The goals of care in acute setting for geriatric patients in case of a hip fracture

Abstract

Purpose For geriatric hip fracture patients, the decision between surgery and palliative, non-operative management is made through shared decision making (SDM). For this conversation, a physician must be familiar with the patient’s goals of care (GOC). These are predominantly unknown for hip fracture patients and challenging to assess in acute setting. The objective was to explore these GOC of geriatric patients in case of a hip fracture. Methods An expert panel gathered possible outcomes after a hip fracture, which were transformed into statements where participants indicated their relative importance on a 100-point scoring scale during interviews. These GOC were ranked using medians and deemed important if the median score was 90 or above. Patients were aged 70 years or older with a hip contusion due to similarities with the hip fracture population. Three cohorts based on frailty criteria and the diagnosis of dementia were made. Results Preserving cognitive function, being with family and being with partner scored in all groups among the most important GOC. Both non-frail and frail geriatric patients scored return to pre-fracture mobility and maintaining independence among the most important GOC, where proxies of patients with a diagnosis of dementia scored not experiencing pain as the most important GOC. Conclusion All groups scored preserving cognitive function, being with family and being with partner among the most important GOC. The most important GOC should be discussed when a patient is presented with a hip fracture. Since patients preferences vary, a patient-centered assessment of the GOC remains essential.

Beyond Mortality: Severely Frail Femur Fracture Patients Can Regain Independence after Surgery

“…This study has several limitations. Given the target population, there was an expectedly low response rate of 42%, introducing a risk for non-response bias; however, the low response rate seen mirrors previously conducted patient-and/or proxy-reported survey studies among fracture patients, with response rates ranging between 38 and 66% [38,39,[41][42][43][44]. Moreover, the response rate was impacted by the number of patients who had already died by the time of survey administration.…”

Dementia and Hip Fractures

“…Figure 1 shows specific topics to investigate when speaking with patients and families. These 13 questions cover 3 main domains in the goals-of-care discussion, namely feelings about postoperative outcomes, quality of life, and the rehabilitation process 29 . For hip fracture patients aged 70 years or older, the most important goals of care were preserving cognitive function, being with family, and being with a partner 29 .…”

“…These 13 questions cover 3 main domains in the goals-of-care discussion, namely feelings about postoperative outcomes, quality of life, and the rehabilitation process 29 . For hip fracture patients aged 70 years or older, the most important goals of care were preserving cognitive function, being with family, and being with a partner 29 . Interestingly, those with dementia ranked “not experiencing pain” as the most important goal of care.…”

Patient and proxy perspectives in decision-making for geriatric hip fracture management in the Netherlands: a qualitative study

“…In an acute setting, the treating physician can initiate a shared decision-making (SDM) process to determine the course of treatment based on the patient’s GOC. 14 For hip fracture patients, these GOC serve as the cornerstone in selecting the most suitable course of action, emphasising the vital role of the patient’s perspective in SDM. 11 14 Recent work into the most important GOC for geriatric patients in the case of hip fracture has shown heterogeneity between patients’ and proxies most important GOC.…”

“… 11 14 Recent work into the most important GOC for geriatric patients in the case of hip fracture has shown heterogeneity between patients’ and proxies most important GOC. 14 …”