Berry SD, et al. - A retrospective cohort study was conducted to compare outcomes, including survival, among nursing home (NH) residents with advanced dementia and hip fracture according to whether they underwent surgical hip fracture repair. Researchers reported that surgical repair of a hip fracture was related to lower mortality among NH residents with advanced dementia and should be considered together with the residents’ goals of care in management decisions. Findings revealed that pain and other adverse outcomes were common regardless of surgical management, suggesting the requirement for broad improvements in the quality of care provided to NH residents with advanced dementia and hip fracture.

Methods

• Using nationwide Medicare claims data linked with Minimum Data Set (MDS) assessments from January 1, 2008, through December 31, 2013, researchers performed a retrospective cohort study of 3083 NH residents with advanced dementia and hip fracture, but not enrolled in hospice care.
• Using the MDS, residents with advanced dementia were identified.
• They used Medicare claims to identify hip fracture and to assess whether the fracture was managed surgically.
• Using multivariable Cox proportional hazards with inverse probability of treatment weighting (IPTW), survival between surgical and nonsurgical residents was compared .
• Between November 2015 and January 2018, all analyses took place.
• Documented pain, antipsychotic drug use, physical restraint use, pressure ulcers, and ambulatory status were compared between surgical and nonsurgical groups among 6-month survivors.

Results

• According to the findings obtained, among 3083 residents with advanced dementia and hip fracture (mean age, 84.2 years; 79.2% female [n = 2441], 28.5% ambulatory [n = 879]), 2615 (84.8%) underwent surgical repair.
• Data revealed that 31.5% (n = 824) of surgically and 53.8% (n = 252) of nonsurgically managed residents died by 6-month follow-up.
• Surgically managed residents were less likely to die than residents without surgery (adjusted hazard ratio [aHR], 0.88; 95% CI, 0.79-0.98) after IPTW modeling.
• Residents with surgical vs nonsurgical management had less docmented pain (29.0% [n = 465] vs 30.9% [n = 59]) and fewer pressure ulcers (11.2% [n = 200] vs 19.0% [n = 41]) among 2007 residents who survived 6 months.
• Surgically managed residents reported less pain (aHR, 0.78; 95% CI, 0.61-0.99) and pressure ulcers (aHR, 0.64; 95% CI, 0.47-0.86) in IPTW models.
• No difference was found between antipsychotic drug use and physical restraint use between the groups.
• They found that few survivors remained ambulatory (10.7% [n = 55] of surgically managed vs 4.8% [n = 1] without surgery).