Comprehensive Geriatric Assessment in Orthogeriatrics
11.5 Conclusions: What’s Next?
The implementation of orthogeriatric services, integrating the traditional geriatric competences, particularly the CGA approach, has significantly improved the care of frail older adults presenting with hip or other osteoporotic fractures. On the basis of available data, it is still uncertain which model, setting, and care organization is optimal in terms of short- and long-term outcomes or more cost-effective. Moreover, there is still insufficient evidence to draw conclusions about how effective these services are for particularly frail and vulnerable patients, such as those with pre- fracture cognitive impairment or severe disability. However, the most complex and sophisticated orthogeriatric models characterized by a standardized CGA approach,
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a multidisciplinary team, and a co-managed care have been shown, in randomized controlled studies (RCTs), before-after trials, and meta-analyses, to produce better outcomes compared to the traditional or simplest ones [1, 36]. Well-designed and head-to-head RCTs are warranted to directly compare the different models and to investigate their efficacy in specific high-risk subgroups of patients. Finally, although CGA methodology has been demonstrated to be an effective and crucial approach to optimize the short- and long-term outcomes of the orthogeriatric model, a better standardization, validation, and implementation of an orthogeriatric CGA may further improve and optimize clinical and functional outcomes.
Conflicting Interests A Giusti has received consulting fees from bisphosphonates, teriparatide, and denosumab manufacturers: Abiogen, Merck & Co, Chiesi, Amgen, and Eli Lilly.
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© Springer International Publishing AG 2018
A. Pilotto, F.C. Martin (eds.), Comprehensive Geriatric Assessment, Practical Issues in Geriatrics, https://doi.org/10.1007/978-3-319-62503-4_12 N. Veronese (*)
National Research Council, Neuroscience Institute, Aging Branch, Via Giustiniani, 2, 35128 Padova, Italy
Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy
e-mail: [email protected] A.M. Mello • C. Musacchio • A. Pilotto
Department Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy