Review Article Orthopaedic-geriatric models of care and their effectiveness Carol P Chong Department of Aged Care, The Northern Hospital, Epping; The Northern Clinical Research Centre, The Northern Hospital; and The Department of Medicine, Austin and Northern Health, The University of Melbourne, Melbourne, Victoria, Australia Judy Savige The Northern Clinical Research Centre, The Northern Hospital; and The Department of Medicine, Austin and Northern Health, The University of Melbourne, Melbourne, Victoria, Australia Wen Kwang Lim Department of Aged Care, The Northern Hospital, Epping; The Northern Clinical Research Centre, The Northern Hospital; and The Department of Medicine, Austin and Northern Health, The University of Melbourne, Melbourne, Victoria, Australia Different types of orthopaedic geriatric units have been established. This review evaluates the effectiveness of this model of care. A computerised literature search was undertaken using Medline (January 1966–February 2009), Cochrane and CINAHL with the search terms orthopaedics, geriatrics, aged, orthopaedic procedures and fractures. Relevant articles were evaluated and appraised with particular focus on randomised controlled trials. Orthopaedic-geriatric models can be divided according to the setting of care (i) acute inpatient orthopaedic-geriatric care; (ii) subacute rehabilitation; and (iii) community-based rehabilitation. Studies have been heterogenous in nature and outcomes measured have differed making pooled data analysis difficult. In general, there is a trend to effectiveness in outcomes such as functional recovery, length of stay, complications and mortality and importantly studies have not shown detrimental consequences. However, because of the varied types of interventions and models of care, it is difficult to draw firm conclusions about the effectiveness of these programs. Key words: fractured neck of femur geriatric, models of care, orthopaedic. Introduction Orthopaedic units have traditionally cared for patients with fractures from the time of admission, through to surgery and during the post-operative phase [1]. These patients often have medical comorbidities with mortality after fractured neck of femur as high as 10–26% at 6 months [2]. Because of this and the increasing incidence of fractures, there has been more medical input from geriatricians [3]. Recent studies have described different models of care combining ortho- paedic management with medical specialties such as geriat- rics, rehabilitation or hospitalist care. This review evaluates the effectiveness of these models and describes the role of the geriatrician. Methods A computerised literature search was undertaken using Medline (January 1966–February 2009) using the search terms orthopaedics, geriatrics, aged, orthopaedic procedures and fractures. Relevant articles were evaluated as well as bibliographies of the articles retrieved with particular focus on randomised controlled trials. The Cochrane Library and CINAHL were additionally searched. Due to the heterog- enous nature of the studies analysed they were grouped according to setting of care. Components of care were identified and noted if different from usual or standard management. Orthopaedic-geriatric models of care Combining the resources of the orthopaedic and geriatric departments might improve the care of elderly patients with fractures. In fact, the first combined orthopaedic geriatric rehabilitation ward was in the United Kingdom in the 1950s [4–7]. Different approaches to orthopaedic care can be divided into three main categories according to the setting of care: 1. Acute inpatient care which comprises of the following models (i) Joint acute orthopaedic-geriatric care such as the geriatric hip fracture program (GHFP); (ii) acceler- ated rehabilitation; and (iii) hospitalist care. 2. Subacute rehabilitation – joint orthopaedic and geriatric inpatient rehabilitation. 3. Community-based rehabilitation – home rehabilitation or in residential care. This review highlights important studies in these three main categories (See Table 1 – orthopaedic-geriatric units: Descrip- tion of models of care and outcomes). Randomised con- trolled trials are given preference but examples of other relevant studies are given to illustrate important findings which may not have been evaluated by randomised trials. In fact, the majority of studies have been descriptive in nature or have used historical control groups [19]. Main outcomes assessed were functional recovery, mortality, complications and length of stay. Correspondence to: Dr Carol P Chong, Northern Clinical Research Centre, The Northern Hospital. Email: carol.chong@nh.org.au There is no conflict of interest for any of the authors. DOI: 10.1111/j.1741-6612.2009.00368.x 171 Australasian Journal on Ageing, Vol 28 No 4 December 2009, 171–176 © 2009 The Authors Journal compilation © 2009 ACOTA