The Evolution of Clinical Care and Transmural Medical Pathways for Frail Older Adults with Hip Fractures
The PhD defence of Wieke Nijmeijer will take place (partly) online and can be followed by a live stream.
Wieke Nijmeijer is a PhD student in the research group Biomedical Signals and Systems (BSS). Supervisors are prof.dr. M.M.R. Hutten and dr. J.H. Hegeman from the Faculty of Electrical Engineering, Mathematics and Computer Science (EEMCS).
Hip fractures present a significant healthcare problem in older adults. Epidemiological data vary between countries, but globally, it is estimated that hip fractures affect approximately 18% of women and 6% of men. By 2025, 2.6 million people per year will suffer from a hip fracture worldwide. This number is expected to increase to 6.3 million by 2050, based on the increasing life expectancy of the world population.
This thesis aims to optimize the care of frail older adults with hip fractures across institutional boundaries: from hospital admission to geriatric rehabilitation and follow-up at an outpatient clinic. To achieve this aim, the first part (Part I) of this thesis focuses on identifying older adults with a hip fracture at high risk of a complicated course. Early identification enables proactive tailoring of orthogeriatric treatment, hopefully preventing complications or at least reducing the severity of the complication. The cornerstone of clinical decision-making regarding nonoperative or operative treatment is the multidisciplinary orthogeriatric team discussion in which clinical judgment and the goals of care for the individual patient are combined and considered. Risk scores identifying the individual risk of early mortality can support this process.
In the second part (Part II) of this thesis, the existing intramural orthogeriatric care pathway is evaluated and found to be consistent. The current orthogeriatric care trajectory is being further developed into a transmural trajectory, in which the rehabilitation phase during stays at geriatric rehabilitation departments of nursing homes and the follow-up at the outpatient clinic are included. In this manner, healthcare professionals at the hospital and the nursing homes can monitor the recovery process of hip fracture patients, enabling proactive and personal tailoring of treatment. Hip fracture care exceeds the boundaries of institutions and should be addressed from the point of view of the entire transmural chain of care.