Elton Strauss MD FACS

1
Elton Strauss MD FACS

• Chief of Orthopaedic Trauma and Adult
  Reconstruction
• Mount Sinai Hospital
• New York, New York

2
Problematic Effects of Aging on Orthopaedic
Surgery An Epidemic with Major Impact
3
THE NUMBER OF OLDER AMERICANS IS GROWING
Source U.S. Census Bureau. Census bureau
projects doubling of nation's population by 2100.
Press release, March 13, 2001.
4
THE PROPORTION OF OLDER AMERICANS IS ALSO GROWING
Source Committee on Ways and Means, U.S.House of
Representatives. Medicare and Health Care
Chartbook. Washington, DC US Government Printing
Office 1997, Table 3.8.
5
AMERICANS ARE LIVING LONGERA TREND THAT IS
EXPECTED TO CONTINUE
Source National Center for Health Statistics,
U.S. Decennial Life Tables for 1989-91, vol. 1,
no. 3, Some Trends and Comparisons of United
States Life Table Data 1900-91. Hyattsville, MD
1999, p. 2, Table A.
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HEALTH STATUS AND SPENDING BY MEDICARE
BENEFICIARIES
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DISABILITY INCREASES WITH AGE
Note ADLs activities of daily living IADLS
instrumental ADLs.
Source Medicare Current Beneficiary Survey,
1997, Table 2.1.
8
Falls account for 87 of fractures over age
65Fractures 5th Leading Cause of
HospitalizationHip Fx.s 60
9
350,000 Hip Fxs Annually in US in 1996525,000
Hip Fxs in US in 2000

• Agency Health Care Policy and Res
• Pub. No. 99-0034,1999
• Thomas Weisel et. Al. 2001

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SURVIVAL ANALYSIS AFTER RX FOR HIP FRACTURE

• JBJS 60A1978 27 (1 YR)
• CORR 1861984 15 (1 YR)
• JOT 341993 29 (3 MO)
• CORR 2931993 9.5 (PO)
• CORR 3481998 22 (1 YR)

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Early discharge to Nursing Home

• Loss of independence
• Mental deterioration
• VIEWED AS PRISION SENTENANCE

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TRENDS IN NURSING HOME USE

• Supply of beds per 1000 people is shrinking
• 1987 141 1996 117
• of Americans aged 65 living in nursing homes
  has remained constant, at 5
• Lifetime chance of ever living in a nursing home
  is rising
• Resident nursing-home population is older and
  more dependent

Source Cobbs EL, Duthie EH,Murphy JB, eds.
Geriatrics Review Syllabus A Core Curriculum in
Geriatric Medicine. 5th ed. Malden MA Blackwell
Publishing for the AGS 2002, p.13.
13
Osteoarthritis X-ray evidence in gt 75 of people
over 65 40-60 will disabling pain of the lower
extremity
14
Joint Replacement is expected to increase by 80
in 2030
15
Age-Related ChangesBone and Soft Tissue

• Osteoporosis affects approximately 20 million
  Americans
• 1.300,000 million fractures are attributed to
  osteoporosis
• Muscle strength decreases by one third after age
  sixty---leads to problems with balance and falls
• Cost of fracture care in 1995 was 13.8 billion

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Orthopaedists must
Geriatricians are needed

• Eliminate historical disinterest and increase
  awareness in geriatrics
• Demystify prevalent myths derogatory to older
  people, which contributes to relative disinterest
  in care of seniors
• Expand and deepen research
• Improve dissemination of new clinical research
  findings

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FUNCTIONAL RECOVERY

• 1 Year mortality of 14 36 after Hip Fracture
  in the Elderly
• After 1 year Mortality Rates Normal
• In-Hospital Complication Increases
• the Mortality Rate 3 Fold
• ASA Grade III or IV 49 Mortality
• Institutionalized Pts. 2-3X Mortality

JOT 118 1997
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Multidisciplinary Integrated Teams
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Functional Recovery Following Hip Fracture in the
Elderly

• Egol KA, Koval KJ Zuckerman JD
• JOT 118 1997

20
Senior citizenship should not require a sedentary
lifestyle
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Exercising regimesReconstructive surgeryshould
be encouraged
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Aging Committee

• Elton Strauss, MD, New York, NY-Chairman
• David Apple, MD, Atlanta, GA
• Peter Cohen, MD, Pittsburgh, PA
• Susan Day, MD, Grand Rapids, MI
• Richard Fisher, MD, Aurora, CO
• Abbot Kagan, MD, Fort Meyers, FL
• Robert Karpman, MD, Peoria, AZ
• Kenneth Koval, MD, New York, NY
• Charles Weiss, MD, Miami Beach, FL
• Kathleen Buckwalter, PhD, RN-Consultant

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Challenges of Aging

• Health care
• Housing
• Assisted living
• Nutrition
• Lifestyles
• Environment
• Pain management
• Transportation

• Frailty and Falls
• Alzheimers and dementia
• Palliative care
• Ethics of treatment
• Exercise
• Financial stability
• Education, research

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The Aging Epidemic requires a Challenge to Arms

• To build consensus among leading international
  organizations of the problem and to develop an
  action plan to government agencies and
  politicians who are in the position to assist in
  establishing better care for elders

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Like an alarm clock aging unsettles most of us.
Yet some people sleep through the alarm clocks
jolting rings.The appeal to be aware of aging is
clear and direct enough, yet too often it is
ignored
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Seniors need our support
27
The Problematic Effects of Aging on Orthopaedic
Surgery An Epidemic with Major Impact
28
Faculty

• Kathleen Buckwalter RN PhD
• Peter Cohen MD
• Richard Fisher MD
• Kenneth Koval MD
• Elton Strauss MD
• Charles Weiss MD