Don Nentwig, 84, cautioned his wife to watch her step as they headed into a restaurant for an early Father’s Day dinner. She maneuvered over the step safely, but he tripped, fell and broke his hip.
That was a Saturday afternoon. Nentwig, of Irving, underwent surgery the next morning and was able to stand by Sunday afternoon. On Wednesday, he headed home from the hospital. Now he’s almost back to normal.
Nentwig’s quick recovery beat the odds. More than 300,000 older adults in the U.S. have hip fractures each year, most of them from falls. About 30% die within a year — a statistic that hasn’t changed in 40 years. At least half will end up with reduced mobility.
Nentwig’s doctor, Megan Sorich, is determined to help change those numbers, as head of Returning Seniors to Orthopedic Excellence, or Restore, a new program at UT Southwestern Medical Center in Dallas. The program specializes in older patients who suffer hip fractures or other “fragility fractures” — broken bones caused by injuries that likely wouldn’t cause breaks in younger patients.
“A hip fracture is one of the scariest things that can happen to seniors and their families,” says Dr. Megan Sorich.(Brian Coats)
“A hip fracture is one of the scariest things that can happen to seniors and their families,” says Sorich, who specializes in orthopedic geriatric trauma. She blames “antiquated systems of silo medicine” focused on fixing broken bones but not overall recovery and underlying causes.
Launched Feb. 1, Restore aims to improve outcomes by coordinating patients’ care with a team of specialists in geriatric medicine, internal medicine, emergency medicine, anesthesiology, pain management, nutrition and physical therapy.
Nentwig says that team approach made all the difference for him.
“I had 10, 15 people coming into my room the day after surgery, asking if I needed anything,” he says. “The therapists showed me how to dress and shower after the surgery so that I could go home. They were very positive, and that helped me get going again.”
The incidence of hip fractures is expected to increase 300% by 2050 as the population ages. Of all fall-related injuries, hip fractures are the most expensive to treat. The risk is not limited to frail, elderly people in poor health; hip fractures can occur in active older adults who happen to suffer a bad fall. Women are at particular risk from osteoporosis, which affects 1 in 3 women in their lifetime; 1 in 5 men are affected, too.
A fall-related injury of any kind can trigger a cascade of medical problems.
“About half of people who break their hip will inherit a new mobilization device,” Sorich says. “A person using a cane will start using a walker for the rest of their life. A person using a walker will upgrade to a wheelchair for the rest of their life.” Good physical therapy that boosts muscle strength can help avoid that.
A key strategy of Restore is ensuring patients get surgery as quickly as possible. Patients are screened quickly and operated on within 24 hours of admission.
“The longer someone is in bed with a broken bone, the more muscle mass they lose and the less likely they are to get up and walk,” Sorich says. “They’re more likely to develop skin ulcers or pneumonia or other medical problems. We want to fix the break as soon as we are medically able.”
Restore patients are typically discharged within three to four days, armed with a comprehensive plan for follow-up care that continues for six to eight weeks. Team members follow up via telehealth to prevent future falls, looking at the patient’s home situation as well as possible underlying causes.
Members of the Restore team also pay particular attention to patients’ mental health. Because it is common for patients to feel discouraged, the team performs a mental wellness check at the midpoint in a patient’s recovery.
That’s what most impressed Linda Webb, 73, a retired physician. She was injured in February when her mobility scooter flipped and fell on her, crushing her right femur.
“I was extremely lucky because the person on call, Dr. Sorich, was a geriatric trauma specialist,” she says.
Don Nentwig, 84, beat the odds with his speedy recovery from a hip fracture.(Lawrence Jenkins / Special Contributor)
Sorich performed surgery to fix the break. The next day, Webb said, a swarm of physicians and therapists descended on her hospital room, helping to manage her diabetes, back pain, vision loss and other issues. The team also knew she’d lost her husband, and some of her eyesight, in the past year and was struggling emotionally.
“Everyone [at Restore] knew what was going on with me psychologically,” she says. “When I broke my leg. I thought, ‘This is it. There is no point in trying anymore.’ [The team] made me see my life was not over. They were able to improve my attitude, which was pretty miraculous.”
Now Webb is on the mend and feeling hopeful.
That’s the kind of patient story that keeps Sorich motivated.
She tells patients: “I want to get you up, active, healthy and walking the dog again as soon as we can.”
When an elderly person breaks a bone, that often triggers a cascade of medical problems that can lead to disability or death. If you or a loved one suffers a fracture, keep these tips in mind for the best outcome:
Get medical attention immediately after a fall. That’s critical if the patient is in significant pain, unable to walk or can’t move parts of the body. People on blood thinners who fall and hit their heads should always get urgent attention.
Enlist a friend or family member to act as the patient’s advocate. Write down the doctor’s recommendations and schedule follow-ups and physical therapy as soon as possible. Managing these details can be stressful or confusing, especially for someone on pain medication.
Make sure the medical team has investigated underlying conditions. Sometimes a fall is just a fall, but often a fall is the first sign of another problem, such as blood pressure or balance problems or osteoporosis, which also need attention.
Pay attention to nutrition. Getting enough protein is especially important to ensure broken bones heal properly after surgery. Patients in the hospital may not eat well because they can’t open containers or cut the food on their trays.
Be wary of weekends. Physical therapy and other departments aren’t always fully staffed on weekends at some hospitals. If the doctor recommends getting the patient up and moving, make sure that nurses or others on duty follow through.
Focus on mental health. After a fall, many seniors develop a fear of falling and become inactive and depressed. As much as possible, help the patient rebuild their confidence to get moving again. Recovery takes time; be sure that support and encouragement continues.
SOURCE: Dr. Megan Sorich, assistant professor of orthopedic surgery, UT Southwestern Medical Center