When the human body enters the aging stage, many aspects of development, metabolism and endocrine are very different from those of young people, and the changes in the skeletal and muscular systems are especially obvious, and the elderly often have complex and extensive cardiovascular, respiratory, digestive and metabolic system problems. The psychological and social problems unique to the elderly population cannot be avoided, and the life expectancy in China has increased significantly in the 21st century. 2001 Population Sample Survey shows that the proportion of the population aged 65 and above in China has reached 7.83% of the total population, and China has entered an aging society. By the end of 2004, China’s population aged 60 or above had reached 144 million, accounting for 11% of the total population. By 2030, the elderly population will account for 25%-28% of the country’s population; the average life expectancy of men in China is currently 70 years old, while that of women is 73 years old. By 2050, the average life expectancy will be about 75 years for men and 80 years for women. The health of the elderly will become a more serious social issue. And fracture is an important factor that affects the health of the elderly. Fracture has become a great challenge to the health of the elderly.
I. Criteria for age division: After the determination of global human quality and average life expectancy, the World Health Organization (WHO) has made new rules for age division, (a) young elderly: 60 to 74 years old; (b) elderly: 75 years old 89 years old; (c) long-lived elderly: 90 years old or above for.
Second, the aging society: the population aged 60 and above exceeds 10% of the total population, or the population aged 65 and above exceeds 7% of the total population, called the aging society.
Third, the physiological characteristics of the elderly bone: the elderly are prone to fracture, and the physiological characteristics of the elderly bone; from five aspects: 1. physiological changes in bone tissue in the elderly; 2. changes in calcium metabolism in the elderly; 3. changes in vitamin D metabolism in the elderly; 4. changes in calcitonin and parathyroid in the elderly: 5. changes in sex hormones and growth hormone.
Fourth, the causes of fractures in the elderly.
1, osteoporosis: osteoporosis is a systemic disease characterized by low bone mass and microstructural destruction of bone tissue, resulting in increased bone fragility and fracture sharing; related to aging (osteoporosis refers to the reduction of bone mass per unit volume, but its composition and ratio do not change significantly, that is, the organic and inorganic components of bone are equally reduced. (Organic matter production is normal, but inorganic mineral salts are reduced). As the body ages, there are major changes in the secretion of various hormones related to bone metabolism, inorganic element reserves and distribution, and even the responsiveness of various tissues and organs, and the characteristics of bone metabolism change, resulting in various types of osteoporosis.
Osteoporosis is the most important factor that triggers bone damage in the elderly and affects treatment, healing, and prevention. Osteoporosis is directly reflected by the amount of calcium contained in human bone.
There are 3 stages of growth, stabilization and decrease of calcium content in bone:
(i) Birth to about 30 years of age, a period of rapid bone growth, with particularly rapid growth before the age of 15.
②Bone mass reaches its peak and remains stable from 30 to 45 years of age.
③Bone mass begins to decrease after the age of 45.
④ rapid loss of bone mass after menopause.
⑤ Bone loss in women over 70 years old can reach 40% to 50%, and slight external force can lead to spine and hip fractures.
2. Mental health: The elderly are a special group, with poor quality of life and low functional requirements. In their physiological, psychological and social roles, all have their inherent characteristics. The distinctive features are psychological “aging”, declining physiological functions, more combined diseases, low responsiveness to the outside world, slowed protective reflexes, and significantly increased chances of trauma, so fractures are very common in the elderly. Medical complications and surgical complications of geriatric fractures can cause psychological fear.
3. Falls: fainting, vision problems, peripheral vascular problems, weakness, balance, joint problems, improper shoe fitting, improper use of walkers, taking analgesic and sleeping pills, environmental changes, and accidents.
V. Common fractures in the elderly: (spine, proximal femur, distal radius, proximal humerus)
VI. Pre-hospital first aid for fractures in the elderly.
1.Principles of first aid: (restoration first, then fixation, stop first, then package, heavy first, then light, rescue first, then send, first aid and breathing together, handling and medical care in line)
2.Special measures of first aid for common fractures in the elderly: (upper limb, lower limb, spine, ribs)
3. Pre-hospital emergency time for elderly fracture: (best emergency period: 12 hours after injury; better emergency period: 24 hours after injury; extended emergency period: 24 hours after)
VII. Complications of fractures in the elderly.
The elderly are prone to a series of complications after fracture, and the complications can in turn induce rapid deterioration of the original disease. For the elderly, aging and fracture form a vicious circle of mutual causation and promotion in different degrees.
1. systemic (shock, combined neurovascular injuries, infections, fat embolism syndrome, post-traumatic respiratory failure syndrome, fall-in pneumonia)
2.Local (osteofascial compartment syndrome, nerve injury, vascular injury).
VIII. Pre-hospital emergency treatment of common fractures: The purpose is to minimize the pain of the elderly, reduce the rate of disability, and reduce mortality.
1. Cervical and lumbar fractures: ① For cervical fractures, place clothing and pillows on both sides of the head and neck so that the fixation does not move. ② lumbar spine fracture, lying flat on a hard bed, both sides of the body with pillows, bricks, clothing stuffed tightly, fixed spine for the positive position. Three people are squatting on the side of the injured person, one person to support the neck and back, one person to support the waist and hip, one person to support the lower limbs, collaborative movement, the patient supine position on the hard board, stretcher, waist with clothes and mattress pad. In transporting with a hard splint, one person is forbidden to hold up, and two to four people should carry to prevent aggravating spinal and spinal cord injury. (Simple fractures are covered with multiple layers of clean cloth, towels or sterile gauze and bandaged with pressure. (Multiple fractures can be fixed with wide cloth or wide rubber around the radius of the thorax).
2, thigh fracture: from the axilla to the heel with a long splint placed on the outside of the injured limb, the healthy limb moved to the injured limb side by side, after the splint with padding.
Precautions.
①Fixation should include the upper and lower joints for the purpose of braking.
②The part with bone protrusion should be padded with cotton and soft cloth, do not make direct contact between the board and the bone protrusion to prevent compression into injury.
③When there is deformity in closed fracture, it should be straightened and fixed at the same time.
④In case of open fracture, flush the wound with clean water only, do not reset the exposed bone, and fix it only with hemostatic bandage.
⑤ The fingers (toes) of the fixed limb should be exposed so that the blood circulation can be observed.
3. Simple fracture of forearm: Elbow joint is flexed at 90°, five fingers are extended, and the thumb is directed towards the position of the injured person’s nose. Three to four boards and cardboard from the wrist to the elbow length. Upper arm fracture two splints (or boards) on the inner and outer sides of the upper limb, respectively, plus padding (cotton, clothes, cloth), etc., and then tied and fixed with a triangular scarf (or cloth, rope).
4, calf fracture: the upper and lower ends of the fracture, below the knee and the middle part of the thigh are wrapped tightly with cloth tape and tied in knots on the outside, and the foot is fixed with an “8” shaped bandage.
IX. Treatment
Principles of treatment for fractures in the elderly: Once multiple injuries occur in the elderly, the condition is critical and requires timely resuscitation. The early stage is to save life, the middle stage is to prevent and control infection and multi-organ failure, and the late stage is to correct and treat various sequelae and deformities. First aid, repositioning, fixation and functional training are the four basic principles of fracture treatment.
New conservative treatments for fractures in the elderly
1.Advocate fixation with various braces or lightweight casts. The better the reset and the more stable the fixation of displaced fractures, the more painless functional exercises can be ensured.
2.Emphasize the early functional activities of the joints adjacent to the fracture, and fully mobilize the patient’s subjective initiative.
3.Avoid the occurrence of fatal complications.
X. Prevention of fractures in the elderly.
1.Maintain regular physical activities; depending on their economic status, functional ability, and functional impairment.
2.Special equipment to help living; equipped with standard assistive walking devices, wheelchairs.
3.Rational nutrition: it can guarantee good nutritional status and fracture healing; factors affecting fracture healing: economic, partiality, depression, infantilism, dental, swallowing, gastrointestinal disorders.
4.Appropriate psychological counseling: make sure there is no medical or surgical disease, no depression, no malnutrition are to encourage them to participate in rehabilitation.
5, osteoporosis conditioning: life of osteoporosis patients, treatment of osteoporosis patients: exercise can accelerate blood circulation throughout the body and bones, muscle contraction and diastole has a stimulating effect on the muscles, can slow down or stop the progress of osteoporosis.