Southampton doctors use broken wrists to diagnose dementia

Mark BaxterDoctors and surgeons at Southampton’s teaching hospitals are using broken wrists to diagnose dementia in elderly patients and prevent them going on to fracture their hips.

In a pioneering project at Southampton General Hospital, patients over 70 who fracture bones in a fall but do not require hospital admission are separated from other patients in the emergency department and seen directly by a team of orthopaedic, osteoporosis and elderly care specialists.

As well as treatment for broken wrists, arms and shoulders, patients are given a basic physical and mental assessment to find out why they are falling to minimise their future risk and prevent more serious fractures of the hips or spine.

There are currently 75,000 cases of hip fracture in the UK every year among people of an average age of 80 years, but experts in Southampton believe earlier intervention into all aspects of an individual’s health needs will lower the number.

“About 40% of people who have a hip fracture have got dementia or some form of cognitive dysfunction and, of them, a significant proportion are not diagnosed, probably more than 25%,” said Dr Mark Baxter, a consultant in elderly care and bone health who is co-leading the initiative.

“We also know around half of all hip fracture patients have fractured bones before, and between 25 and 30% of all people who break their hip die within a year, so it is clear these patients are extremely vulnerable and, based on current statistics, in need of much wider intervention than they currently receive.”

Following a full medical and falls assessment by a consultant geriatrician in clinic, those who show signs of future falls risk are referred directly to the falls service and, if required, to a specialist dementia clinic to care for their cognitive needs.

Simon Tilley, a consultant orthopaedic surgeon and joint project lead, explained: “We are going to treat these patients’ wrist or shoulder fractures, but the knock-on effect will be that we hope to prevent the more serious and life-threatening fractures later on.

“It takes only a few minutes to create a plan for a wrist fracture, but it is about being able to put all the other things in motion to stop them coming back to hospital and to cater for other serious and often undiagnosed issues, such as dementia, to provide the best and safest quality of life for them.”

Although older people who sustain breaks or fractures despite little trauma or force – known as osteoporotic fractures – can be treated in a fracture liaison service, only 30% of NHS trusts have the facility and, in those that do, the focus is often on bone health.

“Straightforward fracture liaison services are effective at reducing fractures but focus on treating and restoring bone function and may miss other underlying conditions, which is why we have combined frailty, dementia and medicine together for the first time,” added Dr Baxter.

“We know that as people age their bones become more weak and fragile, so my concern as an orthogeriatrician is that these people are falling over as well and, if we can get to the bottom of why that is from the outset, we can not only prevent them going on to do further, more serious, harm, but also help treat and manage any brain impairment."

Posted on Monday 10 December 2012