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Brown Alpert Medical School

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Helping Older Adults Get Back in the Game

Student studies a novel hip fracture treatment program for older adults

Fei Cai MD ’16 is researching ways older adults can better recover after a hip fracture. “Oftentimes what happens is these older adults suffer a hip fracture, and then it’s downhill from there—even with otherwise healthy and active people,” says Fei. “I’m interested in how we can help people to avoid winding up in a nursing home after a hip fracture.”

Supported by a Summer Assistantship from Alpert Medical School, Fei spent the summer assessing the problem and potential solutions—and specifically the impact of the Geriatric Fracture Program at Rhode Island Hospital (RIH). “The Summer Assistantship was really helpful,” says Fei. “Otherwise I would have just been living off loan money, and as a medical student, it’s very difficult to find a job.”

The program Fei studied was created in 2011 by Nadia Mujahid, assistant professor of medicine, and Lynn McNicoll, associate professor of medicine, and was designed to streamline the treatment process for older adults who require surgery for hip fractures. It is termed “co-care” or “co-management” to reflect the collaboration among the departments of orthopaedic surgery and emergency medicine and the division of geriatric medicine.

Fei collected and analyzed data from more than 200 patients. She compared length of stay, in-hospital mortality rate, complications, and readmission rates, among other measures. She found that the co-care program, which has patients evaluated by geriatricians instead of internists, improved outcomes overall. Complications following surgery were less frequent and 30-day readmission rates were lower for those treated in the program. “Geriatricians seem more attuned to what the patients need,” says Fei.

The program most drastically impacted length of stay: those not in the program stayed in the hospital an average of 6.4 days compared to 4.8 days for those in the program. “Length of stay is crucial in patient outcomes,” says Fei. “The longer older patients stay in the hospital, the more likely they are to get infections or ulcers.”

Fei presented her research at the sixth annual Summer Research Showcase at Alpert Medical School and is currently working on a manuscript. Her abstract was also accepted by the American Geriatric Society for a poster presentation in May.

More data is being collected about the program, and Fei hopes it can be applied to help contain health care costs. “Health care cost is a big thing right now,” she says, “We’re going to see how much this program ultimately saves RIH.”

Fei sees opportunity for other collaborative programs as well. “There are other injuries and diseases that disproportionately affect older adults. Unfortunately, we don’t have 50 geriatricians running around RIH to help with this.” Eventually, she says she’d like to start a similar co-care program at a hospital that doesn’t’t already have one. “I’m interested in the overlap between medicine and surgery, but ultimately, I just want to help get people back in the game.”

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