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

Loggers, Sverre A I; Van Balen, Romke; Willems, Hanna C; Gosens, Taco; Polinder, Suzanne; Ponsen, Kornelis J; Van de Ree, Cornelis L P; Steens, Jeroen; Verhofstad, Michael H J; Zuurmond, Rutger G; Joosse, Pieter; Van Lieshout, Esther M M

Loggers, Sverre A I; Van Balen, Romke; Willems, Hanna C; Gosens, Taco; Polinder, Suzanne; Ponsen, Kornelis J; Van de Ree, Cornelis L P; Steens, Jeroen; Verhofstad, Michael H J; Zuurmond, Rutger G; Joosse, Pieter; Van Lieshout, Esther M M.

Afiliación

Loggers SAI; Department of Surgery, Northwest Clinics Alkmaar, Alkmaar, the Netherlands.
Van Balen R; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Willems HC; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
Gosens T; Geriatrics Section, Department of Internal Medicine, Amsterdam UMC Location AMC, Amsterdam, the Netherlands.
Polinder S; Department of Orthopaedic Surgery, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands.
Ponsen KJ; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Van de Ree CLP; Department of Surgery, Northwest Clinics Alkmaar, Alkmaar, the Netherlands.
Steens J; Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands.
Verhofstad MHJ; Department Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands.
Zuurmond RG; Department of Orthopaedic Surgery, Dijklander Ziekenhuis, Hoorn, the Netherlands.
Joosse P; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Van Lieshout EMM; Department of Orthopaedic Surgery, Isala, Zwolle, the Netherlands.

Am J Hosp Palliat Care ; 41(6): 583-591, 2024 Jun.

Article en En | MEDLINE | ID: mdl-37403839

RESUMEN

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.

Palabras clave

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

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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Prognostic_studies Idioma: En Revista: Am J Hosp Palliat Care Asunto de la revista: ENFERMAGEM Año: 2024 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Estados Unidos

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