The New APGAR SCORE: A Checklist to Enhance Quality of Life in Geriatric Patients with Hip Fracture

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For geriatric patients with hip fractures, the broken bone is the reason for admission, but only part of the overall disease. Indeed, it may be more helpful to consider the patient having geriatric hip fracture syndrome or sustaining a hip attack, as there are many associated medical, social, psychological, and other problems to which attention must be paid. To that end, we have identified a series of 10 steps, collected into a checklist, that can be undertaken for all patients with geriatric hip fracture. In homage to the maxim “we come into the world under the brim of the pelvis and go out through the neck of the femur,” we defined our checklist by the acronym APGAR SCORE, named after the classic checklist of the same name used to assess a newborn child. The 10 elements include attending to problems of Alimentation and nutrition, Polypharmacy, and Gait; initiating a discussion about Advance care planning; correcting any Reversible cognitive impairment; maximizing Social support; checking for and remediating Cataracts or other impairments of vision; assessing for and addressing Osteoporosis; and last, ensuring that Referrals are made and that the patient has a safe Environment after discharge. For the newborn, the Apgar score has been criticized as an imperfect tool, and likewise the problem of geriatric hip fracture will not be solved with this new Apgar score either. Nonetheless, a score of 10 here,1 point for each item, may help to optimize the outcome for this difficult disease.

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