Should a hip fracture in a frail older person be a trigger for assessment of palliative care needs?

Shared decision-making for the treatment of proximal femoral fractures in frail institutionalised older patients: healthcare providers’ perceived barriers and facilitators

“…Previous research on barriers reported by patients showed that the uncertainty of lack of consensus about treatment decisions, concerns regarding adverse effects and poor healthcare provider communication were the main barriers [ 32 ]. Uncertainty is an important topic in the treatment of proximal femoral fractures, especially with regards to NOM in patients with a limited life expectancy [ 10 ]. This was also reflected in our study, as many healthcare providers indicated they would like to receive more feedback on patients’ well-being after SDM, how patients felt about the SDM conversation and the satisfaction with the decision made, which indirectly indicates a lack of transmural feedback.…”

“…Surgery with rehabilitation goals is the mainstay of care [ 9 , 10 ]. However, goals of care of the frailest patients often do not concern rehabilitation, but primarily focus on (HR)QoL and comfort [ 11 , 12 ].…”

Hip Fracture in the Elderly Patients: A Sentinel Event

“…Given the high morbidity and mortality, it is reasonable to incorporate palliative care in the care of the patient with geriatric hip fracture. One suggested screening method to increase palliative care consultation is “Would it be surprising if this patient died within 1 year?” 44 Despite low overall palliative care referrals in our sample, the risk ratios for patient death, particularly at 60 days, indicate that referrals are being made for patients who are likely to die. The NNT of 3 compares favorably with other interventions in hip fracture and indicates that this population may benefit from more liberal use of palliative care services.…”

Principles of Fracture Management

“…Research increasingly shows that some conditions are lifelimiting. One example is hip fracture which often occurs in very frail elderly patients and may need to instigate a sensitive discussion about the need to implement end of life care (Murray et al, 2012). Decisions and discussions about such matters may not have been, but will need to be, part of the orthopaedic practitioners' skills set as the quality of end of life care reaches a more prominent place in all settings.…”