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Doctors use broken bones to help unmask dementia in elderly patients who may otherwise not be diagnosed
01:14 GMT, 10 December 2012
Brain impairment caused by conditions such as Alzheimer's makes falling over and suffering breaks more likely
Doctors are using broken wrists to diagnose dementia in elderly patients.
They say brain impairment caused by conditions like Alzheimer's make falling over more likely, yet many older people with broken bones remain undiagnosed.
They often get advice on how to strengthen their bones, but little effort is made to identify problems with dementia, it is claimed.
In a pilot project at Southampton General Hospital, patients over 70 who fracture bones in a fall but do not need to stay in hospital admission are sent from the emergency department to be seen 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 believe this could be cut by earlier intervention looking at a whole range of health problems.
Dr Mark Baxter, a consultant in elderly care and bone health who is co-leading the initiative at Southampton, said 'About 40 per cent 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 per cent.
'We also know around half of all hip fracture patients have fractured bones before, and between 25 and 30 per cent 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 assessment by a consultant geriatrician, those who show signs of being at high risk of falling over again are referred directly to the falls service and, if required, to a specialist dementia clinic.
Simon Tilley, a consultant orthopaedic surgeon and joint project lead, said '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.
In a pilot project at Southampton General Hospital, patients over 70 who fracture bones in a fall are seen by a team of orthopaedic, osteoporosis and elderly care specialists
'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 per cent of NHS trusts have the facility and, in those that do, the focus is often on bone health.
Dr Baxter said '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.
'We know that as people age their bones become more weak and fragile'
'We know that as people age their bones become more weak and fragile.
'My concern 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.'
Andrew Chidgey, director of external affairs at the Alzheimer's Society charity, said 'It's vital that people with dementia don't just slip under the radar. This interesting pilot may help point doctors towards people with dementia whose cognitive problems may have otherwise gone undetected.
As the number of those with the condition is predicted to soar to over a million in only ten years, getting a diagnosis is vital.
'800,000 people in the UK have a form of dementia but, shockingly, only 43 per cent have a diagnosis. Doctors across the country must be properly trained and supported to spot the symptoms of dementia and support people to live well with the condition. Measures also need put in place to ensure that trips or falls don't happen again.'