This study sought to analyze GPs’ expectations regarding the care of older patients hospitalized in orthogeriatric units and identify areas for improvement. All GPs expected a stay in the orthogeriatric unit to facilitate physical therapy, reduce the risk of institutionalization, and reduce mortality. The majority of GPs agreed that the liaison between hospital care and primary care should remain a priority of patient care in orthogeriatric units. Lastly, comparing the results of the questionnaire and quantitative study highlighted two areas for improvement: helping patients receive osteoporosis care and involving occupational therapists more in patients’ care.
We are not the first to highlight the lack of osteoporosis screening in orthogeriatric units. In a meta-analysis in 2020, Van Camp et al. showed that the care provided in orthogeriatric units was rarely associated with more osteoporosis diagnoses or the introduction of calcium and vitamin D supplements and osteoporosis medications [17]. In the general population there is also a discrepancy between the number of older adults treated for osteoporosis and the proportion of people considered eligible for treatment according to their fracture risk [18]. Based on the conservative assumption that treatments are only given to high-risk patients, international and European prescribing data suggests that more than 57% of high-risk women do not receive any treatment specifically for their bones [19]. Osteoporosis is a public health problem due to its frequency and population ageing. In orthogeriatric units, the majority of patients have osteoporosis, which is logical as in most cases they are older patients with fractures resulting from low-energy falls [20].
Our study confirms, once again, that osteoporosis screening must be improved for older patients, especially in orthogeriatric units. GPs are also on the front line, as they are responsible for the patients’ long-term follow-up. Orthogeriatric units could offer automatic screening and care procedures to improve the screening and monitoring of osteoporosis patients. If these procedures are already in place, this practice should be evaluated. One solution could be to automatically implement treatment during an orthogeriatric unit stay and, if this is not possible, always liaise with GPs to ensure the treatment is implemented at home. A study by Harwood et al. in 2004 proved that giving vitamin D supplements to women staying at an orthogeriatric unit for a proximal femoral fracture reduced the risk of falls in the following year [21]. In that study, 70% of patients had a vitamin D deficiency, consistent with the characteristics of our study’s patients (70% of stays), confirming the need to take effective measures to prevent diseases linked to fragile bones.
We are not the first to highlight that improving communication with occupational therapists in perioperative orthogeriatric units is another possible area for improvement. In a study in 2023, Jasper et al. showed that the sedentary lifestyle of older patients, particularly in orthogeriatric units, was a real problem limiting early physical therapy, and that one possible solution was to involve occupational therapists in their care [22]. Indeed, occupational therapists play a key role in the care of older patients in orthogeriatric units. They improve and speed up rehabilitation for patients losing their autonomy [23], and patients who have just had surgery after a fracture.
The way occupational therapists are involved in these patients’ care, whether in hospital or at home, must also be reviewed. Training healthcare providers such as occupational therapists from the start of their careers would help them to understand the particularities of care for older patients. This is an interesting idea that has already been suggested [24]. Another solution would be to involve occupational therapists after patients are discharged from the orthogeriatric unit. This goes without saying for patients being discharged to a follow-up care and rehabilitation facility, but does not necessarily happen when patients return home or to a nursing home (which is the case for 37.5% of the stays in our study). Involving the GP to ensure that patients discharged home benefit from occupational therapy is therefore an aspect of care that can be improved.
The quantitative study databases were of high quality. The characteristics of patients treated in the orthogeriatric unit in our study were generally similar to what is described in one of the most cited orthogeriatric studies, which adds external validation to our results (7). What was innovative about our research was that it was able to converge the results of the two complementary studies to meet the main objective.
Our research also has some limitations. It focused on a single-centre analysis of data concerning patients and care activities in the GHICL orthogeriatric unit. This limits our ability to generalize GPs’ expectations and recommendations to all orthogeriatric units. Due to the small number of respondents familiar with orthogeriatric units, it is difficult to extrapolate their impressions from interactions with the perioperative orthogeriatric unit. There may well have also been some memory bias when answering the questions, which is inherent to the questionnaire-based study method.