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We thank Dr Hyams for his thoughtful comments about our article. He raises an important question: will we (or other physicians) unnecessarily confine some patients to bed and chair for the remainder of their lives by not treating their hip fractures?
The patients who were the subject of our report all had severe organic mental syndromes prior to their fractures. (Although our methods of evaluation of mental status were not discussed in the report, we always make every effort to exclude severe depression, thyroid diseases, intercurrent infection, anemia, and other treatable causes of organic mental syndrome before labeling a patient as senile.) The five conservatively treated patients, as well as three more that we have treated similarly since the report was submitted for publication, were already suffering from one or more chronic illnesses requiring prolonged or permanent nursing home care. Only one was independently ambulatory before the hip
Lyon LJ, Nevins MA. Nontreatment of Hip Fractures-Reply. JAMA. 1978;239(15):1492–1493. doi:10.1001/jama.1978.03280420028010