Geriatric challengeMay 8, 2019
Over the past several decades, life expectancy has been steadily increasing. As medical research and technology advance by leaps and bounds, they have been successful in pushing life expectancy to new heights. With an increase in the aging population come new problems, those that were previously not encountered during the younger lifespan. As more and more people cross their 7th decade on earth, more and more people are likely to witness illnesses such as cardiovascular disease, cancer, type 2 diabetes, cataracts, Alzheimer’s, arthritis and osteoporosis. Most of these illnesses come with their own set of cons and disabilities that can significantly affect the quality of life. Another problem associated with aging is the increased risk of falls. Falls may be due to many reasons, including poor eyesight or hearing issues, reflex or balance issues, weak muscles, blood pressure dips or even certain medications that increase dizziness.
Falls are particularly more dangerous in older adults as bones tend to weaken with age due to osteoporosis and the risk of fractures increases. Healing is also a much longer process in the aged with a considerable impact on daily activities and the quality of life after a fractured bone.
One of the most traumatic fractures is the fracture of the hip. It can immobilize the patient completely, making it difficult to perform day-to-day activities. Depending on the location and severity of the fracture, age and the overall health condition of the patient, orthopaedic surgeons need to decide the right treatment strategy. Hip fractures typically require surgical intervention, either in the form of repair or replacement. Repair can be done by metal screws and plates to hold the broken bones together until they heal. Partial or total hip replacements are needed if the fracture is beyond repair.
Here is a case of Lakshmamma, who fractured her left hip due to a fall at 98 years of age. She was taken to consult Dr Vasudev Prabhu, Senior Orthopedic Surgeon, Apollo Hospitals, Sheshadripuram, Bangalore, who had previously treated her for another fall 10 years ago. Previously, she had undergone a hip surgery on the right hip with the insertion of a metallic plate and screws. However, this time, due to her age, Dr Prabhu decided to perform a total hip replacement surgery. “We had to assess the relative risks – Lakshmamma’s overall health condition, including osteoporitic bones, lung fibrosis and cardiac status, and whether she would be able to withstand the surgery.”
The goal of the treatment is to relieve pain, mobilize the patient and enable her to perform daily activities such as going to the bathroom and back. If mobility is not achieved, the patient becomes bedridden and this increases the chances of getting bed sores and pneumonia. It was therefore imperative to perform the surgery on Lakshmamma as long as she was deemed fit to undergo the surgery.
There are always chances of adverse events, such as a heart attack or pulmonary embolism, during the surgery and these chances increase above the age of 75. The first 96 hours after surgery are very crucial and the entire medical team, including the anesthetist, cardiologist and orthopedic surgeon, are deeply involved. Dr Prabhu says that about 80-85% of the patients do very well and recover quickly. However, it is necessary to weigh all the factors before deciding to perform the surgery, especially since not all patients would be able to survive the procedure.
Thankfully, Lakshmamma did very well and was able to start walking a day after the surgery with the help of medical staff. She was kept in the hospital for about a week to monitor her condition. Today, a year after the surgery, she is walking and able to carry out her daily activities and Dr Prabhu is extremely happy to see that the hip replacement surgery was successful even at her age.
Even though hip replacement surgeries can be expensive, costing about Rs 2 lakhs, they are more cost effective in the long run and have better long-term outcomes. The other alternative would require intensive care, which could easily run into 50,000-60,000/month in nursing care costs. Thus, most patients normally see the benefit of performing surgery.
Dr Prabhu says “multi-specialty hospitals will be the need of the hour, as the geriatric population increases, and the medical team needs to be geared up for treating the aged. Today advanced treatments are available, and centres must be equipped to do everything under one roof.”