Preventing Fragility Fractures: A 3-Month Critical Window of Opportunity

Prevalence of Psychiatric Morbidity Among the Elderly Patients Presenting to Emergency Trauma Setting: An Exploratory Study

Background

A limited number of studies have examined the psychiatric morbidity in older adults presenting to emergency departments, but no data is available from emergency trauma clinics.

Aim

To evaluate the prevalence of psychiatric morbidity among elderly patients presenting to the Emergency trauma setting.

Methods

It was a cross-sectional study, with a convenient sampling technique used. 206 elderly patients presenting to the emergency trauma clinic were evaluated for psychiatric diagnosis as per the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) criteria. A trainee psychiatrist made diagnosis. Pa were also assessed on the Charlson Comorbidity Index (uCCI) (Updated), Adult Comorbidity Evaluation-27, Frail-VIG Index, and Visual Analogue Scale Numeric Pain Distress Scale.

Results

Delirium was the most common diagnosis (24.3%), followed by major depressive disorder (8.7%) and followed by dementia (8.5%), generalized anxiety disorder (2.4%), psychotic disorder (0.9%) and Bipolar I disorder (0.5%). The most common substance use disorder was tobacco use disorder (11.2%), followed by alcohol use disorder (9.25%). A significantly higher proportion of those with psychiatric morbidity were males, were employed, from nuclear families and of older age. Those with psychiatric morbidity had significantly higher Charlson comorbidity index score, adult comorbidity index, frailty index score, and severity of pain. Those with delirium had significantly higher Charlson comorbidity index score, adult comorbidity index score, frailty index score, and score on visual analogue pain scale compared to without delirium.

Conclusion

Over half of the older patients presenting to emergency trauma clinic had at least one psychiatric disorder. There is a need to re-organize the emergency trauma clinic service and psychiatric evaluation should be one of the integral components of the emergency set-up.

Post-Fracture Care Program: Pharmacological Treatment of Osteoporosis in Older Adults with Fragility Fractures

PURPOSE OF REVIEW

To present and discuss the recently published scientific evidence on the approach, mode of action, and timing of osteoporosis therapy initiation after fragility fractures.

RECENT FINDINGS

A comprehensive management approach is required to reduce mortality and morbidity associated with fragility fractures. This will help to reduce the risk of missing the diagnosis of osteoporosis as the underlying disorder while at the same time promoting the timely treatment of osteoporosis. The target is to minimize the incidence of post-traumatic disability and to reduce the imminent fracture risk. This article will present a Bone-Care algorithm for the diagnosis and management of fragility fractures in patients presenting for trauma surgery. This algorithm has been developed based on recently published national as well as international guidelines for implementation in standard clinical practice. International figures revealed that only a small proportion of those patients at high risk of sustaining a fragility fracture receive osteoporosis therapy. Based on the best currently available evidence, it is safe to start osteoporosis therapy in the acute post-fracture period (the optimal therapeutic window of romosozumab is the late endochondral phase/throughout bone remodeling). The right Bone-Care pathway ensures the delivery of a comprehensive management approach that meets the global call to action. All parameters including risk, benefit, compliance, and cost should be considered on an individual base for all kinds of therapy.