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Invited Commentary
June 2018

Hip Fractures in Patients With Advanced Dementia: What Treatment Provides the Best Palliation?

Author Affiliations
  • 1Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia
  • 2Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia
JAMA Intern Med. 2018;178(6):780-781. doi:10.1001/jamainternmed.2018.0822

Nursing home residents sustaining a hip fracture have poor outcomes both in terms of survival and ambulation. Using US Medicare data on nursing home residents from 2005 through 2009, Neuman and colleagues1 found that by 6 months after the fracture, 36.2% had died; moreover, among residents who were not totally dependent in prefracture locomotion, 54% had either died or developed new total dependence. Nonetheless, unless patients are imminently dying, conventional wisdom suggests that the advantages of repairing hip fractures in terms of managing pain and facilitating mobility usually outweigh the disadvantages. These issues are particularly pertinent for nursing home residents with advanced dementia for whom a goal of maintaining comfort is often the predominant preference of their proxy decision maker.2 However, the literature contains limited information to guide proxy decision makers regarding short- and long-term outcomes of operative or nonoperative management of hip fracture in these patients.

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