Hip Fracture in the Elderly Patients: A Sentinel Event

Abstract

Hip fracture in elderly patients is an important opportunity to reassess the patient's personal health-care priorities. Advance directives, goals of care, and code status documentation should be updated in all elderly patients with hip fracture, should the patient's health decompensate.

Haemoglobin and transfusions in elderly patients with hip fractures: the effect of a dedicated orthogeriatrician

“…Hip fractures are common in elderly patients [ 1 – 6 ]. They can be classified as medial, or intracapsular fractures, related to an increased risk of osteonecrosis of the femoral head [ 7 – 12 ] and lateral, or extracapsular fractures [ 13 – 16 ].…”

“…Type II osteoporosis, which is age-related, is a risk factor for both female and male patients [ 2 , 17 , 18 , 20 ]; type I, postmenopausal, is responsible for the increased incidence of hip fractures in female patients [ 21 – 23 ]. Most patients report an accidental fall, often the result of a bone failure related to advanced osteoporosis [ 1 , 2 , 4 , 6 ]. These patients often have comorbidities, especially cardiovascular [ 1 , 4 , 16 , 24 – 26 ].…”

“…Most patients report an accidental fall, often the result of a bone failure related to advanced osteoporosis [ 1 , 2 , 4 , 6 ]. These patients often have comorbidities, especially cardiovascular [ 1 , 4 , 16 , 24 – 26 ]. In patients with hip fractures, it is important to monitor blood loss caused by both trauma and subsequent surgical treatment.…”

Advance Care Planning Prior to Death in Older Adults with Hip Fracture

“…2,3 These factors, coupled with the approximately 20-30% 1-year mortality rate, demonstrate the need for advance care planning (ACP) in older adults who sustain a hip fracture. 4 Through ACP, individuals share their values and preferences regarding future medical care. This is typically done via advance directives (ADs), which are written statements of a person's wishes, and surrogate decision-makers, who are appointed to make medical decisions in the event an individual is unable to do so themselves.…”

“…Two prior studies that measured ACP in this population were retrospective, limited to a small number of participants from a single center, and only assessed ACP documented in the medical record during the initial hospitalization; thus, these studies were unable to comment on ACP occurring outside these confines. 4,8 A clear understanding of ACP and the factors associated with its absence at the end of life can provide clinicians with important contextual information to inform the care of this often frail and elderly population.…”