Stephen J.LurieMD, PhD, Senior EditorPhil B.FontanarosaMD, Executive Deputy Editor
To the Editor: Drs Morrison and Siu1 stressed the need for comfort care, rather than aggressive treatment, for patients with advanced dementia who have hip fracture or pneumonia. Although both conditions are common in the elderly, they differ drastically in their rationale for hospitalization and, therefore, require different management.
Treatment of hip fracture necessitates surgery and hospitalization. The procedures in the authors' hospital apparently have not been modified to accommodate the special needs of patients with dementia. For individuals with dementia, the admission process and preoperative evaluation must be streamlined. In a dedicated dementia unit, patients with hip fractures should stay in bed until they are scheduled for surgery. Preoperative evaluation and surgery can be done frequently on the same day. The stay in the hospital should range between 3 and 5 days. Rehabilitation of gait is successful in less than 50% of patients, but no significant increase in mortality was observed (author's unpublished data). It is possible that the "application of distressing and painful procedures" during hospitalization contributes to the low survival rates.
Liss L. Mortality From Pneumonia and Hip Fractures in Patients With Advanced Dementia. JAMA. 2000;284(19):2447-2448. doi:10.1001/jama.284.19.2447-JLT1115-3-1