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. 2024 Jun;41(6):583-591.
doi: 10.1177/10499091231180556. Epub 2023 Jul 5.

The Quality of Dying in Frail Institutionalized Older Patients After Nonoperative and Operative Management of a Proximal Femoral Fracture: An In-Depth Analysis

Sverre A I Loggers  1   2 , Romke Van Balen  3 , Hanna C Willems  4 , Taco Gosens  5 , Suzanne Polinder  6 , Kornelis J Ponsen  1   7 , Cornelis L P Van de Ree  8 , Jeroen Steens  9 , Michael H J Verhofstad  2 , Rutger G Zuurmond  10 , Pieter Joosse  1   7 , Esther M M Van Lieshout  2
Affiliations

The Quality of Dying in Frail Institutionalized Older Patients After Nonoperative and Operative Management of a Proximal Femoral Fracture: An In-Depth Analysis

Sverre A I Loggers et al. Am J Hosp Palliat Care. 2024 Jun.

Abstract

Proximal femoral fractures in frail patients have a poor prognosis. Despite the high mortality, little is known about the quality of dying (QoD) while this is an integral part of palliative care and could influence decision making on nonoperative- (NOM) or operative management (OM). To identify the QoD in frail patients with a proximal femoral fracture. Data from the prospective FRAIL-HIP study, that studied the outcomes of NOM and OM in institutionalized older patients ≥70 years with a limited life expectancy who sustained a proximal femoral fracture, was analyzed. This study included patients who died within the 6-month study period and whose proxies evaluated the QoD. The QoD was evaluated with the Quality of Dying and Death (QODD) questionnaire resulting in an overall score and 4 subcategory scores (Symptom control, Preparation, Connectedness, and Transcendence). In total 52 (64% of NOM) and 21 (53% of OM) of the proxies responded to the QODD. The overall QODD score was 6.8 (P25-P75 5.7-7.7) (intermediate), with 34 (47%) of the proxies rating the QODD 'good to almost perfect'. Significant differences in the QODD scores between groups were not noted (NOM; 7.0 (P25-P75 5.7-7.8) vs OM; 6.6 (P25-P75 6.1-7.2), P = .73). Symptom control was the lowest rated subcategory in both groups. The QoD in frail older nursing home patients with a proximal femoral fracture is good and humane. QODD scores after NOM are at least as good as OM. Improving symptom control would further increase the QoD.

Keywords: hip fracture; nonoperative; palliative care; proximal femoral fracture; quality of dying; quality of dying and death.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow of participants and number of patients in analysis. NOM, nonoperative management; OM, operative management; QODD, Quality of dying and death.
Figure 2.
Figure 2.
Distribution of frequencies with the categorical ratings of the total QODD score and 4 subscales. A: scores of the nonoperative management group. B: Scores from the operative management group. Frequencies are reported as percentages (%) of total respondents. QODD, Quality of Dying and Death.
Figure 3.
Figure 3.
Percentages of if- or to what extent items occurred during the final period of the decedent’s life. A: scores of the nonoperative management group. B: Scores from the operative management group. Numbers are shown as percentage (%) of total respondents.
See this image and copyright information in PMC

References

    1. Collingridge Moore D, Payne S, Keegan T, et al. Length of stay in long-term care facilities: A comparison of residents in six European countries. Results of the PACE cross-sectional study. BMJ Open. 2020;10(3):e033881. - PMC - PubMed
    1. Berry SD, Rothbaum RR, Kiel DP, Lee Y, Mitchell SL. Association of clinical outcomes with surgical repair of hip fracture vs nonsurgical management in nursing home residents with advanced dementia. JAMA Intern Med. 2018;178(6):774-780. - PMC - PubMed
    1. Neuman MD, Silber JH, Magaziner JS, Passarella MA, Mehta S, Werner RM. Survival and functional outcomes after hip fracture among nursing home residents. JAMA Intern Med. 2014;174(8):1273-1280. - PMC - PubMed
    1. Beaupre LA, Jones CA, Johnston DW, Wilson DM, Majumdar SR. Recovery of function following a hip fracture in geriatric ambulatory persons living in nursing homes: Prospective cohort study. J Am Geriatr Soc. 2012;60(7):1268-1273. - PubMed
    1. Loggers SAI, Willems HC, Van Balen R, et al. Evaluation of quality of life after nonoperative or operative management of proximal femoral fractures in frail institutionalized patients: The FRAIL-HIP study. JAMA Surg. 2022;157:424-434. - PMC - PubMed