Hip Fracture Management in Advanced Dementia Patients

Hip Fracture Management in Advanced Dementia Patients - #89

Take Quiz

Older adults presenting with hip fracture in the setting of underlying advanced dementia.

Thoughtfully consider and present surgical and non-surgical care options for hip fracture in advanced dementia patients, weighing risk and benefit in light of determined patient and surrogate goals of care.  

  1. Identify advanced dementia as a risk factor for high morbidity and mortality after hip fracture. 
  2. List three considerations to assist in determination of appropriate post-fracture management of patients with advanced dementia and hip fracture. 
  3. Explain the options towards pain reduction in hip fracture management of patients with advanced dementia.
     

1.    Handoll, H. H., & Parker, M. J. (2008). Conservative versus operative treatment for hip fractures in adults. Cochrane database of systematic reviews, (3).
2.    Mears, S. C. (2014). Classification and surgical approaches to hip fractures for nonsurgeons. Clinics in geriatric medicine, 30(2), 229-241.
3.    Folbert, E. C., et al. "Improved 1-year mortality in elderly patients with a hip fracture following integrated orthogeriatric treatment." Osteoporosis International 28.1 (2017): 269-277.
4.    Schnell, Scott, et al. "The 1-year mortality of patients treated in a hip fracture program for elders." Geriatric orthopaedic surgery & rehabilitation 1.1 (2010): 6-14.
5.    Friedman, Susan M., et al. "Geriatric co‐management of proximal femur fractures: Total quality management and protocol‐driven care result in better outcomes for a frail patient population." Journal of the American Geriatrics Society 56.7 (2008): 1349-1356.
6.    Johnston, C. Bree et al.  “Hip Fracture in the Setting of Limited Life Expectancy: The Importance of Considering Goals of Care and Prognosis.”  Journal of Palliative Medicine.  Volume 21, Number 8 (2018): 1069-1073.  
7.    Alvi, Hasham M., et al. "Time-to-Surgery for Definitive Fixation of Hip Fractures: A Look at Outcomes Based Upon Delay." American journal of orthopedics (Belle Mead, NJ) 47.9 (2018).
8.    Schnell, Scott, et al. "The 1-year mortality of patients treated in a hip fracture program for elders." Geriatric orthopaedic surgery & rehabilitation 1.1 (2010): 6-14.
9.    Berry, Sarah D et al.  “Association of Clinical Outcomes with Surgical Repair of Hip Fracture vs   Nonsurgical Management in Nursing Home Residents with Advanced Dementia.”  JAMA Internal Medicine.  2018: 178 (6): 774-780. 
10.    Moerman, Sophie, et al. "Less than one‐third of hip fracture patients return to their prefracture level of instrumental activities of daily living in a prospective cohort study of 480 patients." Geriatrics & gerontology international 18.8 (2018): 1244-1248. 
11.    Neuman, Mark D., et al. "Survival and functional outcomes after hip fracture among nursing home residents." JAMA internal medicine 174.8 (2014): 1273-1280.
 

You voted '3'.
This GFF ___ my competence in geriatrics.

Elizabeth A. Bukowy, DO
Assistant Professor of Medicine (Geriatrics, Hospice and Palliative Care)
Medical College of Wisconsin

Elizabeth Thiel, MD
Associate Professor of Medicine (Hospice and Palliative Care)
Medical College of Wisconsin