October 1999 Bulletin

Multidisciplinary team needed for elderly

Necessary to meet unique challenges of geriatric orthopaedic patients

By Peter Z. Cohen, MD

The aging of the United States population has occurred steadily over the last century, but growth in numbers and proportions of older people will rise sharply in the coming decades.

Currently, there are about 33 million people age 65 and older, representing 13 percent of our total population. By 2030, this number will climb to 20 percent. In addition, there will be a dramatic increase in the number and the proportion of very old people, those age 85 and older. The number of people age 85 and older, presently 3.5 million, will total nearly 9 million by the year 2030.

Musculoskeletal diseases and symptoms are the second leading reasons why elderly people visit their doctor and/or are admitted to the hospital.

Presently, the health care industry and Medicare are undergoing dramatic changes. The question is how do we deliver greater quantity and quality care to seniors, while resources needed to achieve this are dwindling?

Caring for the musculoskeletal problems of the elderly is complex and made more difficult because of the associated co-morbidities and declining physical and mental capacities. Treatment carries a high incidence of perioperative morbidity and mortality and is associated with tremendous psychosocial and economic burdens for the patient, family, and society.

It is important for orthopaedic surgeons to respond to the musculoskeletal needs of our elderly patients by providing efficient care that achieves functional outcomes. Keeping seniors mobile and independent, recognizing that quality of life issues are extremely important while remaining vigilant of cost will be our measure of success.

A multidisciplinary team approach is necessary to meet the unique challenges presented by the geriatric orthopaedic patient. The "team" should be led (and driven) by the orthopaedic surgeon and should include geriatricians, geriatric psychiatrists, primary care physicians, family practitioners, internists and other medical and surgical specialists and subspecialist. Support members from many areas must include social service, physical and occupational therapy, nursing, nutrition, pharmacy, home care and extended care, and skin care services. A team coordinator is an essential member who will assure that the cooperative effort of all members works toward the common goal of providing quality and cost effective care for geriatric orthopaedic patients, and who, will collect data for outcome studies.

All members of the team should be chosen because they have an interest in caring for the aging patient. They should have skills in this area and sensitivity to the patient's and their caretaker's problems. There are very few medical centers, hospitals or orthopaedic residency training programs in our country presently that focus on musculoskeletal needs of aging patients. Those that exist, primarily do so for the elderly patient with a hip fracture. Once formed, the "team" will be self educating and will spawn programs in areas other than for hip fractures, such as:

An elderly patient with a fractured hip, for example, should not merely be considered for a hip pinning or replacement. The cavalier approach ignores the complexity of the patient and disregards the magnitude of their problems. Instead, a comprehensive and multidisciplinary learn approach by applying special skills can prevent many complications and achieve functional outcomes designed to provide greater independence and quality of life for our seniors.

A quality team will be a winning team.

Peter Z. Cohen, MD, is clinical professor, division of adult reconstructive surgery and general orthopaedic surgery, University of Pittsburgh Physician, department of orthopaedic surgery, University of Pittsburgh Medical Center.


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