The decision-making process for individuals with dementia contemplating surgery is multifaceted, influenced not only by cognitive limitations but also by the critical role of post-operative rehabilitation in ensuring successful outcomes. A recent study conducted by researchers from Brigham and Women’s Hospital, part of the Mass General Brigham healthcare system, focused on assessing the treatment outcomes of hip fractures in dementia patients, comparing surgical versus non-surgical approaches to aid healthcare decision-making. Published in JAMA Network Open, the study revealed that surgically treated patients had lower mortality rates, particularly when fractures occurred in the head and neck of the femur.
Lead author Rachel Adler, ScD, RD, a research scientist at the Center for Surgery and Public Health, highlighted the study’s aim to enhance understanding of surgical decision-making in dementia patients, noting the high incidence of hip fractures among older adults. The findings underscored the importance of considering outcomes that matter to patients and caregivers when weighing the surgery option.
In this retrospective cohort study, data from 56,209 Medicare patients with dementia living independently in the community were analysed, focusing on those who sustained hip fractures between January 2017 and June 2018. Of these patients, 59% underwent surgical treatment, while 41% were managed non-surgically. The study stratified results by dementia severity and fracture location, examining mortality rates at 30, 90, and 180 days post-surgery. The analysis revealed significantly lower mortality odds in surgically managed cases where fractures occurred in the head and neck of the femur, the most prevalent type of hip fracture, across both moderate-to-severe and mild dementia stages.
Interestingly, patients with fractures in other hip locations did not demonstrate similar mortality benefits from surgical intervention. Additionally, the study found that patients with moderate-to-severe dementia undergoing surgery were more prone to experiencing delirium during their hospital stay compared to their non-surgical counterparts. Notably, there was no significant difference in nursing home admissions between surgically and non-surgically managed patients.
Adler and her team plan to extend their research to explore long-term patient-reported outcomes in dementia patients. This will encompass pre- and post-operative periods across various surgical interventions and treatments for other health conditions. This longitudinal approach aims to deepen understanding of how healthcare decisions impact the quality of life in dementia patients.
The study’s implications are crucial for clinicians caring for dementia patients in community settings. It offers valuable insights that can facilitate informed discussions with patients and their caregivers regarding treatment options aligned with individual quality-of-life goals. Adler emphasised the significance of these findings in guiding clinical practice and enhancing patient-centred care for this vulnerable population.
More information: Rachel R. Adler et al, Hip Fracture Treatment and Outcomes Among Community-Dwelling People Living With Dementia, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2024.13878
Journal information: JAMA Network Open Provided by Brigham and Women’s Hospital
