|Title||High levels of geriatric palliative care needs in hip fracture patients before the hip fracture.|
|Publication Type||Journal Article|
|Year of Publication||2016|
|Authors||Ritchie, CS, Kelley, AS, Cenzer, I, Wallhagen, ML, Covinsky, KE|
|Journal||Journal of Pain and Symptom Management|
|Keywords||Hip fracture, Hospitalization, Older Adults, Palliative care|
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. While 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 prior to 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 prior to 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: 856 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 (ADL 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 healthcare 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.
CONCLUSION: A significant proportion of older adults have evidence of functional and medical vulnerability prior to 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.
|Alternate Journal||J Pain Symptom Manage|