Orthogeriatrics in France
Authors: Dr Judith Cohen Bittan (1, 2), Dr Bastien Genet (3)
Afilliations:
Head of the Perioperative Unit, Geriatrics Department at the Pitié Salpêtrière Hospital, Paris, France (Pr Jacques Boddaert).
Co-leader of the SFGG’s Perioperative working group.
Sorbonne Université, Inserm, Sorbonne Public Health Institute, Team PEPITES, Assistance Publique Hôpitaux de Paris, Hôpital Rothschild, Paris, France
Dr Bastien Genet in conversation with Dr Judith Cohen Bittan.
Orthogeriatrics has become an essential component of care for older adults undergoing both emergency and elective orthopaedic surgery. In this interview, Dr Bastien Genet, a geriatrician and clinical epidemiologist at Sorbonne Université and Hôpital de la Pitié-Salpêtrière, speaks with Dr Judith Cohen Bittan, Head of the Perioperative Unit in the Geriatrics Department at Pitié-Salpêtrière Hospital and co-leader of the French Society of Geriatrics and Gerontology (SFGG) Perioperative Working Group.
With more than 15 years of experience in orthogeriatrics, Dr Cohen Bittan works closely with anaesthesia and intensive care teams to optimise peri-operative care for older patients. Dr Genet’s clinical and research interests focus on peri-operative geriatrics, acute care for older people, patient-centred care pathways, and the use of mixed methods to improve outcomes and quality of life of patients, caregivers and healthcare professionals.
Together, they discuss the current state of orthogeriatrics in France, pre-operative rehabilitation and pre-operative assessment, the emerging role of digital tools, and how care pathways can better support the most vulnerable older patients.
Where does orthogeriatrics stand in France in 2026?
By 2026, orthogeriatrics is recognised in France as the gold standard for the management of fractures of the proximal femur [1]. It is no longer an innovation but a standard of good practice, the nationwide roll-out of which is ongoing and as yet incomplete. It constitutes a comprehensive care pathway, from the emergency department (ED) through to the patient’s return home, although there are still significant disparities in care pathways and the provision of care depending on the region.
The aim is to place each patient on the care pathway best suited to their needs. The comprehensive geriatric orthopaedic pathway is intended for patients with the most severe comorbidities and therefore at risk of post-operative complications [1], including delirium:
Pre-operative optimisation using care protocols developed in collaboration with ED staff with a pre-operative waiting time of less than 48 hours;
Transfer to the orthopaedic acute care unit (UPOG) followed by the medical rehabilitation unit (SMR) with a focus on restoring independence and managing osteoporosis;
Then discharge home with adapted assistive devices.
Some patients (with few comorbidities) benefit from intra-operative optimisation but will subsequently be managed by the orthopaedic department. An increasing number of orthogeriatric units are opening up to elective surgery (e.g. hip and knee arthrosis), with patients who are increasingly older and have multiple comorbidities being candidates for these procedures. This requires pre-operative rehabilitation programmes.
What are the main pillars of pre-operative rehabilitation today?
The pre-operative rehabilitation programme currently offered is multimodal, lasts 4 to 6 weeks in the pre-operative period and comprises [2–4]:
Physical pre-operative rehabilitation: muscle strengthening, balance training;
Nutritional pre-operative rehabilitation: screening for malnutrition and sarcopenia, and correction of any deficiencies in the pre-operative period;
Psychological pre-operative rehabilitation: information on the upcoming surgery and the care pathway, motivation and adherence to the programme, reduction of anxiety, sleep;
Cognitive pre-operative rehabilitation: screening for any neurocognitive disorders;
Optimisation of the management of comorbidities and review of prescriptions to minimise iatrogenic complications (e.g. drug adverse events).
The aim of pre-operative rehabilitation is to reduce post-operative complications and thus facilitate a rapid return to the patient’s home environment. Further research is needed in the field of orthogeriatrics, as these pillars are largely inspired by oncogeriatrics in the context of visceral surgery.
What are the key components of a pre-operative geriatric assessment?
Pre-operative geriatric assessment is not a standardised assessment involving a series of scores, but rather a personalised assessment tailored to each patient based on their level of independence and their comorbidities. The aim of this assessment is to propose a personalised care pathway for each patient: pre-operative rehabilitation, orthopaedic pathway with early rehabilitation program (Réhabilitation Accélérée Après Chirurgie -RAAC- in France, Enhanced Recovery After Surgery -ERAS- in UK …) [1, 5], or orthogeriatric pathway.
The main pillars of the pre-operative assessment are:
Assessment of comorbidities (complementary to that carried out by the anaesthetist);
Assessment of iatrogenic factors, including a review of prescriptions;
Assessment of pre-operative malnutrition, an independent risk factor for post-operative complications;
Cognitive assessment, as the most significant risk factor for post-operative delirium is the presence of underlying (often unrecognised) neurocognitive disorders, which must therefore be screened for pre-operatively;
Assessment of mood (also a risk factor for post-operative delirium) using scales such as the Geriatric Depression Scale (GDS) or mini-GDS [6];
Assessment of physical performance using scales such as the Short Physical Performance Battery (SPPB) [7].
What role do digital and technological tools currently play in the pre- and post-operative periods?
Digital and technological tools are still under-utilised in orthogeriatrics. Their uptake is expected to accelerate in the coming years, particularly in the field of pre-operative rehabilitation. There are still relatively few studies in this field. At present, the tools that are beginning to be used in the pre-operative phase are mainly tutorials and educational videos for patients and carers to watch [3]. Teleconsultations are beginning to be rolled out in this field, with teleconsultations with geriatricians, physiotherapists and nutritionists, enabling closer and more regular monitoring of patients. Exergames have also been available for several years [3, 8]. Smartwatches could also be a useful tool for assessing adherence to pre-operative rehabilitation programmes and monitoring progress during pre-operative rehabilitation and subsequently in the post-operative period.
In the post-operative setting, a randomised, multicentre, open-label study conducted in Spain was published in 2024 in The Lancet (Rafael Prieto-Moreno et al.) [9], involving patients in the post-operative phase following a hip fracture, with no cognitive impairment, who were independent prior to the fracture and who had a primary carer. Patients were randomised to either the ActiveHip+ group or the control group. The ActiveHip+ group received a 12-week intervention (access to the ActiveHip+ smartphone app, featuring pre-recorded exercise sessions tailored to the patient, occupational therapy and health education modules). There was a significant improvement in the SPPB at 3 months, but not at 1 year.
What solutions can we offer today for the most vulnerable patients, particularly those facing social isolation or financial difficulties?
Orthopaedic conditions such as osteoarthritis are factors that exacerbate social isolation, as they lead to a loss of independence [10]. The first step is to identify these patients, hence the need for close links with primary care professionals. We should encourage the deployment of coordinating nurses within hospital settings to facilitate this link with the local community, whether for the early identification of these patients or for optimising their care pathway following discharge. We need to attract social care professionals back into hospital settings, and the creation of effective multidisciplinary pathways, such as orthogeriatric pathways, could serve as a catalyst.
References
French National Authority for Health. Orthogeriatrics and Hip Fracture – Key Points Sheet for Care Pathway Organisation. 2017.
Genet B. Thèse de science en Epidémiologie - “Optimiser l’offre de soins orthogéritriques.” 2025.
Genet B, Cohen-Bittan J, Nicolas M, Bonnet-Zamponi D, Naline C, Ouafi-Hendel D, et al. Feasibility of a Multimodal Prehabilitation Program before Elective Knee and Hip Arthroplasty in Older Adults. J Am Med Dir Assoc. 2025;26:105345. https://doi.org/10.1016/j.jamda.2024.105345.
Adebero T, Omana H, Somerville L, Lanting B, Hunter SW. Effectiveness of prehabilitation on outcomes following total knee and hip arthroplasty for osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Disabil Rehabil. 2024;46:5771–90. https://doi.org/10.1080/09638288.2024.2313128.
Borges FK, Bhandari M, Guerra-Farfan E, Patel A, Sigamani A, Umer M, et al. Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. The Lancet. 2020;395:698–708. https://doi.org/10.1016/S0140-6736(20)30058-1.
Clément JP, Nassif RF, Léger JM, Marchan F. [Development and contribution to the validation of a brief French version of the Yesavage Geriatric Depression Scale]. Encephale. 1997;23:91–9.
Welch SA, Ward RE, Beauchamp MK, Leveille SG, Travison T, Bean JF. The Short Physical Performance Battery (SPPB): A Quick and Useful Tool for Fall Risk Stratification Among Older Primary Care Patients. J Am Med Dir Assoc. 2021;22:1646–51. https://doi.org/10.1016/j.jamda.2020.09.038.
Ning H, Jiang D, Du Y, Li X, Zhang H, Wu L, et al. Older adults’ experiences of implementing exergaming programs: a systematic review and qualitative meta-synthesis. Age and Ageing. 2022;51:afac251. https://doi.org/10.1093/ageing/afac251.
Prieto-Moreno R, Mora-Traverso M, Estévez-López F, Molina-Garcia P, Ortiz-Piña M, Salazar-Graván S, et al. Effects of the ActiveHip+ mHealth intervention on the recovery of older adults with hip fracture and their family caregivers: a multicentre open-label randomised controlled trial. EClinicalMedicine. 2024;73:102677. https://doi.org/10.1016/j.eclinm.2024.102677.
Philip K, Jolly A, Diep C, Savage RD, Wijeysundera DN, Witiw C, et al. Association of loneliness and social isolation with postoperative outcomes: a retrospective registry study. Br J Anaesth. 2026;136:247–54. https://doi.org/10.1016/j.bja.2025.09.004.
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