High Levels of Geriatric Palliative Care Needs in Hip Fracture Patients Before the Hip Fracture.

TitleHigh Levels of Geriatric Palliative Care Needs in Hip Fracture Patients Before the Hip Fracture.
Publication TypeJournal Article
Year of Publication2016
AuthorsRitchie, CS, Kelley, A, Cenzer, I, Wallhagen, M, Covinsky, KE
JournalJ Pain Symptom Manage
Date Published2016 10
ISSN Number1873-6513
KeywordsActivities of Daily Living, Aged, 80 and over, Dementia, depression, Female, Hip Fractures, Humans, Interviews as Topic, Male, multimorbidity, pain, Palliative care, Patient Acceptance of Health Care, Prodromal Symptoms, Vulnerable Populations

CONTEXT: Most hip fracture care models are grounded in curative models where the goal is to return the patient to independent function. In many instances, however, hip fractures contribute to continued functional decline and mortality. Although the negative impact of hip fractures is appreciated once they have occurred, what is less understood is what proportion of older adults have high illness burden before experiencing hip fracture and might benefit from geriatric palliative care.

OBJECTIVES: Using data from the Health and Retirement Study linked to Medicare claims (January 1992 through December 2010), we sought to understand the extent of premorbid illness burden before hip fracture.

METHODS: Characteristics were based on the interview before hip fracture. Features used to indicate need for geriatric palliative care included evidence of functional and medical vulnerability, pain, and depression.

RESULTS: Eight hundred fifty-six older adults who experienced a hip fracture were compared to 851 age-, gender-, and race-matched controls. Older adults with hip fractures had significantly more premorbid functional vulnerability (activities of daily living dependent 25.7% vs. 16.1% [P < 0.001]; dementia 16.2% vs. 7.3% (P < 0.001); use of helpers 41.2% vs. 28.7% [P < 0.001]). They also experienced more medical vulnerability (multimorbidity 43% vs. 29.8% [P < 0.001]; high health care utilization 30.0% vs. 20.9% [P < 0.001]; and poor prognosis 36.1% vs. 25.4% [P < 0.001] in controls). There was no difference in premorbid pain and depression between subsequent hip fracture patients and controls.

CONCLUSIONS: A significant proportion of older adults have evidence of functional and medical vulnerability before hip fracture. For these individuals, integration of geriatric palliative care may be particularly important for optimizing quality of life and addressing the high morbidity experienced by this population.

User Guide Notes


Alternate JournalJ Pain Symptom Manage
Citation Key8583
PubMed ID27521282
PubMed Central IDPMC5357076
Grant ListK23 AG040774 / AG / NIA NIH HHS / United States
K07 AG031779 / AG / NIA NIH HHS / United States
R01 NR013347 / NR / NINR NIH HHS / United States
K23 AG040772 / AG / NIA NIH HHS / United States
K24 AG029812 / AG / NIA NIH HHS / United States
P30 AG044281 / AG / NIA NIH HHS / United States