Most healthcare workers and elderly patients become aware of osteoporosis when a fracture has occurred, most often after an innocuous injury. The real incidence of Osteoporosis related minimal trauma fracture (ORMTF) might not be estimated correctly because of the poor health records in Nigeria. One out of every two women and one in every four men over 50year will have osteoporosis related fracture in their life time.
In Nigeria, it has been affecting adult women at a considerably earlier age than the western counterparts. Increasing life expectancy and a consequent increase in the elderly population has posed a new challenge to their health needs. Fractures related to osteoporosis are quite common. It is also an established fact that bone density measurements correlate well to the risk of developing fracture. This can be measured using DEXA (Dual energy X Ray Absorptiometry) and Quantitative Ultrasound (QUS). It is estimated that 1 out of 8 males and 1 out of 3 females suffer from this, making Nigeria one of the highest affected countries in the world.
History of regular exercise by the patients is statistically significant on the reduction of osteoporosis. There is a high prevalence of osteoporosis among pregnant women in Nigeria. This may be due to the predominant poor adherence and low dose of calcium supplementation among pregnant women in Nigeria. Therefore, there is an urgent need for sensitization on this public health problem.
What differentiate older adults especially patients with osteoporosis is having high rates of fractures, which are associated with higher morbidity, higher mortality, and more frequent social and home health care complications than in younger patients. This is going to be factored into our survey. Any fracture in an older adult may be complicated by low Bone mineral density, and all should be referred for testing and treatment.
Starting vitamin D supplementation and referring for outpatient BMD testing can be done from the emergency department in order to improve healing and prevent subsequent fractures in patients with osteoporosis. Physicians must also give increased attention to a patient’s social situation and ability to care for the injury at home. Physicians should be aware of occult fractures, or X-ray-negative fractures, especially when a patient has persistent pain or inability to ambulate. Once identified, older adults with fractures should be treated swiftly and aggressively. When surgical repair is indicated, it should not be delayed due to the patient’s age, as delays more than 24 hours are associated with higher complication risks.
Be proactive with time management is a kind of one cap fit all approach that can go a long way in assisting old people and young ones including nursing mother in attending to their health to live healthier, longer and prevent future fracture. They should really focus on planning out their schedules and designating certain days of the week to accomplish particular tasks including having time to take care of their health, family, visit exercise centre and library.
Loneliness is bad experience for patient with osteoporosis, bad for their health and wellbeing. It can even be as harmful as smoking. The rural-urban migration of family members in Nigeria often leads to a higher probability of older people living alone, and minimizes family/social networks, which increases old age loneliness in patients with osteoporosis.
Loneliness, is not necessarily about being alone. Instead, if patient with osteoporosis feel alone and isolated, then that is how loneliness plays into his or her state of mind. For example, a patient with osteoporosis might feel lonely despite being surrounded by caregivers and relatives. A patient beginning his first admission at hospital might feel lonely after being in hospital ward, despite being constantly surrounded by other patients and medical practitioners. Loneliness has a wide range of negative effects on both physical and mental health and one of the health risks associated with loneliness is alcoholism and drug abuse which can lead to further fracture in patient with osteoporosis.
"Lonely patients with osteoporosis may consume more alcohol and get less exercise than those who are not lonely. Their diet can be higher in fat, their sleep can be less efficient, and there can be report of more daytime fatigue. Loneliness also disrupts the regulation of cellular processes deep within the body, predisposing one to premature aging."
Patients on top of the pain and anxiety of their fractures, patients face a disjointed system where the appropriate next step may not be recommended. The most successful in healing are often those who take a very proactive approach to their care.
The patient's problem in preventing a second break is that not every patient has the time, will, or ability to do so, and some don’t feel it’s necessary because they trust the medical authority or because they’ve always been relatively healthy.
Most of Orthopedic Surgeons are less focused on future fracture/osteoporosis prevention than on addressing the patient’s trauma from their bone break, and their administrators want to ensure they generating as much revenue as possible from their surgical practice. But some health systems have designated coordinators meant to provide continuity between moments of care. Often viewed as a luxury rather than an essential part of healing, good coordinators are scarce and manage many patients at a time, all while navigating the complicated worlds of health institutions and insurance coverage. Yet they are incredible advocates and guides for patients, and are well positioned to spot patterns and underlying causes like osteoporosis.
Proactive patients are responsible, they correct and learn from mistake. Proactive patients recognize that they are "response-able." They don't blame genetics, circumstances, conditions, or conditioning for their behaviours. They know they choose their behaviour. A proactive person uses proactive language--I can, I will, I prefer, etc.
Proactive patients have to be encouraged to continue to be while those not proactive have to be advised to be proactive through thinking and acting ahead of anticipated fracture. Not only it is a great method for avoiding fracture, it can also be extremely important for averting problems. To be proactive, patient have to start taking action, embracing responsibility, and controlling lifestyle. By doing things such as anticipating future and focusing on solutions instead of problems, patients maintain a happier, healthier and live longer.
Tips to Prevent Loneliness by patients with Osteoporosis
Loneliness can be overcome by patient with osteoporosis. It does require a conscious effort on their part to make a change. Making a change, in the long run, can make them happier, healthier, and enable them to impact others around them in a positive way and through:
- Recognize that loneliness is a sign that something needs to change.
- Understand the effects that loneliness has on their life, both physically and mentally.
- Consider doing community service or another activity that they enjoy. This present great opportunities to meet people and cultivate new friendships and social interactions.
- Focus on developing quality relationships with people who share similar attitudes, interests, and values with them.
- Expect the best. Lonely people with osteoporosis often expect rejection, so instead they should focus on positive thoughts and attitudes in their social relationships.
We will collect more information about how the different stakeholders perceive of the problem through survey/IOS platform. Survey shall be used during initial design and also be used by CHC as an ongoing tool.
Preventing second fracture can be tackled through pairing patients with community health coordinators who have passion and love their job.
IOS is an application to be used to send reminders to patients with first fracture to remind them of good practices they should be engaging in to avoid second fracture. It is also an avenue to educate them on the need to be proactive, keeping appointment with medical practitioners and visiting exercising center cum library.
IOS shall be loaded with useful information that can assist patients to be proactive, question can be asked, answer provided on the platform. Sample of advice to be available on IOS for patient are to:
i. Keeping appointment with medical practitioners and visiting exercising center regularly.
ii. Maintain cordial relationship with CHC
iii. Visiting library for information about their health regularly
iv. Be reading books for ideas on living their best life
v. Life style changes like keep active and so on
IOS is a platform that facilitates interaction and targeted information exchange between patients and community health coordinators to connect the dots between patient and their appointments. The same platform will also be used by CHC for combination of solutions for patients with less intentional habits.
We are going to focus on impact of pairing patients with CHC and interaction on IOS platform through proper monitoring and evaluation (internal and external) cum indicators. Mr Gbenga Adaramodu, our programmer is to design I.O.S.
We will leverage on how to strengthen, protect & armed patient with first fracture with information & support of doctor so as to significantly improve bone health & reduce risk of future fractures with a combination of Community Health Coordinator, medication, diet, exercise and lifestyle modifications using IOS platform. Community Health Coordinator:
a) assist patients to have seamless transitions between settings; appropriate & unduplicated tests; optimized wait times for test results, specialist appointments and social services delivery; and available beds in hospitals or long-term care homes when patients need them. b) They are designated medical officers meant to provide continuity between moments of care to allow patient with fracture to live healthier & longer lives. c) Take care of patients with fracture & then allow older adults to participate fully in social life. d) Advocating for support for patients with fracture like connect patients with a variety of resources available to them including clinical interventions such as a DEXA scan for bone mineral density to evidence based community resources such as a Matter of Balance. e) Follows up with fracture patients and their primary care physicians by telephone & mail (intervention) to ensure patients receive appropriate post-fracture management.
Local librarians shall be supplied with easily accessible information to guide patrons to the most relevant (online or offline) information through training, regular update on new information, meeting and online discussion. Computers, online public access catalog (OPAC), union catalogue, CD-ROM, scanner, radio frequency identification, tele text, facsimile, photocopy, printing technology, bar code, document delivery services, interlibrary loan, indexing and abstracting services, chat services, current-awareness service, selective dissemination of information, scanned copies, bulletin board services, electronic services and e- resources, digital library, audiovisual materials, internet, library website and database shall also make available for the use of patients with osteoporosis through librarians.
Our strategy is to make use of: a) IOS platform through the use of Quick Response Code to provide access to information & analysis of social data to pair patients with community health coordinators who will help to connect the dots between their appointments in different departments in the hospital. The community health coordinators who have passion & love their job are to be linked with patient with fracture. Having attention to detail, motivated attitude, patience & thoughtfulness when dealing with patients will go a long way in ensuring the first fracture is their last. b) An automatic & personalized reminder tool for patients with fracture, coupled with a tracking system for drop outs will be sent out. The IOS will be on time reminders of all schedules like visiting exercise class (life style changes like keep active & avoid sitting for long time) for seniors which is proven to build strength & balance for fall prevention and monitoring.
The IOS messages will also include: the need for patients to be proactive, have time for themselves, will, or ability to request the surgeons to be focused on future fracture prevention than addressing the trauma from their bone break, as some administrators want to ensure the surgeon generating as much revenue as possible from their surgical practice instead of providing continuity between moments of care.
We are going to engage in the following activities;
i. Organise seminars for patients with first fracture with emphasis on behavioural change
ii. Appointment of Community Health Coordinators
iii. Training of Community Health Coordinators
iv. Pairing of Community Health Coordinators with patients who already experienced first fracture.
v. Monitoring and evaluation
vi. Publicity of the project through the use of jingle, social media, television, newspaper and so on.
To shop for qualify Community Health Coordinator, advertisement will be made in national newspapers, radio and social media. After which interview of shortlisted candidate shall follow. Successful applicants who demonstrate the quality of good CHC shall be hired and pair with patients with first fracture.
The light experiments we are trying to test are:
i. To test pairing patients with fracture with Community Health Coordinators.
ii. To test the correlation between patients who are proactive and those who are not through behavioural change.
iii. To test IOS platform in connecting patients with fracture & the platform will be used to collect up-to-date information about those with first fracture & those with further fracture.
iv. To test customized reminders for patients with fracture to:
a) be reading books for ideas on living their best life by visiting library & at home, retrofitting their home to prevent falling, follow the instructions & advises from endocrinologist or rheumatologist, therapist, partners, extended family members, & local community organizations. b) avoidance of excessive consumption of alcohol & possibly tobacco. c) dietary factor like increase intake of calcium & vitamin D, eating orderliness strengthen bone & surgery to reduce the size of stomach to allow surface area available to absorb nutrients, including calcium. d) outdoor hazards prevention like: wear low-heeled shoes with rubber soles for more solid footing (traction), and wear warm boots, use of hand rails for up & down steps & on escalators, if sidewalks look slippery, walk in the grass for more solid footing, use of walker & so on will be encouraged. Indoor hazards prevention like: placing of items in use most often within easy reach, use assistive devices to help avoid strain or injury and so on will be also encouraged.