Orthopaedics and Rehab
After the fall: RESTORE bone health and prevent future hip fractures in seniors
February 9, 2021
Suffering a fall that results in a hip fracture is one of the scariest things that can happen to seniors and their families. As the U.S. population trends older, it has become an all-too-common problem.
More than 300,000 seniors in the U.S. suffer hip fractures annually – 95 percent from falling. Worldwide, hip fracture results in serious physical and emotional injuries or death for approximately 30 percent of senior patients – a statistic that has not budged much in three decades.
But a new program at UT Southwestern is designed to change that. RESTORE (Returning Seniors to Orthopedic Excellence) mobilizes experts from geriatrics, orthopedics, and pain management to provide comprehensive fracture care from the moment a senior enters our emergency department with hip pain until long after they return home and begin rehabilitation.
RESTORE is the only program of its kind in North Texas. Data from 2020 show that a proactive, co-management approach can cut the wait time for surgery in half (from more than three days to 36.44 hours). At UT Southwestern, we've also reduced the length of hospital stays by 50 percent (from 11.29 days to 6.44 days), compared with data from January 2018 to September 2019.
Research from other centers across the country has shown that orthogeriatric co-management programs can decrease one-year mortality rates by approximately 12 percent and provide patient benefits such as improved quality of care, shortened stays, and a lower rate of readmissions.
By 2050, worldwide hip fracture incidents are expected to increase 310 percent in men and 240 percent in women, which means that now is the time to perfect our protocols and protect the health, mobility, and independence of Texas seniors.
Who does RESTORE serve?
Anyone 60 and older who comes through the ER with a fragility fracture – a broken bone from an injury that likely wouldn't cause a break in a younger patient – is automatically cared for through RESTORE.
The risk for fragility fractures is not limited to seniors in poor health or who require in-home family or medical care. These injuries can happen to vibrant, healthy seniors who happen to have a bad fall. Hip fractures are often due to ground-level falls, such as tripping or falling from a seated position.
Women are particularly at risk for fragility fractures due to osteoporosis, a condition that thins women's bones. Approximately 75 percent of patients with hip fractures are women. According to the International Osteoporosis Foundation, a 50-year-old woman faces a 2.8 percent risk of death related to hip fracture in her lifetime – nearly equal to her risk of dying from breast cancer.
Ground-level falls may not be quickly diagnosed in older patients, who might be in shock or confused about the injury. Some don't want to "be a burden" and don't seek care. Often, patients are injured when at home alone, and the injury goes undetected until it becomes an emergency.
Of course, most families don't feel that their elders are a burden. They are committed to supporting their loved one's health however they can. In turn, RESTORE physicians are committed to families. We work with patients' loved ones in the hospital and at home to develop effective senior communication strategies and action plans to get help quick if a fall occurs.
In older adults, complications from delayed hip fracture surgery can manifest as life-threatening infections, lost mobility and independence, and fear or anxiety about falling again. After traditional hip fracture management, only half of patients regain full independence. These complications can lead to isolation and depression, particularly if proactive fall prevention strategies are not in place.
Delayed surgery for a hip fracture and taking too much pain medication can also increase the risk of post-operative delirium – a state of confusion that can affect older patients for weeks after surgery.
RESTORE starts with early diagnosis and expedient surgery and continues with long-term bone health and fall prevention support that follows through a patient's return home. The process relies on a team that includes experts in geriatric medicine, orthopedic surgery, physical therapy, palliative care for pain management, anesthesiology, bone mineral metabolism, and nutrition.
Working together closely, the RESTORE Team ensures patients get the right diagnosis sooner, which leads to faster and more effective care, less time waiting for hip fracture surgery, fewer unnecessary tests, and a shorter hospital stay, with supportive recovery from family members, caregivers, and geriatric-orthopedic experts at home.
How RESTORE works, start to finish
When a hip fracture is suspected, RESTORE patients can expect to be:
1. Screened through a quick identification process to speed up admission and potentially get into surgery quicker.
2. Admitted to a floor reserved for geriatric/orthopedic patients and seen by geriatric medicine and orthopedics experts.
3. Optimized for surgery, which means making sure surgery will be safe for them. This includes meeting with an anesthesiologist to start our enhanced recovery after surgery protocol to help reduce post-operative delirium. Patients will also have routine lab work done and get an IV placed to make sure they are adequately hydrated.
4. Operated on within 24 hours of admission.
5. Met by the co-management care team after recovery to design a nutrition, physical therapy, and fall-prevention plan.
6. Bearing weight and sitting up in a chair for meals after surgery.
7. Discharged home within three to four days. Patients with complex needs may benefit from care and services at a rehabilitation center.
8. Scheduled for geriatric/orthopedic follow-up care that continues for six to eight weeks as they regain strength and mobility.Your first follow-up appointment will be at UT Southwestern. We encourage you to bring a loved one to all your visits – I always say two sets of ears are always better than one to take notes and ask questions.
When possible, we'll schedule all your post-surgery specialist appointments in one day to save you an additional trip. Then most of your subsequent recovery and fall prevention support will be conducted through telehealth visits, which can have the added benefit of being accessible to family members who may not live in the area.
Connecting Orthopedic and Geriatric Care for Seniors
UT Southwestern is providing new hope for older adults who suffer fractures and the complications that can result from those injuries with the new Returning Seniors to Orthopedic Excellence (RESTORE) Program. This program is the first of its kind in North Texas.
These appointments are conversational check-ins where we talk about progress and how you’re feeling. Typically, I'll ask patients to walk so I can watch for limping or stiffness, which can signal a problem. I'll also take a look at their surgical incision to check for proper healing.
One of the most important steps in these visits is a mental wellness check. Around the four- to six-week mark, some patients start feeling discouraged. It's the midway point in healing, and they just want to feel better. We always make time in follow-up visits to encourage patients to keep going and remind them of all the progress they’ve made.
Most of my patients love video visits and do well with the technology on their own or with a loved one's help. For patients without internet access, talking on the phone usually works just as well.
How RESTORE supports patients and families
William “Bill” Lawson, 96, and his wife, Jane, 95, experienced falls within a week of one another last year. Dr. Sorich and her team provided them with the surgical procedures and specialized care needed to get on the road to recovery.
Tips to prevent falls and future fractures
Sadly, five to 10 percent of patients with hip fractures will suffer another broken hip – nearly a quarter of these injuries will occur within a year of the initial fracture. Protect yourself and aging loved ones by taking precautions to help reduce the risk of falling:
- Establish proper footing: Adhere nonslip backing to rugs, carpets, and mats, and install slip-resistant stick-ons in your bath or shower. Also, be mindful of your pets' whereabouts – cats and dogs love to snuggle underfoot.
- Mind your nutrition: Eating a healthy diet is a key part of healing and fracture prevention. Your nutrition plan likely will include taking supplements for calcium and vitamin D for bone health. Many seniors don't get adequate protein due to dental or digestion issues, so we may recommend protein shakes along with fruits and vegetables to ensure you get the nutrients you need.
- Prioritize vision care: Impaired vision is one of the most common causes of falls. Some patients have let their eye appointments lapse during the pandemic, but your sight is a vital part of maintaining good health and avoiding potential falls.
- Attend physical therapy: Building stronger leg muscles can improve your balance and help you regain confidence after a fall. Your physical therapist will guide you in exercises to bolster your strength and help maintain your independence.
- Manage osteoporosis: Having stronger bones reduces the risk of a serious fracture in the future. Our bone mineral metabolism experts can help you retain and build bone strength through medications, exercise, and improved nutrition.
Future of RESTORE
Over the next five years, we will monitor and grow the hip program, incorporating other important fragility fracture sites, such as the shoulders, wrists, and arms. We are closely monitoring length of stay, infection risk, and mobility milestones, and we expect to see continued improvements in patient outcomes.
In the future, we plan to roll out a mobile health outreach program, where we'll send an advanced practitioner to the patient's home or care center. In-home care, combined with telehealth, will allow more patients to benefit from long-term support.
UT Southwestern is a Healthgrades five-star recipient for 2020 for hip fracture treatment and an established geriatric center of excellence. We also offer our patients proven programs such as Acute Care for Elders (ACE) Unit at William P. Clements Jr. University Hospital and the UT Southwestern Perioperative Optimization of Senior Health (POSH) Program.
RESTORE is an extension of our dedication to providing the best care for elders in our communities, and we are proud to offer full-circle care to help seniors prevent future falls.