People living with dementia who had hip fractures treated with surgery lived longer than those who didn’t have surgery, a new study finds.
Choosing to undergo surgery can be a complicated decision for people living with dementia. The individuals may have limited decision-making capabilities as well as challenges with post-surgical rehabilitation, which is vital for success.
The researchers evaluated hip fracture treatment outcomes in people living with dementia. The team compared outcomes in those who had surgery with those who didn’t. Their results were published on Thursday in JAMA Network Open.
People who underwent surgery had lower odds of dying than those who didn’t have surgery. Interestingly, the benefit was seen only in people who had fractures of the head and neck of the femur compared with other areas of the hip.
Data came from 56,209 Medicare beneficiaries with dementia who were living in their communities and who had a hip fracture between January 2017 and June 2018. Of them, 59% had surgery, and the rest had non-surgical treatments. The team looked at dementia severity and hip fracture location, as well as death rates within 30, 90 and 180 days after surgery.
When the hip fracture occurred in the head and neck of the femur bone — that’s the most common type of hip fracture — people with moderate to severe dementia and mild dementia who had surgery had lower odds of death than people treated non-surgically. The surgery didn’t give the same benefits to people with fractures in other locations of the hip, the data showed.
People with moderate to severe dementia who underwent surgery were more likely to experience delirium during their inpatient hospital stay compared with people who didn’t undergo surgery. There wasn’t a difference in nursing home admission between those who had surgery and those who didn’t.“When making decisions about surgery, it is really important to think about the patient’s quality-of-life goals,” Rachel Adler, ScD, RD, one of the authors and a research scientist at the Center for Surgery and Public Health at Brigham and Women’s Hospital, said in a statement. “This analysis provides valuable information for clinicians caring for people living with dementia in their communities, and can help them talk with this group of patients and their caregivers about what is most important to them.”
