regime for adults during their in-hospital recovery from a fragility fracture of the lower limb?
- What is the best physiotherapy and/or occupational therapy regime for adults during out-of-hospital recovery from a fragility fracture of the lower limb?
- What is the best way to reduce harmful blood clots in adults treated with a plaster cast (or splint) for fragility fractures of the lower limb?
- What information about recovery (e.g. rehabilitation, medication, exercises, nutrition, pain), and in what form, should be provided to patients and carers following a fragility fracture of the lower limb?
- What is the best weight bearing regime following treatment (with or without surgery) for fragility fractures of the ankle?
- What is most important to adults in their recovery from a fragility fracture of the lower limb?
- What are the best treatments to prevent and treat confusion and delirium after surgery in adults with a fragility fracture of the lower limb?
- What is the best pain relief, including non-drug therapies and alternatives to reduce morphine or opioid use, for adults with a lower limb fragility fracture during anaesthesia and immediate recovery after surgery?
- What are the key components of a rehabilitation pathway for adults with dementia/cognitive impairment following a fragility fracture of the lower limb?
- What is the best way to prevent surgical site infection in adults undergoing surgery for fragility fractures of the lower limb?
The following questions were also discussed and put in order of priority at the workshop:
- How can we improve the way we link services and the effectiveness of rehabilitation when patients transition from one environment to another (e.g. from hospital to home) following a lower limb fragility fracture?
- What is the best pain relief, including non-drug therapies and alternatives to reduce morphine or opioid use, for adults with a lower limb fragility fracture on arrival in hospital (in the emergency department or ward)?
- What is the best weight bearing regime following treatment (with or without surgery) for fragility fractures of the pelvis and acetabulum (hip socket)?
- What is the best method to assess pain in adults with and without confusion (either short term or long term such as dementia) following a lower limb fragility fracture?
- What are the important parts of an enhanced recovery pathway (such as early mobilisation) for adults with a fragility fracture of the lower limb?
- What is the best pain relief, including non-drug therapies and alternatives to reduce morphine or opioid use, for adults with a lower limb fragility fracture upon discharge from hospital?
- What is the best way to reduce harmful blood clots in adults with a fragility hip fracture?
- What is the best intervention/method to enable and support early discharge of patients from hospital with a lower limb fragility fracture?
- What is the best weight bearing regime following treatment (with or without surgery) for fragility fractures of the tibial plateau (the top of the shin bone which forms part of the knee joint)?
- What are the best physical therapies to treat adults with a fear of falling after a lower limb fragility fracture?
- What is the best pain relief, including non-drug therapies and alternatives to reduce morphine or opioid use, for adults with a lower limb fragility fracture during in-hospital rehabilitation?
- What are the best psychological therapies to treat adults with a fear of falling after a lower limb fragility fracture?
- What are the specific barriers to hospital discharge (factors which delay or prevent discharge from hospital) for adults with a fragility fracture of the lower limb?
- What is the best way to promote healing in adults with a fragility fracture of the lower limb?
- What is the best treatment for surgical infections in adults following surgery for fragility fractures of the lower limb?