95-year-old Johanna Quaas from Halle/Saale in rehab following breaking a femoral neck. The former competitive gymnast benefits from basic fitness, positive attitude and adequate training.
Photo: dpa/Waltraud Grubitzsch
Things might get tight in the next few years: the hospital landscape will change; 650 to 700 of today’s 1,900 houses will still be available for acute care in ten years, where trauma surgery is also located. The internist and geriatrician Clemens Becker opens up this perspective. On Wednesday, the doctor presented a white paper on geriatric traumatology and orthogeriatrics with colleagues from trauma surgery and orthopedics. The anthology deals with problems in the care of fractures, the replacement of large joints, signs of wear and tear on the spine – and all of this in elderly patients. The essays are intended to show ways to better care.
In addition to the restructuring of the clinics mentioned above, the proportion of older people is constantly increasing. This results from the baby boomer cohorts of the so-called baby boomers. The challenge is foreseeable: around 700,000 patients in Germany already suffer broken bones as a result of bone loss (osteoporosis), which is usually triggered by a fall.
The risk of such injuries increases with age. It is projected that the number of these fractures will increase by 21 percent by 2030 and by 57 percent by 2050. Although the mortality rate following hip fractures has fallen significantly in recent years, it is still around 25 percent in frail patients twelve months following the accident. But even those who survive the consequences of such a break have to cope with severe cuts in everyday life.
These patients are often no longer able to continue their independent lives. After a hip fracture, 30 percent of them are classified as requiring care for the first time as part of the long-term care insurance. Admission to a home often follows.
Current estimates assume that social care costs in Germany will increase from around 11 billion euros in 2017 to 14 billion euros in 2030. To counteract this development, the authors of the White Paper propose several approaches. Not only doctors such as trauma surgeons and geriatricians should be available for treatment and care, but also enough specialized nursing staff, physiotherapists and ergotherapists as well as a social service. Care in centers is recommended. These already exist: In Germany there are 130 specialist centers for the treatment of injuries caused by the elderly.
At least theoretically, the Federal Joint Committee (G-BA) for the health care system has already reacted to the higher requirements: After fractures near the hip joint, patients have had to be treated surgically within 24 hours since 2012 and also be treated by geriatricians. Physiotherapy must be able to take place continuously, including on weekends. However, this high expense is not yet covered by a corresponding payment, criticizes the orthopedist and trauma surgeon Ulrich Liener from the Marienhospital Stuttgart, among others. Modern, minimally invasive surgery also helps to avoid the need for care.
The geriatrician Rainer Wirth from Bochum pointed out the peculiarities of the over 80-year-old patients: “Elderly people are not just adults who have grown old and are suffering from an increasing number of diseases, but people with a very different metabolism, a very unique physiology, which is characterized in particular by a pronounced vulnerability.« Data from an English general practitioner register have shown, for example, that 21 percent of dementia patients still suffer from coronary heart disease and 32 percent from depression.
On average, the elderly have more than four illnesses at the same time. In addition, many suffer from frailty, which is even more relevant to surviving accidents than the illnesses. Risks such as muscle loss, drug side effects or malnutrition must be identified at an early stage and included in treatment concepts.