PALLIATIVE CARE AFTER A HIP FRACTURE IN THE ELDERLY POPULATION: WHICH PATIENTS WOULD BENEFIT THE MOST?

Hip fractures have a high rate of mortality. Typically, most patients presenting with a hip fracture regardless of their comorbidities are surgically treated. Lately, there has been an increase interest of palliative care for hip fractures among frail elderly patients. A growing body of research states that a certain type of elderly patients could benefit more from a palliative approach; that is, patients with neurocognitive disorders (NCD), with multiple medical comorbidities, who are dependent in ADL/IADL and/or with a reduced pre-fracture mobility. These categories remain to be confirmed. Our research thus aims to identify the patient who would benefit most from a palliative care approach instead of a surgery. A retrospective cohort study was conducted between 2015 and 2021. Patients older than 65 years old admitted by the palliative care team for a hip fracture treated non-operatively were included (PG). This cohort was compared to a matched cohort (for age, sex and fracture type) who underwent surgery but died within three months of the procedure (SDG) and another matched cohort who survived more than three months (SAG) following surgery. The primary outcome was prevalence of NCD in the three cohorts. We secondarily explored comorbidities and administrative data. Analyses were performed through univariate and multivariate models with SAS University (alpha 0.05). The patients in the PG (n=129) were 88.2±7.2 years old, 71.3% were females and 61.2% had a femoral neck fracture. The patients in the SDG (n=95) and SAG (n=107) were well matched (p>0.05). The PG differed from the SDG (n=95) and SAG (n=107) regarding NCD (85.3% vs 57.9% vs 36.4%, p<0.01) and presence of behavioral and psychotic dementia related symptoms (19.4% vs 5.3% vs 3.7%, p<0.01). There were more coronary arterial disease (43.2% vs 29.5%, p=0.03) and chronic obstructive pulmonary disease in SDG compared to PG (26.6 vs 14.7%, p=0.03). Pre-fracture mobility, autonomy and living situation significantly differed between the groups (p<0.01). Median survival was six days in PG and 17 days in SDG. To this day, all patients in SAG are still alive. All groups lost autonomy and mobility. There were more complications in the SDG compared to PG. End-of-care trajectory was death or hospice for most patients in PG and SDG. More than 30% of the SAG group could not return home at discharge. This work shows that presence of a NCD and a diminished pre-fracture autonomy strongly support counselling for palliative care. When patients are carefully selected and a multidisciplinary expert approach (including palliative care specialists) is established, palliative care for hip fracture surgeries are ethical and provide a safe and effective option for these patients.