Orthogeriatrics in Taiwan: Overview and experiences

Hip fracture is one of the common surgical indications seen in the geriatric population. The perioperative assessment and care are complicated with multiple comorbidities in this patient group, and the complications and high mortality resulted from immobility. The geriatricians in the United Kingdom started to join the care of hip fracture patients with orthopedic surgeons since 1950s to facilitate the preoperative assessment and avoid unnecessary delay in surgery, to optimize the patients' conditions perioperatively and reduce complications, and to provide comprehensive rehabilitation and correct reversible medical conditions that may precipitate next falls and fractures. It has become a trend worldwide, for an increasing body of evidence has revealed that geriatrician-led multidisciplinary team care for hip fracture patients can detect more medical conditions, lower the mortality rate and length of hospital stay, and reduce the admission to the nursing homes because of diminished function. More prospective randomized studies are needed to further prove the efficacy of the care models and make the most of the service not only to patients suffering from hip fracture but also other geriatric syndromes. The incidence of hip fracture in Taiwan is approaching faster that in the Western world as the population ages rapidly. The care for hip fracture patients faces many challenges perioperatively, especially the lack of postacute destinations for care and rehabilitation after the implementation of new reimbursement system. It is an urgent need for more domestic trials and audits to create orthogeriatric models of our own.