Impact of orthogeriatric care: prescription patterns in hospitalized older adults.

Abstract

Orthogeriatric co-management aims to optimize care for high-risk hip fracture patients. Implementation significantly increased secondary prevention (osteoporosis/anemia) and reduced intramuscular haloperidol. With a 63% relative reduction in mortality (8.6% to 3.2%), this model proves essential for enhancing safety and survival in complex older populations.

Purpose: Proximal femoral fractures (PFF) impose a substantial burden on older adults and healthcare systems. Orthogeriatric co-management aims to optimize care for this high-risk population, yet its influence on in-hospital prescribing is poorly characterized. This study examines how implementing an orthogeriatric unit affects medication patterns in hospitalized older adults with PFF.

Methods: A 23-month retrospective, observational study included consecutively admitted PFF patients aged ≥65 years. Clinical and pharmacological data (demographics, chronic medications, length of stay, surgical timing) were extracted from electronic and pharmacy records. In-hospital prescribing was assessed across key domains: analgesia, anaemia, delirium, antimicrobial stewardship, bowel regulation, and osteoporosis. Pre- and post-implementation cohorts were compared using descriptive statistics, chi-squared, and t tests (p < 0.05).

Results: A total of 872 patients were included in the study. Implementation of the orthogeriatric unit was associated with significant increases in the prescription of laxatives (lactulose: 8.1% vs 74.5% p < 0.001; oral bisacodyl: 2.7% vs 48.9% p < 0.001), haematopoietic therapies (folic acid: 6.8% vs 22.0% p < 0.001; ferric carboxymaltose: 1.4% vs 20.6% p < 0.001), and secondary fracture prevention treatments (calcium: 2.7% vs 51.5% p < 0.001; vitamin D: 2.5% vs 56.7% p < 0.001; zoledronic acid: 1.4% vs 12.7% p < 0.001). Intramuscular haloperidol use significantly decreased (21.7% vs 10.9% p < 0.001). Oral paracetamol use increased, while opioid prescribing remained stable. Unadjusted intra-hospital mortality declined significantly (7.7% vs 2.9%, p = 0.005).

Conclusion: The orthogeriatric approach successfully streamlined both management across key therapeutic domains and patient survival. This study quantifies the positive impact of co-management, supporting evidence for the implementation of safer, proactive therapeutic protocols in hip fracture care.