Today's News

Friday, February 23, 1996

Orthopaedists face challenges of aging population

An aging America presents orthopaedic surgeons with an enormous new challenge: how to provide comprehensive musculoskeletal care that will enable elderly patients to remain independent.

"When you reach 80, remember that life is really just beginning," said moderator Victor M. Goldberg, MD, Charles H. Herndon Professor and Chairman, Department of Orthopaedics, Case Western Reserve University, University Hospitals of Cleveland, Ohio. "Statistics tell us that women have another 10 years after they reach 80 and men have about seven." Dr. Goldberg told a press conference on "Orthopaedic Challenges in an Aging Population" Thursday that, by the year 2020, about one-half of the U.S. population will be over the age of 65. For orthopaedists, this means a dramatic increase in the incidence of hip and knee replacements and a challenge to find new ways to improve the health of their patients.

"We hope to prevent some of the problems associated with aging, such as stiffness, weakness and mobility problems," Dr. Goldberg said. "These things affect the person's independence and quality of life. Prevention and treatment of musculoskeletal disorders is very cost effective for society. Can you imagine the cost to society if 60 percent of the elderly in 2020 needed nursing-home care or home care?"

Albert S. Schultz, PhD, Vennema Professor of Mechanical Engineering and Applied Mechanics, University of Michigan, said that older adults have many things in common, such as problems with bathing themselves, walking and getting up from chairs or beds. About one-fourth have difficulty in lifting more than 10 pounds. Schultz pointed out that the decrease in strength and mobility as people age is not explained by largely inactive lifestyles. Elite runners experience a one-third decline in speed after age 65, despite continuing training.

Schultz also pointed out that reaction times and problems with proprioception increase after age 65, putting older adults at risk for more auto accidents and falls, which often lead to broken hips and wrists. But, he said, our society has failed to recognize that healthy older adults are very able and have good reaction times. His challenge for orthopaedic surgeons was to learn more about how to keep older adults independent throughout life, by focusing on why they fall, how to prevent injury and how to return them to activity after surgery.

Wilson C. Hayes, PhD, said one problem encountered with preventing hip and knee fractures in older adults is that "we don't really understand the mechanisms of the fractures." He pointed out that conventional wisdom focuses on exercise, calcium intake and pharmaceutical intervention only. "We, as a country, believe that if we exercise, drink our milk and use estrogen therapy we'll be okay," Hayes said. "But we need to focus on falls. Why do they occur and why don't they always results in fractures for older adults?"

One in seven falls result in fracture; these fractures are one of the foremost reasons that the elderly lose their independence and require nursing-home care. Hayes has conducted research that has shown a fairly simple result: if patients fall on their hips, they break them; if they fall and land on any other body part, they don't. "It sounds so simple, but we didn't really know this before," he said. "Now we are looking at devices such as hip pads for older adults who are prone to falling."

Another often-overlooked aspect of hip and knee repair in the elderly is that of the patient's mental health. Kenneth J. Koval, MD, Chief of Fracture Service, Hospital for Joint Diseases, New York, NY, said the loss of independence associated with hip fractures has a great effect on the mental health of the elderly. "Our idea is to return the patient to full preinjury function," Dr. Koval said. "We want to get them weight bearing not just to promote healing and prevent embolisms but to help the patient avoid slipping into depression." Dr. Koval said a team of specialists, including the patient's primary-care physician and a social worker, work with the patient from injury through rehabilitation.

As the American population ages, Dr. Goldberg said orthopaedists need to educate patients and insurance companies alike that hip and knee replacements for older adults are quite successful and will improve the patient's quality of life. Also, these procedures decrease the cost of care for an aging population by maintaining the patient's independence and reducing the need for nursing home care.

"Age is no deterrent to hip replacements outcomes," he said. "We need to remind people that it is a matter of physiology, not chronology."

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Last modified 27/September/1996