Nursing home residents who undergo surgical repair for hip fractures have a lower rate of death than residents who opt for comfort care in lieu of surgery, according to the findings of a new study.
Harvard researchers compared approaches toward hips fractures in nursing home residents with dementia. Some residents had surgery to repair the hip fracture and others opted for palliative care, which focuses on symptoms and pain relief. The findings of the study were published May 7, in the journal JAMA Internal Medicine.
Data on nearly 3,100 nursing home residents with advanced dementia and hip fractures were evaluated by researchers from the Hebrew SeniorLife’s Institute for Aging Research and Brown University. Follow-up was conducted over two years.
According to the findings, death rates were 12% lower among nursing home residents whose hip fractures were treated with surgery, compared to those who received palliative care. Patients who underwent surgery for hip fractures not only had lower death rates, they also experienced less pain and fewer pressure ulcers than patients who chose palliative care.
Patients in both groups who survived by the six month mark experienced pain, antipsychotic drug use, physical restraint use, pressure ulcers, and loss of ambulation. These conditions and measures were common, regardless of whether the patient was treated surgically or with palliative management. In fact, few patients in either group were able to walk again after fracturing their hip.
This is the first study to focus on outcomes among nursing home residents with advanced dementia who also experienced hip fractures. Researchers suggest there may be a need for improvements in the quality of care provided to nursing home residents, especially those suffering from dementia. However, there may be a survival benefit to undergoing surgery after hip fracture compared to palliative care.
They also noted the decision to undergo surgery can be a difficult one to make. However, information should be provided to both residents and their family members to help work toward nursing home resident goals.