Common Orthopedic Conditions in the Elderly and Their Treatment
India is home to 138 million people over the age of 60 and this number is only expected to increase in the coming years. This increase is attributed to enhanced medical care, treatment and the constantly evolving advancements in medical research.
While the increase in longevity is a reason to celebrate for sure, it is crucial that the quality of life be good to enjoy the increased life span. There are certain conditions that plague the elderly and orthopedic conditions form a significant part of that. It helps to be aware of these conditions so that timely orthopedic treatment can be sought. An orthopedic doctor can also help with preventive measures to prevent or delay the onset of many conditions.
A joint is the meeting point of two bones. There is a cushioning cartilage at the joint that enables smooth movement of the joint. When this cartilage gets worn out, the bones rub against each other leading to pain. With time, the bones too get affected.
This condition is called osteoarthritis and its incidence increases with age. A person with osteoarthritis will have pain in the affected joint, reduced joint mobility and inflammation. Sometimes, movement of the joint will result in a popping sound.
Treatment for Osteoarthritis
- Maintaining ideal weight will help immensely. Extra weight means extra load on the joint which leads to more wear and tear.
- Medications like Paracetamol will help provide relief from arthritis pain. Non-steroidal anti-inflammatory drugs can also provide relief but the dosage given by the doctor should be followed strictly as they do have side-effects.
- Physiotherapy exercises to bolster surrounding muscles will give pain relief. They will also reduce stiffness and make movement easier.
- Incorporating changes to make everyday tasks easier will also help. For example, installing some kind of seating in the kitchen and bathroom and grab rails for support in the bathroom. An occupational therapist can help with this.
- A procedure called transcutaneous electrical nerve stimulation which delivers electrical impulses to the affected joint can help relieve pain.
- Corticosteroid injections will also give pain relief but the side effects of these injections prevent their frequent usage. Not more than 3-4 injections can be given to a person within a year.
- Surgical procedures like osteotomy for knee osteoarthritis and joint replacement are reserved for severe cases.
Fractures are breaks or cracks in the bone as a result of falls, trauma or impact to body. In some cases, stress fractures might also occur. A stress fracture is the result of overuse of a particular part which leads to stress build up and ultimately a fracture. Other possible causes of fractures include conditions like cancer and osteoporosis.
When a fracture happens due to a fall from a standing height or less, it is called a fragility fracture. This usually happens because the bones are already weak and a low impact fall is enough to cause a fracture.
Vertebral fractures, hip fractures and wrist fractures are some of the commonly seen fractures. If a fracture is suspected, immediate treatment is a must. If getting an ambulance is not possible, see to it that while transporting the person to the hospital, the injured area is not disturbed as much as possible.
Treatment for Fractures
- After a fracture, the bones have to be set in place (reduction) – this can be done either with or without surgery.
- In closed reduction, the bones are set and immobilized with a cast. Open reduction involves surgery with metal plates, screws, etc. to set the bones in place. A cast will be placed after surgery to avoid movement and hasten recovery.
- For pain, medication will be prescribed. Surgery will be followed by a course of antibiotics.
- Treatment for fracture does not stop with setting the bone in place as rehabilitation after a fracture is very important too.
- It is crucial to make the person mobile once again and a physiotherapist will help with exercises to regain mobility and strengthen muscles.
A fracture is traumatic for the elderly as it can affect their independence and also have implications on their mental health. Preventing falls and following safe practices while on the road should be encouraged. Regular physical activity which includes strengthening and balance exercises will help the elderly a lot. Calcium supplements can also be started with the doctor’s consent.
While the causes for a fracture and dislocation are more or less similar, dislocations usually affect bigger joints. The difference between a fracture and dislocation is that in dislocation there are no broken or cracked bones. The bone is pushed away from its original position due to some kind of impact. However, this is also a painful condition which requires immediate medical attention.
Treatment for Dislocation
- The severity of the dislocation determines the treatment.
- The doctor may set the bones back in place and then immobilize it with a cast to promote healing.
- If the dislocation has damaged surrounding nerves or there are broken bones also involved, then surgery will be suggested.
Osteoporosis is a condition that commonly affects post-menopausal women. However, older men too can get osteoporosis. Old bone tissue is constantly being replaced with newer tissue. With age, this replacement with new tissue slows down. As a result, the bones become weak and break easily. This condition is called osteoporosis. People with osteoporosis are more prone to fractures.
During the initial stages, the condition is symptomless. But as it progresses, back pain, hunched back and fractures start to manifest.
Treatment for Osteoporosis
- A bone density test will reveal the risk for fractures. Based on the results of the test, either lifestyle modifications or medications will be suggested.
- Lifestyle modifications include quitting smoking and reducing alcohol.
- It is important that the body gets the required amount of calcium and vitamin D. If the diet intake does not fulfill the requirement, supplements can be taken with the doctor’s approval.
- The importance of regular exercises cannot be stressed enough. Balance exercises will prevent falls from happening; strength training and cardio exercises will strengthen bones and muscles.
- Medications will be prescribed if the scan reveals increased fracture possibility.
- Bisphosphonates are commonly prescribed; hormone therapy and other medications form the other possible treatment modalities. All have a few side-effects which will be discussed before the patient is started on it.