Beyond the Fracture Clinic: 3 Things a Surgeon Can Do to Help Older Patients Stay Out of the Hospital

Musculoskeletal conditions, particularly osteoarthritis, account for >40 million disability-adjusted life years worldwide among persons aged 60 years and above. Research has also demonstrated that up to half of older adults have multimorbidity, which requires optimization for positive surgical outcomes. The World Health Organization introduced the concept of intrinsic capacity, which refers to the physical, mental, and psychosocial capacities that a person can draw upon to maintain their health and that are foundational components of healthy aging. Intrinsic capacity includes 5 domains: locomotion, vitality, cognition, sensory function, and psychological well-being. Two of these domains, locomotion and vitality, are directly relevant to orthopaedic surgery, as they focus on neuromuscular function, skeletal muscle mass, bone health, and related metabolic and nutritional factors. Substantial increases in the rates of primary arthroplasty worldwide create an important opportunity to incorporate interventions into existing orthopaedic surgical care processes in order to optimize locomotion and vitality and keep older adults healthy and out of the hospital. Orthopaedic surgeons are uniquely positioned to influence healthy aging well beyond the operating room. Three simple and effective interventions that can be championed by orthopaedic surgeons are (1) encouraging locomotion by giving patients a written prescription for muscle strengthening and balance training, (2) supporting vitality through malnutrition screening and reinforcing optimal nutrient intake, and (3) being a leader in bone health optimization. Addressing these factors can optimize intrinsic capacity, reduce falls and fragility fractures, improve surgical outcomes, and keep older adults out of the hospital long after the surgical episode has ended.