Nursing home residents with advanced dementia have lower mortality rate with hip surgery

Researchers from Hebrew SeniorLife's Institute for Aging Research and Brown University have conducted the first study to examine outcomes in nursing home residents with advanced dementia and hip fracture. They discovered that advanced dementia residents have a lower mortality rate after 6 months, if they undergo surgical repair. Those advanced dementia patients managed with surgery also reported less pain and fewer pressure ulcers than those whose proxies chose a palliative care approach in lieu of surgery.

The study was published today in the JAMA Internal Medicine, and examined 3,083 nursing home residents with advanced dementia and hip fracture. Researchers caution that although residents who underwent surgery had a modest improvement in outcomes, pain, pressure ulcers, and antipsychotic use were common among advanced dementia residents with hip fracture that survived six months, regardless of surgical management. Further, few survivors in either cohort were ever able to walk again following surgery or palliative care measures. Researchers say their finding suggest the need for broad improvements in the quality of care provided to nursing home residents.

Sarah Berry, M.D., M.P.H, lead author on the study and Associate Director, Musculoskeletal Research Center and Associate Scientist at Hebrew SeniorLife's Institute for Aging Research said, "In nursing home residents with advanced dementia and hip fracture, surgical repair was associated with a survival benefit as compared with a purely palliative approach. The survival benefit of surgery should be considered together with the patient's goals for care when determining the appropriate management plan. Clearly there is an opportunity to improve quality of care regardless of how the fracture is managed."

Researchers also advise that they do not know the quality of palliative care provided to these nursing home residents, which could potentially ameliorate these issues without surgery.

The decision to surgically repair a hip fracture or not in nursing home patients with dementia remains a challenge, although this study's findings help shed light on the options for residents and family members as they work toward their goals for care.