Kırılganlık Kırığı Olan Ortogeriatri Hastalarında Malnütrisyon ve Hemşirelik Bakımı

Öz

Dünya genelinde yaşlı nüfusun hızla artmasıyla birlikte geriatrik bireylerin sağlık bakım ihtiyaçları çeşitlenmiş ve giderek daha karmaşık bir hal almıştır. Bu doğrultuda ortogeriatri, yaşlı bireylerde görülen kas iskelet sistemi hastalıklarının multidisipliner bir yaklaşımla yönetildiği özel bir alan olarak öne çıkmaktadır. Özellikle kırılganlık kırıkları, yaşlı bireylerde en sık karşılaşılan ve ciddi sonuçlara yol açan sağlık sorunlarından biridir. Kırılganlık kırıkları, genellikle düşük enerjili travmalar sonucu meydana gelir ve çoğunlukla osteoporoz gibi altta yatan kemik zayıflığı ile ilişkilidir. Ancak bu kırıkların ortaya çıkmasında yalnızca kemik sağlığı değil, yaşlı bireylerin genel kırılganlık durumu ve beslenme yetersizlikleri de önemli rol oynamaktadır. Malnütrisyon, kırılgan yaşlı bireylerde sık görülen ve değiştirilebilir bir risk faktörü olup; kas gücünde azalma, yara iyileşmesinde gecikme, kırılganlık kırıkları ve komplikasyon riskinde artış gibi olumsuz sonuçlara yol açabilmektedir. Bu noktada hemşireler, bireyin bütüncül bir yaklaşımla değerlendirilmesinde, kırılganlık ile malnütrisyonun erken dönemde tanılanmasında ve bireye özgü bakım planlarının oluşturulmasında kilit bir rol üstlenmektedir. Bu kapsamda, hemşirelerin multidisipliner ekiplerle iş birliği içinde çalışması, kanıta dayalı bakım uygulamaları geliştirmesi ve kırılgan yaşlı bireylerin yaşam kalitesini artırmaya yönelik önlemleri zamanında alması beklenmektedir. Bu derleme, ortogeriatri kapsamında kırılganlık kırıkları ve malnütrisyonun önemini ortaya koymayı, malnütrisyonun yönetiminde hemşirelerin rolünü açıklamayı ve ilgili literatüre katkı sağlamayı amaçlamaktadır.

Anahtar Kelimeler

• Hemşirelik bakımı
• Kırılganlık kırığı
• Malnütrisyon
• Ortogeriatri

Malnutrition and Nursing Care in Orthogeriatric Patients with Fragility Fracture

Öz

With the rapid increase in the elderly population worldwide, the health care needs of geriatric individuals have diversified and become increasingly complex. In this direction, orthogeriatrics stands out as a special field where musculoskeletal system diseases seen in elderly individuals are managed with a multidisciplinary approach. In particular, fragility fractures are one of the most common health problems that lead to serious consequences in elderly individuals. Fragility fractures usually occur as a result of low-energy trauma and are often associated with underlying bone weakness such as osteoporosis. However, not only bone health but also the general frailty status and nutritional deficiencies of the elderly play an important role in the occurrence of these fractures. Malnutrition is a common and modifiable risk factor in frail elderly individuals and can lead to adverse outcomes such as decreased muscle strength, delayed wound healing, fragility fractures and increased risk of complications. At this point, nurses play a key role in evaluating the individual with a holistic approach, diagnosing frailty and malnutrition at an early stage and creating individual-specific care plans. In this context, nurses are expected to work in collaboration with multidisciplinary teams, develop evidence-based care practices and take timely measures to improve the quality of life of frail elderly individuals. This review aims to reveal the importance of frailty fractures and malnutrition within the scope of orthogeriatrics, explain the role of nurses in the management of malnutrition and contribute to the relevant literature.

Anahtar Kelimeler

• Nursing care
• Fragility fracture
• Malnutrition
• Orthogeriatrics

Kaynakça

1. Alamri, A., Alaamer, K., Almogbel, Y., Alsalahi, H., Al Shareef, M., Alanazi, S., … Alhusaini, F. (2025). Prevalence of malnutrition in people hospitalized for surgery: Prospective cross-sectional study. Healthcare, 13(4), 380. doi: 10.3390/healthcare13040380
2. Besora-Moreno, M., Llauradó, E., Tarro, L., & Solà, R. (2020). Social and economic factors and malnutrition or the risk of malnutrition in the elderly: A systematic review and meta-analysis of observational studies. Nutrients, 12(3), 737. doi: 10.3390/nu12030737
3. Bohl, D. D., Shen, M. R., Hannon, C. P., Fillingham, Y. A., Darrith, B., & Della Valle, C. J. (2017). Serum albumin predicts survival and postoperative course following surgery for geriatric hip fracture. The Journal of Bone and Joint Surgery. American Volume, 99(24), 2110–2118.
4. Carli, F., Scheede-Bergdahl, C., & Baldini, G. (2020). Prehabilitation to enhance postoperative recovery for an elderly population: A narrative review. Canadian Journal of Anesthesia, 67(6), 756–771.
5. Cederholm, T., Barazzoni, R. O. C. C. O., Austin, P., Ballmer, P., Biolo, G. I. A. N. N. I., Bischoff, S. C., … Singer, P. (2017). ESPEN guidelines on definitions and terminology of clinical nutrition. Clinical Nutrition, 36(1), 49–64.
6. Cederholm, T., Jensen, G. L., Correia, M. I. T. D., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., ... & GLIM Core Leadership Committee, GLIM Working Group. (2019). GLIM criteria for the diagnosis of malnutrition–a consensus report from the global clinical nutrition community. Journal of cachexia, sarcopenia and muscle, 10(1), 207-217.
7. Chen, B., Zhang, J. H., Duckworth, A. D., & Clement, N. D. (2023). Effect of oral nutritional supplementation on outcomes in older adults with hip fractures and factors influencing compliance: A systematic review and meta-analysis of randomized controlled trials. The Bone & Joint Journal, 105(11), 1149–1158.
8. Damar, H. T., Savcı, A., & Bilik, O. (2021). Ortopedi hastalarının malnütrisyon durumları ve risk faktörlerinin belirlenmesi. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 8(3), 487–494.

9. de van der Schueren, M. A. E. Öztürk, Z. A. (Çev.). (2020). Yaşlılıkta nütrisyon: Yaşlılarda nütrisyonel tarama, değerlendirme, tanı, diyet önerileri ve oral beslenme ürünleri (Modül 36.2, Topik 36). ESPEN Yaşam Boyu Öğrenme Programı. Erişim adresi: https://kepan.org.tr/files/pdf/LLL_Kurs/M36.2_Yeni.pdf. Erişim Tarihi: 30.07.2025
10. Dempewolf, S., Mouser, B., Rupe, M., Owen, E. C., Reider, L., & Willey, M. C. (2023). What are the barriers to incorporating nutrition interventions into care of older adults with femoral fragility fractures? Iowa Orthopaedic Journal, 43(2), 172–182. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10777707/
11. Dyer, S. M., Crotty, M., Fairhall, N., Magaziner, J. S., Beaupre, L. A., Cameron, I., & Sherrington, C. (2017). A critical review of the long-term disability outcomes following hip fracture. Innovation in Aging, 1(suppl_1), 736–736.
12. Egbert, R. C., Bouck, T. T., Gupte, N. N., Pena, M. M., Dang, K. H., Ornell, S. S., & Zelle, B. A. (2020). Hypoalbuminemia and obesity in orthopaedic trauma patients: Body mass index a significant predictor of surgical site complications. Scientific Reports, 10(1), 1953. doi: 10.1038/s41598-020-58987-4
13. Feng, W., Wang, J., Zhang, H., Wang, Y., Sun, Z., & Chen, Y. (2024). Association between malnutrition and cognitive frailty in older adults: A systematic review and meta-analysis. Geriatric Nursing, 58, 488–497. doi: 10.1016/j.gerinurse.2024.06.020
14. Fernández Miró, M., Cabrejo Gavidia, V., Carrascosa Piquer, O., Valero Lanau, J., Toapanta Valencia, M., & Aguado Jodar, A. (2023). Malnutrition is associated with postoperative complications in elderly patients undergoing total hip arthroplasty. Endocrinología, Diabetes y Nutrición (English Edition). doi: 10.1016/j.endien.2023.06.003
15. Ghaly, P., Iliopoulos, J., & Ahmad, M. (2021). The role of nutrition in wound healing: An overview. British Journal of Nursing, 30(5), S38–S42. doi: 10.12968/bjon.2021.30.5.S38
16. Gobbens, R. J., & Uchmanowicz, I. (2023). Frailty viewed from a nursing perspective. SAGE Open Nursing, 9, 23779608221150598. https://doi.org/10.1177/23779608221150598
17. Gomathi, B. (2024). Nutritional care: Nurses’ critical role in improving patient outcomes. SBV Journal of Basic, Clinical and Applied Health Science, 7(3), 144–147.
18. Guzón-Illescas, O., Pérez Fernández, E., Crespí Villarias, N., Quirós Donate, F. J., Peña, M., Alonso-Blas, C., … Mazzucchelli, R. (2019). Mortality after osteoporotic hip fracture: Incidence, trends, and associated factors. Journal of Orthopaedic Surgery and Research, 14, 1–9.
19. Hirsch, K. R., Wolfe, R. R., & Ferrando, A. A. (2021). Pre- and post-surgical nutrition for preservation of muscle mass, strength, and functionality following orthopedic surgery. Nutrients, 13(5), 1675. doi: 10.3390/nu13051675.
20. Ihle, C., Freude, T., Bahrs, C., Zehendner, E., Braunsberger, J., Biesalski, H. K., ... Nüssler, A. (2017). Malnutrition—an underestimated factor in the inpatient treatment of traumatology and orthopedic patients: A prospective evaluation of 1055 patients. Injury, 48(3), 628–636.
21. Lee, H., Lee, E., & Jang, I. Y. (2020). Frailty and comprehensive geriatric assessment. Journal of Korean Medical Science, 35(3), e16-e16.
22. Magalhaes, P., Gonçalves, M., Silva, F., Fernandes, T., Oliveira, A. & Veríssimo, R. (2023). Implementation of orthogeriatrics in Portugal. Cureus, 15(2), e35361. doi: 10.7759/cureus.35361
23. Marques, A., & Queirós, C. (2018). Frailty, sarcopenia and falls (Canbolat Seyman, Çev.). In K. Hertz & J. Santy-Tomlinson (Eds.), Fragility fracture nursing: Holistic care and management of the orthogeriatric patient (Ünlü H., Bilik Ö., & Ayhan H., Çev.) (pp. 15–26). [Türkçe çeviri 2021]. ISBN 978-605-73970-0-3
24. Meehan, A. J., Maher, A. B., Brent, L., Copanitsanou, P., Cross, J., Kimber, C., … Hommel, A. (2019). The International Collaboration of Orthopaedic Nursing (ICON): Best practice nursing care standards for older adults with fragility hip fracture. International Journal of Orthopaedic and Trauma Nursing, 32, 3–26.
25. Meyer, M., Leiss, F., Greimel, F., Renkawitz, T., Grifka, J., Maderbacher, G., & Weber, M. (2021). Impact of malnutrition and vitamin deficiency in geriatric patients undergoing orthopedic surgery. Acta Orthopaedica, 92(3), 358–36. doi: 10.1080/17453674.2021.1882092.
26. Ninomiya, K., Takahira, N., Ikeda, T., Suzuki, K., Sato, R., & Kazuo, H. (2023). Prevalence of frailty and associated factors among community-dwelling older adults after total hip arthroplasty. Hip International, 33(3), 397–403.
27. Patrick, R. (2018). Nutrition and hydration (Çoşkun, H. & İyigün, E., Çev.). In K. Hertz & J. Santy-Tomlinson (Eds.), Fragility fracture nursing: Holistic care and management of the orthogeriatric patient (Ünlü H., Bilik Ö., & Ayhan H., Çev.) (pp. 95–106). [Türkçe çeviri 2021]. ISBN 978-605-73970-0-3
28. Pes, M., Pulino, A., Pisanu, F., & Manunta, A. F. (2023). Why malnutrition in orthopaedic elective patient is still an issue? A recent review of the literature. European Journal of Orthopaedic Surgery & Traumatology, 33(8), 3723–3727. doi: 10.1007/s00590-023-03593-z.
29. Santy-Tomlinson, J., Hertz, K., & Kaminska, M. (2018). Orthogeriatric nursing (Ünlü, H., Çev.). In K. Hertz & J. Santy-Tomlinson (Eds.), Fragility fracture nursing: Holistic care and management of the orthogeriatric patient (Ünlü H., Bilik Ö., & Ayhan H., Çev.) (pp. 141–147). [Türkçe çeviri 2021]. ISBN 978-605-73970-0-3.
30. Schoene, D., Rapp, K., Roigk, P., Becker, C., Jaensch, A., Konnopka, C., ... Rothenbacher, D. (2025). Orthogeriatric co-management and incident nursing home admissions in older patients with fragility fractures other than the hip—a retrospective cohort study using insurance claims data from Germany. BMC Medicine, 23(1), 248.
31. Sheean, P., Gonzalez, M. C., Prado, C. M., McKeever, L., Hall, A. M., & Braunschweig, C. A. (2020). American Society for Parenteral and Enteral Nutrition clinical guidelines: The validity of body composition assessment in clinical populations. Journal of Parenteral and Enteral Nutrition, 44(1), 12–43.
32. Tsantes, A. G., Papadopoulos, D. V., Lytras, T., Tsantes, A. E., Mavrogenis, A. F., Koulouvaris, P., ... Bonovas, S. (2020). Association of malnutrition with surgical site infection following spinal surgery: Systematic review and meta-analysis. Journal of Hospital Infection, 104(1), 111–119.
33. Tsantes, A. G., Papadopoulos, D. V., Lytras, T., Tsantes, A. E., Mavrogenis, A. F., Korompilias, A. V., … Bonovas, S. (2019). Association of malnutrition with periprosthetic joint and surgical site infections after total joint arthroplasty: A systematic review and meta-analysis. Journal of Hospital Infection, 103(1), 69–77.
34. Venianaki, M., Andreou, A., Nikolouzakis, T. K., Chrysos, E., Chalkiadakis, G., & Lasithiotakis, K. (2021). Factors associated with malnutrition and its impact on postoperative outcomes in older patients. Journal of Clinical Medicine, 10(12), 2550.
35. Veronese, N., Kolk, H., & Maggi, S. (2021). Epidemiology of fragility fractures and social impact. In Orthogeriatrics: The management of older patients with fragility fractures (pp. 19–34).
36. Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Hooper, L., Kiesswetter, E., ... & Bischoff, S. C. (2022). ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clinical Nutrition, 41(4), 958–989.
37. Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Hübner, M., Klek, S., ... & Singer, P. (2021). ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition, 40(7), 4745–4761.
38. Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Hübner, M., Klek, S., ... & Singer, P. (2017). ESPEN guideline: clinical nutrition in surgery. Clinical nutrition, 36(3), 623-650.
39. Wilkinson, B. R., An, Q., Glass, N., Miller, A., Davison, J., & Willey, M. C. (2022). Malnutrition is common and increases the risk of adverse medical events in older adults with femoral fragility fractures. Iowa Orthopaedic Journal, 42(1), 69–74. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9210413/
40. Williams, D. G., & Wischmeyer, P. E. (2020). Perioperative nutrition care of orthopedic surgery patient. Techniques in Orthopaedics, 35(1), 15-18. doi: 10.1097/bto.0000000000000412
41. Williams, D. G., Ohnuma, T., Haines, K. L., Krishnamoorthy, V., Raghunathan, K., Sulo, S., ... Wischmeyer, P. E. (2021). Association between early postoperative nutritional supplement utilisation and length of stay in malnourished hip fracture patients. British journal of anaesthesia. 126(3), 730-737.
42. Wu, A. M., Bisignano, C., James, S. L., Abady, G. G., Abedi, A., Abu-Gharbieh, E., … Vos, T. (2021). Global, regional, and national burden of bone fractures in 204 countries and territories, 1990–2019: A systematic analysis from the Global Burden of Disease Study 2019. The Lancet Healthy Longevity, 2(9), e580–e592.
43. Yeşilyaprak, T., & Korkmaz, F. D. (2024). Ortopedik cerrahi hastalarında kırılganlık ve hemşirelik bakımı. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 9(3), 477–481.
44. Zhang, H. T., Tan, N., Gao, Y., She, K. Y., Luo, Q., Yao, K. R., … Yin, X. H. (2024). Prediction of postoperative mortality in older surgical patients by clinical frailty scale: A systematic review and meta-analysis. Geriatric Nursing, 59, 581–589.