Julie Switzer, MD, is a board-certified orthopedic surgeon and the director of geriatric trauma at Regions Hospital in St. Paul, Minn. She is an associate professor of orthopedic surgery at the Minneapolis-based University of Minnesota Medical School, and her research interests include fracture care, elder abuse and osteoporosis.
Question: What trends do you see in geriatric orthopedic care?
Dr. Julie Switzer: Fractures in the elderly are increasing as the population ages. The greatest predictor of a fracture in an older patient is a previous fracture, and fractures in the elderly are sentinel events, particularly hip, vertebral compression and periprosthetic fractures.
As orthopedists, we can be involved in preventing fractures. We need to shift to a more comprehensive approach to the geriatric patient because they have health care needs related to being older beyond isolated orthopedic issues. Orthopedists must take ownership of musculoskeletal medicine beyond the actual surgical care, taking responsibility for osteoarthritis treatment or nonoperative fracture care of their geriatric patients.
The American Orthopaedic Association is making a push in that direction with its Own the Bone Program. Regions Hospital/HealthPartners was one of the first to implement this program, which helps prevent fragility fractures and facilitates responsibilities for osteoporosis treatment.
Collaboration is key. The easiest and most important thing is to work with primary care physicians and hospitalists to coordinate orthopedic and medical care when a geriatric patient is hospitalized. Orthopedists can really affect the care of hospitalized older patients in a significant way. In the first 24 hours, we need to figure out a patient-focused plan. We don't operate in silos; instead, we meet as a co-management group with other providers and as partners in the musculoskeletal care of our patients.
Q: Why are you developing a Geriatric Fracture Registry?
JS: There is power in knowing more about patients and what patient characteristics influence outcomes. The more we understand about this patient population and their comorbidities, the more effectively we will be able to treat them. The University of Minnesota has been a great support to our department as we develop this registry.
Q: How are physicians, particularly orthopedists, uniquely equipped to recognize and respond to elder abuse?
JS: Most common forms of elder abuse are not physical. Neglect or financial abuse is much more common. When physical abuse occurs, it can manifest in the form of fracture, bruising, or contusion. It is important our radar is up for it.
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