Impact of nurse-led orthogeriatric co-management for older patients with a major osteoporotic fracture: An observational pre-post study.

BACKGROUND: Older patients with a major osteoporotic fracture are at risk for complications during hospitalization. We evaluated whether proactive nurse-led orthogeriatric co-management leads to better inpatient outcomes than reactive geriatric consultation for older patients with any type of fracture. METHODS: We evaluated 108 patients aged ≥ 75 years hospitalized with a major osteoporotic fracture before and after the implementation of a nurse-led orthogeriatric co-management program. This included proactive geriatric care, comprehensive geriatric evaluation, multidisciplinary interventions, and systematic follow-up. The primary outcome was the occurrence of in-hospital complications. Secondary outcomes at discharge included functional status, instrumental activities of daily living status, mobility status, cognitive status, quality of life, return to pre-fracture living situation, length of stay, and in-hospital costs. Furthermore, adherence to the intervention’s core components and care processes was assessed. RESULTS: After implementation, 8% fewer patients experienced in-hospital complications (46% vs. 38%; p = 0.215). Median in-hospital length of stay increased (9 vs. 12 days, p = 0.013), yet in-hospital costs did not increase significantly. Adherence to several care processes improved (p < 0.001): a swallowing test was introduced (0% vs. 70%), more patients received a laxative when necessary (67% vs. 94%) and started with calcium-vitamin D supplements (20% vs. 58%). CONCLUSIONS: This study suggests that nurse-led orthogeriatric co-management results in in-hospital complication rates comparable to geriatric consultation while enhancing adherence to proactive geriatric care processes and maintaining similar in-hospital costs. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN) Registry: ISRCTN20491828. Registered on 11/10/2021, https://www.isrctn.com/ISRCTN20491828.