Author: Sibel Cavdar
Affiliation: Izmir City Hospital, Department of Internal Medicine, Division of Geriatrics. Izmir, Turkiye
This year, FFN European Regional Congress was held in Istanbul between 10-12 October 2024. As ECGI reporters members, Fatma Özge Kayhan Koçak and I attended this congress. We were happy to host many valuable professors who are experts in their fields in our country, and also to meet with dear Luba, one of the members of ECGI reporters.
The congress program was very busy, starting with the courses held on the precongress day. The first course was ‘Nursing care for fragility fracture patients’, and the second was about Fracture Liaison Services (FLS) which is a coordinated approach to the care of patients who have experienced fractures and this approach ensures that older patients receive appropriate treatment and follow-up to prevent further fractures. Here I would like to mention about FAN (FLS Academy & Network) which is a great opportunity and helps to start and develop a successful FLS through an online platform (here is the link to visit and register: https://fan.within3.com). Dr. Inder Sıngh who is a consultant geriatrician from Welsh emphasized after a sentinel fracture the next 2 years are critical period of very high fracture risk and healthcare systems need to act fast to reduce fracture risk.
At the first day of the congress, Morten Tange Kristensen, PT, a clinical professor, discussed about early immobilisation time after hip fracture. Mobilization out of bed on the day or day after hip fracture surgery is possible for most patients and with significant positive impact (patients mobilized within the day after surgery do much better on several outcomes and associated with a lower risk of mortality.). About the surgical delays it was mentioned that organizational factors account for 50% of delayed hip fracture surgeries. There are also many reasons for delay of the surgery after hip fracture such as clinical stability, comorbidity, anticoagulant antiplatelet medication. International Fragility Fracture Network Delphi consensus statement on the principles of anesthesia for patients with hip fracture emphasizes ‘’Surgery should be delayed only if benefits of additional medical treatment outweigh the risks of delaying surgery.’’ Dr. Antony Johansen, an orthogeriatrician from London focused on 3 steps that we should overcome; haemorrhage, ımmobility, pain for recovery after hip fracture. Prof. Dr. Gülistan Bahat explained the role of geriatricians in a detailed form and Prof. Dr. Nathalie van der Velde gave a speech about Worlf Fall Guidelines.
At the second day, Dr. Hanna C. Willems from Netherlands mentioned about the outcomes of FRAIL HIP trial. 50% of older adults, who were independent before hip fracture, fail to regain their pre-fracture status, and worldwide 10-13% dies within the 30 days after fracture. Living in nursing home, total immobility before fracture, dementia diagnosis, cachexia, ASA 4-5 risk scores are the predictors of 30 day mortality. In FRAIL HIP study, 25 hospitals and 130 nursing homes were included. Frail patients were divided into 2 groups nonoperative management or surgical treatment groups according to shared desicion making often with geriatricians. It was concluded as in some hip fracture patients you might not need to fix the fracture in frail older adults. These results created a nice discussion environment in the hall. I recommend you to read this study. Marsha van Oostwaard a nurse practitioner talked about fracture and falls prevention in frail older populations with nursing perspective. She emphasized the road to recover from a fracture includes more nurses than physicians. She indicated honestly only 1/5 of nurses have sufficient knowledge on osteoporosis or increased fracture risk. The nurse power and knowledge must be increased in fracture prevention. Guidelines for nurses can help to overcome barriers in fracture prevention care. Prof. Jack Bell and Dr. Tuğba Erdoğan emphasized bettter nutrition is related with better outcomes. Dr. Carmelinda Ruggiero mentioned about frail person with fragile bones and focused on the interdisciplinary approach facilitates the identification and management of priorities by using the most appropriate way. She identified the pacemaker of this process is the orthogeriatrician. Geriatricians can play a pivotal role in re-orienting care for older people towards an integrated and person-centred care system focused on functional ability, preventive strategies and age friendly services. Dr. Toby Ellmers mentioned about concerns about falling. Whilst ‘fear of falling ‘ is commonly used, he recommended using the term ‘concerns about falling’. Because concerns about falling is less intense and emotional (and therefore may be more socially acceptable to disclose) on behalf of the ‘Concerns (Fear) about Falling Working Group’. They recommend including an evaluation of concerns about falling in a comprehensive fall risk assessment of older people. They also recommend using a standardised instrument to evaluate concerns about falling (the Short FES-I).
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