October 2013: Question 2
Osteoporosis and fractures frequently occur in the older
population. How would you council someone at risk for this disease and injury
for prevention? How would you council an older woman for treatment after a hip
fracture?
posted by Unknown @ 7:25 PM
15 comments
15 Comments:
Sarah S said...
I would make sure to encourage them to get adequate vitamin D and calcium in order to help prevent osteoporosis. I would also encourage them to participate in some type of weight-bearing and stretching exercises to help strengthen their bones and improve balance. Finally, I would encourage them to use stair railings and other walking assistants in order to prevent falling. When counseling a woman after a hip fracture I would use similar information but encourage her to exercise only when physically able and not overdo things.
I would inform them that the way to build strong bones is through weight bearing activities, which can be as simple as walking, and calcium and vitamin D. Non weight bearing activities such as swimming are great but they do not help in strengthening bones. Hip fractures are hard to come back from in the elderly so it will be ideal for her to get through physical therapy and try to get back to her previous ADLs. Calcium and vitamin D supplements will also be beneficial for her.
I too would encourage my at-risk clients to regularly consume foods that provide adequate calcium and vitamin D in addition to taking a supplement if they are unlikely to meet their needs through food alone. I'd also help them identify those foods and try to encourage them to increase their physical activity. Finally, I'd share the same information for an older woman undergoing treatment following a hip fracture in addition to encouraging her to increase her calorie and protein intake for wound healing.
Similar to the last questions, I would emphasize the importance of weight bearing activity and the physiology of it's effect on bone strength. As far as diet goes, I would educate them on the importance of getting a balanced yet modified diet to maintain a healthy weight while still maintaining nutrient density. For the hip fracture, I would educate on the same things except modify them for her lifestyle. I'm sure she would be doing physical therapy for the fracture, so I would place extra emphasis on eating a nutritionally adequate diet with increased protein for healing.
Calcium and Vit D are very important in slowing down the effects of these diseases. Talking with the pt about fall prevention is also very important as their risk is elevated. Encouraging physical activity that has been cleared by a doctor and not too strenuous for the pt is also important, stretching and range of motion are key exercises that have little risk for injury if the pt has proper technique and doesn't over exert their abilities. The woman with the hip fracture: I would make sure she knew the risks of over exertion and encouraged her to meat with a physical therapist for ideas on the best exercises for her rehabilitation.
I agree with Beth about the weight baring activities to increase bone strength and I would refer to a PT before recommending any weight baring activities to an older woman after fracture.
As everyone above mentioned, I would encourage them to eat foods/drinks that contain vitamin D and calcium. Supplements could be secondary if one is not able to get the proper amounts from their diet. Nutritional shakes could be something they should try like Ensures, for example. I would recommend one to a physical therapist or a trainer to help teach them prevention measures/exercises. I would encourage protein for an older individual since you slow down on eating as you get older.
I would suggest a supplement that contained calcium to ensure the client receives adequate nutrients needed to prevent deterioration of bones. I would also council them on consuming adequate protein at each meal. This would be to prevent muscle loss, which is also common in the older population. I would finally suggest to someone that is able to do some weight baring activities to prevent muscle and bone loss. For an older women with a hip fracture, I would refer them to a physical therapist to ensure they heal properly.
I also agree that education on preventing falls is important to prevent hip fractures in the elderly.
I would emphasize the importance of impact & resistance exercise for the development of bone tissue (especially for white women with a lower BMI), leafy greens for the vitamin K & calcium content, & dairy for the vitamin D & calcium content. Going for a daily walk would be a great way to both boost bone health and get some natural vitamin D. Following a hip fracture, I think it is so important to gage someone's mental status & how willing they are to participate in PT/OT to get better. So often we see death in the older population within 1-year after a hip fracture I think because of the unwillingness to participate in therapy, or because they might give up on themselves. Diet and exercise is of course important, but being encouraging is important as well.
Fall prevention is a key component that I didn't think of. That would be a great way to increase awareness.
Aria brings up a good point to evaluate a persons willingness to participate in therapy before refering them to a physical therapist. It is important to help them in the most realistic way possible.
Good point Courtney. We can't forget about the importance of protein with the elderly, especially since they are muscle toning/building (if they are working out). I agree with Aria that encouragement is key since some people wanna give up when they are down.
Courtney brings up a very good point about muscle loss. We focus very much on bone rehab, but most certainly muscle loss would come along with not being able to move around much during recovery, especially with the understanding of how prevalent malnutrition & muscle-wasting are in the elderly population. Perhaps recovery from hip fractures is poor in part because of LBM loss.
Incorporating the expertise of other members of the health care team is important. I agree with those of you who have shared that referral to a PT/OT may be needed. Of course, however, as Aria shared it is unnecessary to get another professional on board if the patient is not motivated to receive therapy or advice.
I would council them on the importance of eating proper foods and exercising. I would explain the roles that calcium and vitamin D play in the strength of their bones. I would give examples of foods to include in their diet. I would also suggest they go for walks and possibly lift small hand weights. I would also tell them to not push themselves too far and take plenty of precautions.
Carly had some good ideas about the use of nutritional shakes or ensure to increase their nutrient consumption. She also made a good point that a physical therapist would be helpful to give them good exercises that they would be able to do.
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