Aging in place (AIP) is the interdisciplinary practice of creating built environments that are safe and comfortable for older adults to live in their homes as long as possible. The baby boomer generation, now at retirement age and beyond, coupled with a housing market deemed largely unsuitable for AIP, has created a demand for products and resources. Instituting AIP strategies in the built environment can significantly increase safety and reduce healthcare encounters in older adults. With the healthcare, technology, and building industries addressing the demand, a broad range of AIP information and products are available. However, with the recent boom in technology and resources, nurses may not always understand how they can contribute to this process. This article aims to provide an overview of current practices and developments that support AIP and the implications for orthopaedic nurses practicing in a variety of settings.
Sciatica is a common condition in middle-aged and older adults, typically presenting as unilateral low back and buttock pain radiating down the posterior leg. Additional symptoms may include paresthesia and weakness. Common causes include disc herniation, lumbar spinal stenosis, spondylolisthesis, vertebral fractures, and, more rarely, congenital stenosis or tumors. Patients frequently report inciting events such as heavy lifting. Initial evaluation includes radiographs to assess bony abnormalities, while magnetic resonance imaging remains the gold standard for identifying nerve root compression. Most cases resolve within 3 months with activity modification alone. Conservative management, such as physical therapy, oral medications, and epidural steroid injections, may be pursued for persistent symptoms, while surgery is reserved for progressive neurological deficits or significant functional impairment. Through multidisciplinary collaboration, orthopedic nurses play a key role in educating patients on proper biomechanics, managing symptoms, and monitoring for specific signs and symptoms that may indicate more serious pathology.
BACKGROUND AND PURPOSE:Chronic low back pain (CLBP) significantly affects older adults' quality of life and functional abilities. Self-management programs formatted using the 5A model (Assess, Advise, Agree, Assist, and Arrange) have been proven effective in empowering patients to manage chronic diseases. The present study evaluated the effect of implementing a self-management program based on the 5A model on reducing functional disability and improving the quality of life of older adults with CLBP. METHODS:This single-blind randomized controlled trial investigated the effectiveness of the 5A approach of self-management for CLBP in older adults. Sixty-four participants were recruited from specialized clinics affiliated with Abadan University of Medical Sciences, Iran, between February and April 2023. Participants were randomly allocated to an intervention group (receiving the 5A program) or a control group. Study outcomes included functional disability assessed using the Oswestry Disability Questionnaire, and quality of life measured with the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. These measures were administered at baseline, 4, and 8 weeks following the intervention. RESULTS:There was no significant difference in functional disability and quality of life between the intervention and control groups before the intervention. After the intervention, a significant difference was observed in both functional disability or quality of life between the two groups (p < .001). The results also revealed a significant improvement in the means of functional disability and the quality of life at 4 and 8 weeks after the intervention implementation in the intervention group (p < .001). CONCLUSION:Findings from this study demonstrate that a 5A-based self-management program can effectively mitigate functional disability and enhance the quality of life in older adults with nonspecific CLBP. These results suggest that nurses can employ this supportive, nonpharmacological approach to manage CLBP in this population.
Pickleball's rapid growth in the United States is accompanied by a significant rise in injuries, particularly among older adults. This review summarizes current evidence on the epidemiology, mechanisms, and risk factors associated with pickleball-related injuries. Falls represent the most common cause, with wrist fractures, rotator cuff tears, ankle sprains, and heat-related illnesses occurring frequently. Age, sex, higher body mass index, and inadequate physical conditioning increase the likelihood of injury. Practical prevention strategies are presented, including pre-participation health assessments, targeted conditioning programs, dynamic warm-up routines, and appropriate footwear and equipment selection. A clinical case highlights the evaluation and management of a shoulder injury sustained during play. By integrating prevention and education into routine care, clinicians can help players reduce injury risk while safely enjoying the benefits of this rapidly growing sport.
OBJECTIVE:To evaluate the combined predictive value of the frailty index (FI) and prognostic nutritional index (PNI) for prognosis in elderly hip fracture patients. METHODS:Clinical data from 110 elderly hip fracture patients were prospectively analyzed with 1-year postoperative follow-up. Patients were stratified into survival (n = 76) and non-survival (n = 34) groups based on outcomes. Collected parameters included demographic characteristics, fracture patterns, treatment modalities, and laboratory indices. Receiver operating characteristic curve analysis assessed the predictive efficacy of FI and PNI individually and combined. Optimal cutoff values were determined for patient stratification. Kaplan-Meier analysis evaluated 1-year survival rates, while Cox proportional hazards modeling identified prognostic factors. RESULTS:Significant intergroup differences (P < .05) were observed for body mass index, intraoperative transfusion rates, American Society of Anesthesiologists classification, frailty prevalence, FI values, lymphocyte counts, albumin levels, and C-reactive protein (CRP). The nonsurvival group demonstrated significantly lower PNI (P < .05). Receiver operating characteristic analysis yielded area under the curve values of 0.713 (FI), 0.782 (PNI), and 0.816 (combined). Patients with high FI/low PNI showed the poorest 1-year survival. Multivariate analysis identified decreased lymphocyte counts and PNI, along with elevated CRP and FI, as independent risk factors for adverse outcomes (P < .05). CONCLUSION:The FI-PNI combination provides superior prognostic accuracy for elderly hip fracture patients, reflecting comprehensive pathophysiological changes. Key independent risk factors include lymphopenia, hypoalbuminemia, elevated CRP, and increased FI. Routine frailty and nutritional assessments should guide personalized care plans to optimize outcomes.
Ehlers–Danlos syndrome (EDS) is a group of inherited disorders affecting collagen and extracellular matrix proteins, which can cause skin hyperelasticity, joint hypermobility, atrophic scarring, and blood vessel fragility. Complications include joint dislocation, chronic pain, fatigue, functional gastrointestinal disorders, mast cell hyperactivity, orthostatic intolerance, anxiety disorders, and pelvic and bladder dysfunction, among others. This article discusses the orthopedic concerns and complications, diagnosis, genetic testing, and multidisciplinary approach to management in EDS patients. A comprehensive review of the literature in PubMed was performed, focusing on EDS and its orthopedic implications, diagnosis, genetic testing, and management. Search terms included EDS with/without diagnosis, orthopedics, and management. Peer-reviewed journals were prioritized. Each source’s credibility, findings, and level of evidence were organized by theme to synthesize the information. Literature within 5 years was prioritized. However, given the little information available about EDS, this was expanded to include landmark and highly relevant sources. EDS patients often have weak spinal muscles, deformities, and reduced column support leading to joint instability, recurrent dislocations, and chronic pain. Diagnosis is primarily clinical, but identifying the type of EDS by the gene encoding the defect in collagen or other proteins is essential to guide management. Physical therapy, pain management, skin care, and nutrition form the cornerstone of EDS management. Orthopedic surgery to address orthopedic concerns such as joint stability is controversial due to the potential for complications and should be considered only after nonoperative medical treatments have failed. EDS presents unique considerations that must be addressed, especially when orthopedic intervention is being considered. Due to the unique symptom presentation, goals and care plans should be individualized. The orthopedic nurse plays a vital role throughout all phases of care and should be aware of the special considerations with patients with EDS. The focus of treatment should be on patient safety, symptom management, and the prevention of future injuries.
Metal allergies pose challenges in patients with implantable devices, yet no standardized protocols exist for preoperative metal patch testing. This case details a 53-year-old woman with systemic dermatitis and impaired hand function after left thumb trapeziectomy with Arthrex Mini TightRope placement. Despite treatment, including hardware removal, symptoms including rash, pruritus, and impaired mobility persisted for months. Metal patch testing confirmed hypersensitivity to nickel, chromium, and other metals, implicating type IV hypersensitivity. Nickel is the most common allergen, affecting up to 20% of the population, yet clinical guidelines for managing implant-related hypersensitivity are lacking. This report underscores the critical role of perioperative nursing in comprehensive preoperative screening, including obtaining a detailed history of metal sensitivities, educating patients on potential risks, and facilitating multidisciplinary collaboration with dermatology and immunology specialists. Future research should explore the immunopathology of metal hypersensitivity and develop evidence-based nursing protocols and interdisciplinary strategies to reduce adverse outcomes and improve patient safety.
BACKGROUND:Postoperative delirium and impaired rehabilitation are major challenges in elderly femoral neck fracture patients. Enhanced recovery nursing (ERN) protocols emphasizing early mobilization and cognitive support may mitigate these complications. PURPOSE:This study evaluated the impact of a perioperative ERN model on delirium incidence, sleep quality, recovery milestones, and long-term functional outcomes. METHODS:In a retrospective observational study, 254 patients (≥65 years) undergoing hemiarthroplasty or total hip arthroplasty for femoral neck fractures were allocated to conventional care (n = 116) or ERN groups (n = 138) based on treatment period. Outcomes included delirium incidence (Confusion Assessment Method), sleep quality (Pittsburgh Sleep Quality Index), time to first ambulation, hospital stay, Harris Hip Score, and 36-Item Short Form Survey (SF-36) quality of life at 1 to 12 months postoperatively. RESULTS:The ERN group showed significantly lower cumulative delirium incidence (6.5% vs. 19.8%; risk difference = -13.3%, 95% confidence incidence [CI]: -20.1% to -6.5%, p = .002), shorter time to ambulation (mean difference [MD] = -1.7 days, 95% CI: -2.2 to -1.2), and hospital stay (MD = -1.6 days, 95% CI: -2.3 to -0.9; both p < .001). Sleep quality improved significantly across all time points (p < .001). Long-term functional recovery was superior in the ERN group, evidenced by higher Harris scores (12-month MD = 4.7, 95% CI: 3.1-6.3) and SF-36 scores (12-month MD = 6.3, 95% CI: 3.9-8.7) at all intervals. CONCLUSIONS:The ERN model significantly reduced delirium, accelerated recovery, and improved long-term function and quality of life, supporting its integration into routine perioperative care for elderly femoral neck fracture patients.
BACKGROUND AND OBJECTIVE:Patients with orthopedic injuries frequently utilize online resources to seek information that could be proactively addressed through anticipatory guidance from their healthcare provider. A gap in the literature exists regarding the information orthopedic patients seek from the internet to meet their educational needs. PURPOSE:To ascertain the topics and reasons for seeking orthopedic information from online sources. METHODS:This cross-sectional study utilized the online orthopedic subreddit called "r/brokenbones" to examine patients' reasons for seeking online help, the varying aspects and emotional tone of the posts, and the background of patients/responders. RESULTS:Data from 195 posts demonstrated that most inquiries centered around recovery and progress expectations. The primary reason for posting was a concern or need for advice, followed by the request for general information. The underlying emotional tone of the posts was one of concern or worry. CONCLUSION:Given that patients increasingly turn to the internet for information, modern healthcare teams must recognize the role of online forums in patient experience and develop strategies for educating and communicating more effectively.
BACKGROUND:Venous thromboembolism (VTE), to include both deep vein thrombosis and pulmonary embolism, is a diagnosis with a significant clinical burden. Patients undergoing total joint arthroplasty (TJA), which encompasses total hip arthroplasty and total knee arthroplasty, are at an increased risk of developing a VTE as a postoperative complication. Current guidelines offer providers a multitude of options when selecting VTE prophylaxis interventions with no clear designation of superiority. PURPOSE:The purpose of this study is to guide providers, with assistance of an algorithm, in identifying the best pharmacologic modality for VTE prophylaxis of a postoperative TJA patient. A systematic review was conducted in reference to the question: in patients who received TJA, how does the use of different antithrombotic agents affect the incidence rate of VTE? METHODS:A literature search was conducted utilizing CINAHL, PubMed, and Embase. Articles were included if they utilized both antiplatelets and anticoagulants, included both total hip arthroplasty and total knee arthroplasty patients, and analyzed VTE occurrence as a subject of interest. RESULTS:It was concluded that there is no statistically significant difference between acetylsalicylic acid and anticoagulant use in the prevention of VTEs in postoperative TJA patients. An algorithm was developed based on clinical findings, medication parameters, and current guidelines to assist in determining the best antithrombotic medication for a patient. CONCLUSION:While VTE prophylaxis regimens are typically based on institutional guidelines or surgeon preference, the proposed algorithm can help guide providers in prescribing a treatment modality for patients who may not benefit from existing regimens.
