@article{ref1,
title="End-of-life care planning and fragility fractures of the hip: are we missing a valuable opportunity?",
journal="Clinical orthopaedics and related research",
year="2015",
author="Dunn, Robin H. and Ahn, Jaimo and Bernstein, Joseph",
volume="474",
number="7",
pages="1736-1739",
abstract="BACKGROUND: Approximately 20% of all geriatric patients who sustain low-energy hip fractures will die within 1 year of the injury, and approximately 3% will die during the initial inpatient hospital stay. Accordingly, the event of a geriatric hip fracture might be an apt prompt for discussing end-of-life care: in light of the risk of death after this injury, the topic of mortality certainly is germane. However, it is not clear to what degree physicians and patients engage in end-of-life planning even when faced with a hospital admission for this potentially life-threatening condition. QUESTIONS/PURPOSES: We assessed the frequency with which end-of-life care discussions were documented among a sample of geriatric patients admitted for hip fracture surgery. <br><br>METHODS: We studied 150 adult patients, 70 years and older, admitted between September 2008 and July 2012 for the care of an isolated low-energy hip fracture, who did not have documented evidence of end-of-life care planning before the time of admission. For each patient, the medical record was scrutinized to identify documentation of end-of-life care discussions, an order changing &quot;code status,&quot; or a progress note memorializing a conversation related to the topic of end-of-life care planning. <br><br>RESULTS: Of the 150 subjects who had no documented evidence of end-of-life care planning at the time of admission, 17 (11%) had their code status changed during the initial hospitalization for hip fracture, and an additional four patients (3%) had a documented conversation regarding end-of-life care planning without a subsequent change in code status. Accordingly, there were 129 (86%) patients who had no record of any attention to end-of-life care planning during the hospital stay for hip fracture surgery. <br><br>CONCLUSIONS: Our findings suggest that physicians may be missing a valuable opportunity to help patients and their families be better prepared for potential future health issues. End-of-life care planning respects patient autonomy and enhances the quality of care. Accordingly, we recommend that discussion of goals, expectations, and preferences should be initiated routinely when patients present with a fragility fracture of the hip. LEVEL OF EVIDENCE: Level IV, therapeutic study.<p /> <p>Language: en</p>",
language="en",
issn="0009-921X",
doi="10.1007/s11999-015-4675-1",
url="http://dx.doi.org/10.1007/s11999-015-4675-1"
}