Improving care in older people with fractures

The care of older patients with hip fracture is a high priority for the NSW Agency for Clinical Innovation (ACI).


“These people [older patients] represent some of the most vulnerable members of our society and it is critical to ensure that they receive the best care available” Associate Professor Jacqui Close, Chair of the ACI’s Aged Health Network, said


“We have a growing ageing population, which means that hospitals are increasingly treating older people for falls, which often lead to injuries such as hip fractures.”


“Best practice care includes timely access to surgical intervention. However, when older people have fractures, the treatment provided must look at the person as a whole - not just the fracture.


It is critical to ensure that people are stable medically before putting them through an anaesthetic and surgical procedure.”


The ACI Aged Health Network has led the development of a National Hip Fracture Steering Group to develop Clinical Guidelines, Quality Standards and a National Hip Fracture Registry to improve the care and outcomes for people who sustain a hip fracture.


The ACI is also working with Local Health Districts and the Clinical Excellence Commission to implement a model of collaborative care to improve the care provided to older people with fractures.


Under the ACI Orthogeriatric Model of Care, older people with fractures have an initial assessment by a specialist aged health physician (geriatrician), as early in the admission as possible, with ongoing care from multidisciplinary specialist aged care services working together with the orthopaedic surgical team.


The assessment is designed to identify existing conditions including cardiac, renal and respiratory disease as well as any unidentified problems such as bleeding gastric ulcers to ensure that all conditions are addressed prior to undergoing a major surgical procedure


The family and carers of older people with a fracture are asked for their advice and information and are closely involved in any decisions around patient care.


Special attention is paid to getting people up and returning to independence as quickly as possible, to avoid complications such as chest infections, blood clots and muscle weakness which can affect recovery and length of stay in hospital.


Preventing future fractures is also important and this should be done by assessing risk factors for falls and treating osteoporosis.


The ACI is a board-governed statutory health corporation that reports to the NSW Minister for Health and the Director-General of the NSW Department of Health.


The Agency for Clinical Innovation web site can be seen at


20 January 2012.