Despite all we know about the dire effects of an osteoporotic break on a patient’s’ quality of life (see, for instance, Al-Sari et al, 2016 and Jung et al, 2017), and despite the high degree of mortality associated with — but not directly caused by — fragility fractures — there has been an almost systematic negligence of the emotional and psychological effects of such fractures.
Why do some patients bounce back whereas others don’t? In no small part due to their mindsets and the stories they tell themselves. A patient's degree of hope and optimism improve a variety of disease outcomes, such as mortality, pain, and physiological markers — regardless of health status (Rasmussen et al, 2012; Schiavon et al, 2016). The patient’s sense of self-efficacy may be a better predictor of fall risk than balance or mobility measures (Pang & Eng, 2007).
A hope-less patient is a non-compliant patient, and all the interventions in the world will not help if the patient doesn’t use them...and post-fracture geriatric patients have a high degree of noncompliance. This intervention exists to improve patients’ mindsets, to dispel any mistaken beliefs about the “preordained” outcomes of falls, to catch depression early and encourage patients and caregivers to seek treatment for it, and to establish a sense of hope, efficacy, and resilience against osteoporosis (HERO).
The intervention would include:
- debunking common myths about fragility fractures and osteoporosis (it’s inevitable, it’s the beginning of the end)
- emotional fitness strategies (acceptance vs ruminations, overcoming avoidance)
- cognitive fitness/mindset strategies (you can still learn, your life still has purpose)
- a self-administered depression screen
- a token (perhaps in the shape of a washable bracelet) with a visual reminder of why the struggle is worth it
In order to maximize reach, the education materials would be provided as a large-font workbook and as online or app-based video instructions (this intervention could be packaged with or within one of the other interventions from the Challenge.)
To maximize impact, caregivers (family members) should be made aware of the mental difficulties that patients can go through and what might help. This could be done as a note to caregivers within the workbook and stand-alone information in the form of a brochure and web-based information. A CME module for health care providers could increase their awareness of the problem, and the potential malleability of mindset to achieve better outcomes.