Ethical Dilemmas with Regard to Elderly Patients with Hip Fracture: The Problem of Nonagenarians and Centenarians

Herrera-Pérez, Mario; González-Martín, David; Sanz, Emílio J.; País-Brito, José Luis

doi:10.3390/jcm11071851

Cited by 8 publications

(3 citation statements)

References 37 publications

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“…The involvement of geriatricians in this decision-making process is crucial in the very elderly, as is taking into consideration the patient’s rights and wishes. 33 Furthermore, the multidisciplinary team should work to minimize surgery time, optimize the patient prior to surgery, mobilize the patient early and prevent postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Demographic Characteristics of Centenarians versus Other Age Groups Over 75 Years with Hip Fractures

Boixareu¹,

Ojeda-Thies²,

Valtueña³

et al. 2023

CIA

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Objective The primary objective was to describe the clinical characteristics, management, and outcomes of centenarians with fragility hip fracture and compare them to other age groups. The secondary objective was to determine the variables associated with length of stay, in-hospital mortality and 30-day mortality. Materials and Methods This is a secondary analysis of the Spanish National Hip Fracture Registry. We included patients ≥75 years admitted for fragility hip fractures in 86 Spanish hospitals between 2017 and 2019, dividing the sample into four age groups. The variables studied were baseline characteristics, type of fracture, management, length of stay, in-hospital mortality and 30-day mortality. Results We included 25,938 patients (2888 were 75–79 years old; 14,762 octogenarians; 8,035 nonagenarians and 253 centenarians). Of the centenarians, 83% were women, 33% had severe dementia, 9% had severe dependency and 36% lived in residential care homes. Six out of ten had intertrochanteric fracture. Length of hospital stay was 8.6 days; in-hospital mortality was 10.3% and 30-day mortality 20.9%. Older age groups had more women, severe functional dependency, severe dementia, intertrochanteric fracture, living in care facilities and being discharged to nursing care. They had less frequent early mobilization, osteoporosis treatment and discharge to rehabilitation units. In-hospital and 30-day mortality were higher with increasing age. In centenarians, time to surgery >48 hours was independently associated with length of stay (correlation coefficient 3.99 [95% CI: 2.35–5.64; p<0.001]) and anaesthetic risk, based on an ASA score of V, was related to 30-day mortality (ASA score II [OR 0.25, 95% CI: 0.09–0.70; p=0.009] and ASA score III [OR 0.43, 95% CI: 0.19–0.96; p=0.039]). Conclusion Centenarians had different clinical characteristics, management and outcomes. Although centenarians had worse outcomes, nearly 4 out of 5 centenarians were alive one month after surgery.

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Section: Discussionmentioning

confidence: 99%

Clinical and Demographic Characteristics of Centenarians versus Other Age Groups Over 75 Years with Hip Fractures

Boixareu¹,

Ojeda-Thies²,

Valtueña³

et al. 2023

CIA

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“…The sensory qualities of set dahi were evaluated in the study, including colour and appearance, flavour, body and texture, and overall acceptance. The sensory evaluation tool used a nine-category hedonic grading system: dislike extremely (1), dislike very much (2), dislike moderately (3), slightly dislike (4), neither like nor dislike (5), slightly like (6), moderately like (7), like very much (8), and extremely like (9).…”

Section: Sensory Analysismentioning

confidence: 99%

Development and Validation of Flaxseed Lignan-Enriched Set-Type Fermented Milk to Manage Postmenopausal Osteoporosis

Thomas,

Panjagari,

Ganguly

et al. 2024

Fermentation

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A functional set dahi (fermented milk analogous to yoghurt) with a desirable probiotic (Lactiplantibacillus plantarum A5) count of 9.36 log CFU/mL and excellent techno-functional attributes (DPPH: 41.95% RSA, firmness: 485.49 g, sensory overall acceptability: 8.51) was developed to contain 260 mg of SDG in 20 g of dahi. Twenty-four female Albino Wistar rats (3 months old, >180 g) were ovariectomized (OVX) and divided into three groups: OVX control, OVX and control dahi, and OVX and SDG-enriched dahi. The animal study found that ovariectomy decreased serum calcium, oestrogen, and bone ash calcium levels by 32.27, 30.95, and 48.46 percent, respectively, compared to the sham group (n = 8), while daily administration of SDG-enriched dahi (20 g) for eight weeks restored them. The proximal tibial metaphysis and distal femoral epiphysis micro-CT study showed that the ovariectomy lowered bone mineral density (BMD) by 11.06% and 9.18%, respectively, and lowered Trabecular thickness (Tb. Th) by 12.66% and 11.86%, respectively, while increasing Trabecular separation (Tb. Sp.) by 90.69% and 87.70%, respectively, compared to the sham control-group rats. SDG-enriched dahi improved BMD by 16.06 and 12.24% and Tb. Th by 35.32 and 19.62%, respectively, and decreased Tb. Sp by 47.04 and 47.22%, respectively, in OVX rats. The results suggest that the developed set dahi may help treat postmenopausal osteoporosis.

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“…At present, there is a lack of agreement concerning the most effective approach to treating individuals aged 90 and above who have suffered a hip fracture. Surgeons and patients are often hesitant to proceed with surgery due to concerns over advanced age and pre-existing comorbidities that may lead to postoperative complications and mortality 9 , 10 . While certain experts 11 , 12 particularly regarding the survival results, have indicated advantages, there is concern 13 – 17 among certain research that high proportion of complication rates after surgery were observed whether they had been treated surgically or conservatively.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of surgical intervention over conservative management in intertrochanteric fractures among nonagenarians and centenarians: a prospective cohort study

Guo,

Xu,

Geng

et al. 2024

International Journal of Surgery

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Background: Optimal treatment strategy for nonagenarians and centenarians with hip fractures (NCHF) remained unknown. We aimed to compare the outcomes of surgical and conservative management in NCHF. Methods: A prospective cohort study was conducted based on CPMHF database with NCHF patients hospitalized during 2014–2020. Comorbidities were evaluated by mECM score and restricted cubic spline was utilized to visually assess the dose-effect relationship between the mECM and outcomes. Propensity score matching was performed to balance baseline characteristics between non-surgical and surgical groups. Multivariate logistic regression, Cox proportional hazard analysis, and survival analysis were employed for unfavorable outcomes (UFO) evaluation. Competing risk of death were analyzed based on Fine and Gray’s hazard model and then constructed nomogram models for predicting survival rates. Subgroup analyses were used to determine potential population heterogeneity and sensitivity analyses were performed to test robustness of the results. Results: We found increasing trends for UFO with the increase in the mECM score, and that high mECM score (HMS, ≥3) was independently associated with a 2.42-fold (95%CI, 2.07-3.54; P=0.024) increased risk of UFO, which remained significant after considering the competing role of death and were more pronounced in non-surgical treatment, women, no insurance, and patients with spouse (all P for interaction<0.05). Surgical intervention was identified to be significant protective factors for UFO (RR, 0.59; 95%CI, 0.46-0.75; P<0.001) and severe complications (RR, 0.63; 95%CI, 0.41-0.96; P=0.033) after PSM, as well as survival (HR, 0.40, 95%CI, 0.28-0.58; P<0.001), which remained significant after considering the competing role of death and in all sensitivity analyses and were more pronounced in HMS participants (P for interaction=0.006). Subgroup analyses revealed surgical patients with HMS had a significantly higher UFO rate (excluding death, P<0.001) while non-surgical patients with HMS had higher mortality rate as compared to the others (P=0.005). Conclusion: Surgical treatment for NCHF yields better outcomes compared to conservative treatment.

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Ethical Dilemmas with Regard to Elderly Patients with Hip Fracture: The Problem of Nonagenarians and Centenarians

Cited by 8 publications

References 37 publications

Clinical and Demographic Characteristics of Centenarians versus Other Age Groups Over 75 Years with Hip Fractures

Clinical and Demographic Characteristics of Centenarians versus Other Age Groups Over 75 Years with Hip Fractures

Development and Validation of Flaxseed Lignan-Enriched Set-Type Fermented Milk to Manage Postmenopausal Osteoporosis

Efficacy of surgical intervention over conservative management in intertrochanteric fractures among nonagenarians and centenarians: a prospective cohort study

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