1 Introduction

With future demographic changes, an increasingly large number of geriatric fracture patients are expected. As an example, the total number of 80- to 100-year old patients with a proximal femoral fracture will more than double by 2050 [1]. Notably, these injuries carry a 1-year mortality rate of up to 30%. Furthermore, many of these patients are threatened by the loss of their independence and about 50% require nursing care or general support within the first year [2].

Specialized centers for geriatric fracture care nicely address some of the problems associated with the treatment of fragility fracture patients (FFPs). Two approaches can be differentiated:

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  The “ward round model” or “network model” has the patients being treated on a standard trauma ward with additional regularly scheduled ward rounds by a geriatrician to address the specific geriatric problems.

  
  
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  The “ward model” or “comanaged program” on the other hand has FFPs treated on a specialized ward, whereby the specialization also concerns its construction. Ward rounds are made by a trauma surgeon as well as a geriatrician resulting in comanaged care [3].

2 Rationale for adaptation

Older patients often have an altered cognitive status as well as physical condition. Their health and well-being are at risk as an inpatient and therefore require special caution:

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  The healing process is complicated for older adults [4, 5]. Patients on a geriatric fracture ward should therefore be protected from harm. The patient′s unsteady gait must be considered [6].

  
  
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  Facilities should be designed to avoid the development of delirium; nursing interventions to enhance patients’ activity and early mobilization are helpful in this regard [7]. It is necessary to provide the appropriate patient rooms, therapy rooms, and bathroom facilities. These must be accessible without obstacles and offer enough space and safety, ie, handrails to help the patients with their personal hygiene.

  
  
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  A therapy room located on the ward helps to avoid patient transportation, which is both time-consuming, costly in terms of manpower, and provocative for the onset of a delirium by changing the familiar environment.

3 General measures

As with children, older adults have unique needs and requirements, which need to be met by specialized facilities. The creation of a completely new special geriatric fracture ward will in many cases not be feasible, but is also not mandatory. Many existing structural factors can be modified to meet these special requirements at an economically justifiable cost and effort.

Typical examples are:

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  Wards

  
  
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  Walls and colors

  
  
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  Common rooms

  
  
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  Patient rooms and beds

  
  
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  Common areas

  
  
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  Washrooms and bathroom facilities

  
  
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  Therapy rooms

On a specialized geriatric trauma ward, these measures will prove extremely valuable and may be indispensable.

3.1 Inpatient ward

Suitable wards are essential ( Fig 2.5-1 , Fig 2.5-2 ):

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  Usually a hospital′s hallways are sufficiently wide but are often used for the storage of carts with bandaging materials, food, wheelchairs, material for ward rounds, etc. This creates a lot of obstacles that hinder the mobilization of the patient. Such hallway clutter should be avoided.

  
  
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  The hallways of a geriatric fracture ward should not only allow for patient transport, but also for gait training and exercise. For these reasons, the halls need to be free of barriers and obstacles, steps, thresholds, or tripping hazards. Furthermore they should offer solid handrails and benches to sit down and recover from strenuous practice. Seating for intermittent recovery breaks enhances mobility.

  
  
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  Good lighting is also important to prevent tripping and assist with reduced visual acuity. Contrasting colors on the walls, such as pictures, can aid patient′s orientation and motivation by, for instance, defining an area to be covered in mobilization. A visible scaling along the floor can also be helpful.

  
  
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  Floors that reduce tripping have proper visual characteristics for aging eyes and reduction of doorway thresholds.

  
  
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  Mobile telemetry units can be retrofitted to nearly any ward without difficulty.

3.2 Walls and colors

Suitable wall equipment and colors are important ( Fig 2.5-3 ):

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  The color scheme of the ward can also be designed to meet the needs of older adults. Smooth, pastel shades are both calming and mood-lifting. Sufficient contrast between walls, floors, and doors allow good orientation even with impaired eyesight. Differing colors of doors and walls can be used to illustrate the covered distance.

  
  
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  For the patient′s optimal mobilization, the hallways should be equipped with a sufficient amount of handlebars or handrails. Fold-out seating offers possibilities for breaks, and they do not obstruct when in a hinged position. Both increase the ability of older adults to ambulate.

Related posts:

2.2 Overcoming barriers to implementation of a care model 2.4 Elements of an orthogeriatric comanaged program 2.3 Clinical practice guidelines 2.9 Use of registry data to improve care 2.10 Lean business principles 2.6 Orthogeriatric team—principles, roles, and responsibilities

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