Attention to frailty and treatment wishes helps in a well-considered choice of care for the elderly with hip fracture
A fractured hip is one of the leading causes of hospitalization in the elderly and is associated with loss of independence and a reduction in quality of life. There is also a major task for informal carers and high healthcare costs are associated with it.
Mapping vulnerability in advance
The majority of patients undergo surgery to relieve pain and improve mobility. But in more vulnerable patients – a growing group partly due to the increasing life expectancy – surgery does not always lead to the desired outcome, due to complications and early death. By mapping the vulnerability of the patient in advance, a better prognosis can be made for the outcome of an operation and care can be better planned.
Support to healthcare providers
This is what Marc van de Ree states in his PhD research at Tilburg University. As a medical researcher at the Elisabeth-TweeSteden Hospital (ETZ), he researched what a hip fracture means for the patient’s quality of life, what the social impact is and what is needed for better medical decision-making. His dissertation provides support to health care providers to enter into discussions with vulnerable patients and relatives in order to arrive at the right treatment and also to pay attention to quality of life and psychological complaints.
The study shows that more than half of the patients with a hip fracture can be considered frail. More than 30% still have psychological complaints such as anxiety and depression one year after the operation. Marc van de Ree: “In most cases, surgery is the standard policy for a hip fracture. This is usually the right decision, but there are patients for whom this is a bridge too far. The estimate for this can be made using the vulnerability measurement method we have developed.
Early Vulnerability Recognition
Early recognition of the degree of frailty, with a frailty test, is also important for estimating the prognosis and for planning the right care. In addition, attention should also be paid at an earlier stage within this very vulnerable group to the treatment wish and the feasibility of an operation.” In the Netherlands, in some cases, the discontinuation of surgery for vulnerable elderly people with a hip fracture is increasingly open to discussion. Discussing end-of-life treatment wishes early, when the patient is still able to make decisions for himself, helps to make better treatment decisions at a later stage.
In addition, consultation between primary and secondary care should be intensified in vulnerable patients. With regard to vulnerable nursing home patients, the national Frail-Hip study – a collaboration between geriatricians, geriatric specialists and orthopedic and trauma surgeons – will have to answer the question of what the difference is between operative or conservative treatment with regard to quality of life, clinical outcomes, such as the degree of pain and the quality of the dying process.
Photo: Marc van de Ree
Source: Tilburg University
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