Assessing frailty in elderly patients with hip fractures: A retrospective review comparing geriatrician and orthopedic trainee assessments.

To assess the correlation of orthopedic surgery residents compared with expert geriatricians in the assessment of frailty stage using the Clinical Frailty Scale (CFS) in patients with hip fractures. A retrospective chart review was performed from January 1, 2015 to December 31, 2019. Patients admitted with a diagnosis of hip fracture were identified. Those patients with a CFS score completed by orthopedic residents with subsequent CFS score completed by a geriatrician during their admission were extracted. Six hundred and forty-eight patients over age 60 (mean 80.5 years, 73.5% female) were admitted during the study period. Orthopaedic residents completed 286 assessments in 44% of admissions. Geriatric medicine consultation was available for 215 patients such that 93 patients were assessed by both teams. Paired CFS data were extracted from the charts and tested for agreement between the 2 groups of raters. CFS assessments by orthopedic residents and geriatrician experts were significantly different at P < .05; orthopedic residents typically assessed patients to be one CFS grade less frail than geriatricians. Despite this, the CFS assessments showed good agreement between residents and geriatricians. Orthopaedic surgery residents are reliable assessors of frailty but tend to underestimate frailty level compared with specialist geriatricians. Given the evidence to support models such as orthogeriatrics to improve outcomes for frail patients, our findings suggest that orthopedic residents may be well positioned to identify patients who could benefit from such early interventions. Our findings also support recent evidence that frailty assessments by orthopedic surgeons may have predictive validity. Low rates of initial frailty assessment by orthopedic residents suggests that further work is required to integrate more global comprehensive care.

Stress, mental health and sociocultural adjustment in third culture kids: exploring the mediating roles of resilience and family functioning.

Introduction: This cross-sectional study explores the contributions of personal and contextual factors in the adjustment process of a sample of internationally mobile children and adolescents having relocated to Switzerland. Based on evolutionary developmental theories and recommendations by Research Domain Criteria and The Hierarchical Taxonomy of Psychopathology theoretical frameworks, we hypothesized and tested a heuristic model of TCK adjustment, aiming to identify prevention and treatment targets tailored for our sampled population. Methods: We assessed the relationships in the hypothesized models, particularly how perceived and acculturative stress influence TCK adjustment and whether the relationship between the predictors of TCK stress and the outcomes of TCK adjustment are mediated by resilience and family functioning. A total of 143 participants aged 7-17, having relocated internationally with their working parent(s), recruited in local and international schools in Switzerland, were included in this study. Data were collected using an online survey after we collected consent. We assessed factors of adjustment using validated questionnaires: perceived stress and acculturative stress and the potential mediating roles of family functioning and resilience. We measured the outcome of adjustment through mental health difficulties and sociocultural adjustment. We used path analysis to test the model. Results: Results highlight the contributions of perceived stress and acculturative stress to TCK mental health and sociocultural adjustment. We also we found a mediation effect for resilience in the relationship between perceived stress and mental health. Family functioning was not a significant mediator in any relationship that we assessed. Discussion: We discuss implications for future research, promoting TCK adjustment and preventative psychotherapeutic interventions.

Continuing bonds following stillbirth: protective and risk factors associated with parental bereavement adaptation.

OBJECTIVE: To investigate any association between expressions of parents' continuing bond with their stillborn baby and bereavement adaptation. BACKGROUND: Continuing bonds theory suggests that bereaved parents adapt to the loss of their child by sharing and transforming mental representations of the child, allowing them to be integrated into parents' everyday lives. Little is known about the mental health benefits of expressing continuing bonds following stillbirth. This study examined any association between aspects of parents' relationship with their stillborn baby, social support for the relationship, and bereavement adaptation. METHODS: Cross-sectional questionnaire study. Parents of stillborn babies (N=170) completed an online questionnaire examining engagement in continuing bonds expressions; characteristics of parents' relationship with their stillborn baby and their experience of sharing it; social support, and meaning-making. Measures of mental health were included to quantify bereavement adaptation. RESULTS: Regression analyses showed that time since death, meaning-making, engaging with nature, and legacy building are positively linked to bereavement adaptation. Risk factors included inadequate social support for the relationship, a greater desire to share it more freely, an increased sense of integration with baby, and societal pressure to move on. CONCLUSION: Key aspects of parents' ongoing relationship with their stillborn baby and the social context are related to bereavement adaptation.