For many Americans, joint discomfort is that dark cloud hanging over all those sunny, summer plans. But it doesn’t have to be that way. Our friends at Cosamin for Joint Health have put together some essential travel tips to help make sure your next vacation is also a break from joint discomfort.

TRAVEL TIPS FOR JOINT COMFORT

Consider Space
No, we’re not suggesting you visit the Moon. We mean consider the personal space you have on the way to your destination. If you’re flying or taking a train, pay a little more for a seat with extra legroom so you can stretch out. If that price point is too high, try to get an aisle seat so you can easily get up and move around periodically. Keeping your joints limber while you travel is essential for arriving at your destination in comfort so you can get the most enjoyment out of that well-earned vacation.

Roll With It
When it comes to efficiently moving your belongings while you travel, nothing beats a quality rolling bag. By diverting extra weight from your body and reducing heavy lifting, you are taking all that unnecessary pressure off your joints. For even more joint relief, do your best to not over pack so transporting your luggage will be as cool and breezy as that ocean view.

Give It A Rest
It may sound like redundant advice for someone on vacation, but take some time to relax. If your trip involves a lot of walking and movement, be sure to plan some time-outs, whether it’s grabbing a refreshing beverage at a trendy cafe or stopping for a delicious snack. Even if you’re not particularly hungry or thirsty, the “people watching” is always worth the time.

Honesty Is The Best Policy
Chances are you’re not the only one on this vacation and that’s great! What is not great is lying to yourself or your travel partners about your comfort level. If you need a break or want to give that whitewater rafting lesson a pass, let your loved ones know. They will be happy to not see you in discomfort.

New Shoes, You Lose
Going on a more active vacation is probably not the best time to buy new shoes. Instead, go with a trusty pair that offers good support and a lot of traction. If you do want to purchase a new pair, do your research and find shoes designed to distribute weight and reduce stress on your joints. Be sure to give yourself a few weeks to break them in and ensure you are not adding to your discomfort.

Supplement Your Enjoyment
Take a premium glucosamine & chondroitin joint supplement that is clinically proven to help promote joint comfort and mobility both home and abroad. For those planning a more active getaway, a joint supplement specially formulated for faster action will help ensure comfort stays with you every step of the way. Just remember to pack enough pills to get you through your adventure!

For more information about how to improve your joint health, check out How Cosamin Works or talk to your physician about the benefits of Cosamin, a premium joint health supplement.

“They were trying a different approach,” says Kolzig, 45, who played nearly his entire career with the Washington Capitals. “They felt the hospital wasn’t the best place for my recovery, so they set up a hotel room with a hospital bed.”

It’s a philosophy that I, as an orthopedic surgeon (www.alexanderorthopaedics.com) continue to promote. I’m a pioneer in the effort to allow patients who undergo total-joint arthroplasty to spend their recovery away from the antiseptic walls of a hospital.

While with Kolzig that meant a hotel room, for most of my patients it involves heading home after surgery to recover in familiar surroundings, aided by family and home healthcare professionals.

It takes away a lot of the nervousness about being in a hospital that so many people have. People are more comfortable and recover better when they are in their own homes.

There are other advantages to handling these knee, hip and shoulder surgeries – which I perform in my practice’s own surgical center – on an outpatient basis.

We have helped eliminate over and under medication by hospital nurses, and have lessened the risk of infection.

Total-joint arthroplasty is the surgical replacement of a joint or joint surface with artificial materials, such as metal and high-density plastic. Kolzig, for example, suffered a degeneration of his hip that became worse and worse until bone was scraping against bone.

The procedure he underwent is called a Birmingham hip resurfacing. Unlike a total hip replacement, where the bone in the ball-and-socket hip joint is removed, just a few centimeters of the bone are resurfaced.

Traditionally, total-joint arthroplasty requires a three to four-day hospital stay where the patient is managed medically and orthopedically while they recover from the surgery.

But I believe that hospital stay isn’t necessary – or even desirable – for many patients, which is why I began offering the surgeries on an outpatient basis five years ago, making ,e one of a handful of surgeons doing that nationally.

This especially appeals to patients who are in their 40s and 50s and need joint replacement sooner than they expected. Probably 60 percent of my patients are middle-aged, weekend athletes.

Not all patients are ideal to have their surgical recovery handled on an outpatient basis. The best candidates are:

• Younger than 65
• Healthy and mobile
• Have a good support system at home

I envision this approach as the wave of the future in orthopedics. In five to 10 years, outpatient will be part of the normal discussion when doing a consultation on joint replacement. It is a better technique and a safer technique. And I think there is just this peace of mind from the patients’ point of view when they know they will go home immediately and spend their recovery time in comfortable surroundings.

Olie Kolzig is certainly happy with the success of his procedure. As a player development coach with the Capitals, he still takes to the ice regularly to work out with younger athletes.

He also golfs and paddle boards.

There is nothing I do that is ever impeded by my hip,” Kolzig says. “No limitations. No aching. No twinges. Nothing like that. The only negative is I set off the metal detector when I go to the airport.”

Dr. Vladimir Alexander is an orthopedic surgeon and founder of Alexander Orthopaedic Associates (www.alexanderorthopaedics.com), which offers patients the latest in cutting-edge technology and new advances in orthopedic surgery and care. He specializes in disorders of the shoulder, hip and knee, including total-joint arthroplasty and Birmingham hip resurfacing. Dr. Alexander earned his undergraduate degree at The John Carroll University in Ohio and his medical degree at The Ohio State University College of Medicine.

A releasr from AAOS notes that hip fractures, common in older adults, often occur due to falls or slips because bones are fragile.

The release quotes Robert Quinn, MD, AUC Section Leader for the AAOS Committee on Evidence-Based Quality and Value, as saying, “Hip fractures are one of the most feared injuries in older adults because this trauma creates pain and can force a change in lifestyle or limited mobility. We are providing evidence-based assistance for physicians and patients to determine the best course of action for surgery and follow-up care.”

Pinning bones back together using surgical screws versus reconstructing the hip joint through total hip replacement (THR) surgery has long been debated. The AUC criteria rely on peer-reviewed studies and practices to recommend different procedures depending on a patient’s individual indications such as activity levels, bone and joint health, location(s) of the fracture, and whether the break is stable or displaced. The AUC addresses patients age 60 and above with fractures caused by low-impact events.

The AUC panel included physicians and physical therapists from leading academic medical centers, in addition to orthopaedic and other professional medical societies, who reviewed 30 potential patient scenarios to create the “Appropriate Use Criteria for the Treatment of Hip Fractures in the Elderly.” Each treatment in each patient scenario is rated “appropriate,” “may be appropriate,” and “rarely appropriate.”

For example, THR is rated “appropriate” for a highly active patient with a non-displaced fracture in the neck of the femur bone. However, the same procedure is “rarely appropriate” for a non-ambulatory patient.

Another example rates reattaching bone with a specific type of screw (sliding hip anti-rotation screws) as “appropriate” for highly active patients with and without arthritis who have a stable fracture of the intertrochanteric crest, located near the top of the femur.

Dr. Quinn added that in some cases, the AUC review panel did not reach consensus on a single best course of action due to surgeons’ preferences and multiple correct treatments for surgery.

Accompanying the AUC, the AAOS created a “Preoperative Checklist” to assist surgeons and allied medical providers in delivering quality care to patients by completing 12 important initiatives. They include limiting preoperative traction; managing Warfarin, a blood-thinning medication; and discussing the patient’s home environment prior to discharge.

Hip fracture recovery guidelines

The second AUC, “Appropriate Use Criteria for Postoperative Rehabilitation for Low Energy Hip Fractures in the Elderly,” provides universal recommendations for recovery across elderly patient populations including:

• Interdisciplinary care to prevent deep vein thrombosis
• Prevention or management of postoperative delirium
• Multi-modal perioperative pain management
• Interdisciplinary management of recovery at rehabilitation and skilled-nursing facilities
• Home care therapy following discharge
• Osteoporosis assessment and management.

Supplementing the AUC, a “Perioperative Prevention of Future Fractures Checklist,” emphasizes important follow-up measures to reduce patients’ risk for future injuries. Participation in a fall prevention program, and supplements and medications to improve bone density are among the recommendations.

“It is very important to think ahead to make the right care choices after a fracture is repaired. Not only can this help patients recover, but this also helps prevent fractures from happening again, which is a big problem,” Dr. Quinn said.

AAOS created the AUCs following the 2014 release of the Clinical Practice Guideline (CPG) “Management of Hip Fractures in the Elderly,” which gives a broad overview of care options. In contrast, the AUC provides guidance for circumstances when a specific surgical procedure should be applied.

The sweeping new analysis shows that the most experienced skilled nursing facilities were more than twice as likely as the least experienced to discharge patients successfully back to the community within 30 days of breaking a hip. The results, led by Brown University researchers, appear in the Journal of the American Geriatrics Society.

A release from the university quotes lead author Pedro Gozalo, associate professor (research) of health services, policy and practice in the Brown University School of Public Health, as saying, “While volume is not a direct measure of post-acute care quality, it appears that it is a good proxy that captures hard-to-measure aspects of quality, like the expertise of the staff, that are clearly associated with an outcome that patients care about: returning home soon and in a condition that allows them to remain at home without further institutionalization in a hospital or a nursing home.”

Gozalo and his colleagues reviewed records of more than 512,000 patients age 75 and older who sought care at more than 15,400 skilled nursing facilities between 2000 and 2007. The researchers measured the volume of cases at each of the facilities in the 12 months leading up to each admission and noted whether the patient was discharged to the community within 30 days.

In all, about 31 percent of people were able to return home within a month, but that rate varied widely among facilities of different experience. The rate of successful discharge from facilities with more than 24 cases in the prior year was 43.7 percent, but it was only 18.8 percent at facilities with one to six cases a year.

To check whether this could be for some reason other than volume, Gozalo and his colleagues statistically accounted for a large number of attributes of the patients and of the facilities, such a nurse and therapist staffing levels.

“Even adjusting for a long list of patient risk factors and for important facility characteristics, facilities that had cared for more than two dozen hip fracture patients in the last 12 months were more than twice as likely to successfully discharge patients in a timely manner compared to facilities that had three or less hip fracture admissions,” Gozalo said.

You better shop around

The study also revealed that many patients are not going to higher-volume facilities, even though they could. According to the records, more than 70 percent of people who went to a lower-volume facility could have found a higher-volume facility within 10 miles.

That finding, Gozalo said, suggests that people don’t have much information about quality. The Centers for Medicare and Medicaid Services make some information available, but that can be hard for many families to access and interpret. Hospital discharge planners also vary widely in what information they provide to families.

“Based on our results, it would seem that in addition to any other sources of information and recommendations the family can get, they should definitely ask each facility they are considering what was the number of hip fractures they cared for in the last year,” Gozalo said. “It’s a basic but very informative predictor of how well their loved one may fare at that facility.”

A study by the Johns Hopkins Bloomberg School of Public Health found frailty to be more prevalent in older people and more common among women and the poor. In addition, the study found wide regional differences in the U.S., with older people in central southern states more than three times as likely to be frail than those in the western states. The researchers also found significant racial differences, with blacks and Hispanics nearly twice as likely to be frail as whites.

The study was published in Journals of Gerontology: Medical Sciences.

Frailty, once thought of as a generalized state that befalls some people as they get older, is increasingly considered a medical process in and of itself. Frailty is thought to be exhibited by a set of symptoms including weakness, exhaustion and limited mobility. It often progresses separately from any underlying conditions, and is also common among patients with chronic diseases such as heart disease and diabetes, especially in their advanced stages.

Understanding frailty, and finding ways to prevent its onset or slow its progression, could improve older people’s quality of life by extending their so-called robust years. It could also increase their chances of surviving surgery, for example; previous research has suggested that older, frail patients are less likely to survive major surgical procedures. Reducing frailty could lower health care costs, since frail persons are prone to falls and falls often lead to hospitalization. Hospital care is the largest component of Medicare spending.

Of their findings, the authors were most surprised by the significant racial and regional differences, says study leader Karen Bandeen-Roche, PhD, the Frank Hurley and Catharine Dorrier Professor and Chair of the Department of Biostatistics at the Johns Hopkins Bloomberg School of Public Health. The study is believed to be the first that examines regional differences in frailty in the U.S.

“We can’t really explain the regional differences,” says Bandeen-Roche, who also co-directs the Johns Hopkins Older Americans Independence Center and is a Core Faculty member at the Johns Hopkins Center on Aging and Health. “We know there are health differences across the country, differences in diet and to some extent exercise habits. Observing the relatively low prevalence in the mountain west, you can imagine an active lifestyle might be a factor.” As for the racial differences, Bandeen-Roche says it’s too early to speculate and that they merit further study.

For the study, researchers drew on interviews with 7,439 participants in the 2011 National Health and Aging Trends Study, a longitudinal study of people age 65 and older drawn from Medicare records. Participants, who resided either at home or in an assisted living facility, completed a two-hour, in-person interview that assessed frailty using several criteria: exhaustion, weakness, low physical activity, shrinking and low walking speed. Participants were also asked about their medical history and ability to perform daily tasks such as meal preparation and other household activities. The researchers also assessed probable dementia.

Aside from the 15 percent found to be frail, the researchers also found that 45 percent were what the authors deemed “pre-frail,” or older people who have begun to experience the same symptoms of frailty, but to a lesser extent. “It’s a question of degree,” Bandeen-Roche says. The so-called pre-frail are a prime target of study in order to help researchers understand the progression of frailty so doctors can develop recommendations – for instance, changes in diet or exercise – that could extend a person’s robust years.

“We would love for frailty assessment to become a standard component of assessment of older Americans,” Bandeen-Roche says. “Understanding frailty could potentially help us extend people’s quality of life into their later years.”