Should Hip Fractures Be Repaired Surgically in Nursing Home Residents with Dementia?

A common dilemma is whether to repair hip fractures in nursing home patients with severe dementia. To explore this issue, investigators used a Medicare dataset to identify 3083 nursing home patients (mean age, 84) with advanced dementia and hip fractures; 15% were managed without surgery. Patients with directives that prohibited hospitalization were excluded.

One third of all patients died within 6 months; mean survival for surgical patients was 1.4 years compared with 0.4 years for nonsurgical patients. In analyses adjusted for a wide range of demographic and clinical factors that might influence management decisions, all-cause mortality was about 12% lower among surgical patients. In analyses stratified by whether patients were ambulatory …