Everybody wants their say: Finances, frailty, and family in geriatric fracture care

This thesis is an exploration into several perspectives on geriatric fracture care. Together, these may provide recommendations for durable healthcare which is equipped for the future challenges of our aging population. First, there are considerable direct and indirect financial consequences of geriatric fracture care, which argue for more efficient and value-based healthcare.
Second, assessing frailty can aid in aligning patients’ individual goals of
care with the use of diagnostic and therapeutic resources.
Third, while family of patients are a potential resource of informal caregiving in geriatric fracture care, the relatively negative bias of healthcare proxies on patient- reported outcome measures must be acknowledged in research and
decision-making discussions. In overview of these perspectives, it becomes clear that patients, healthcare proxies, or healthcare providers may not be heard in their needs and challenges. If the stress on our healthcare system continues to increase, despite our efforts to find a compromise, something has to give. Therefore, there is need for an honest and transparent message about the different perspectives on healthcare for older adults: unfortunately, not everyone can get their say. It is up to the leadership of policy makers to not only acknowledge distress signals from our healthcare system, but also draw the ultimate – and likely unpopular – conclusion that some perspectives have to be prioritized in order to maintain a durable geriatric fracture care system.