Factors Considered by Interprofessional Team for Treatment Decision in Hip Fracture with Dementia

Abstract

Objectives: Patients with dementia are at high risk for hip fractures and often have poor outcomes when a fracture is sustained. Despite this poor prognosis, little data are available on what factors should be prioritized to guide surgical decision making in these cases. We aimed to understand the decision-making process for older dementia patients hospitalized after hip fractures.

Design: We performed a qualitative analysis of in-depth elite interviews conducted with a clinical care team involved in management of patients with dementia after hospitalization for hip fractures.

Setting: Interviews were conducted with an interprofessional team involved in the care of patients with dementia after being hospitalized for hip fractures.

Participants: Interviewees included nine orthopaedic surgeons, three hospitalists, three geriatricians, five nurses, three occupational therapists, three physical therapists, and two clinical ethicists.

Measurements: Verbatim transcripts of the interviews were analyzed and coded using QSR International's NVivo 10 qualitative database management software.

Results: The three main themes that most interviewees discussed were pain control, functional status, and medical comorbidities. Interviewees brought up many factors related to restoring functional status including baseline functional status, rehabilitation potential, social support, and the importance of mobility. Dementia and its impact on rehabilitation potential were mentioned by all geriatricians.

Conclusion: Although frailty, prognosis, and life expectancy were largely absent from the responses, the emphasis on dementia, advanced directives, and involving family or caregivers by the three geriatricians indicates the importance of including geriatricians in the decision-making team for these patients.

Keywords: dementia; hip fracture; interprofessional team; treatment decision making.