Decision making and outcomes of a hospice patient hospitalized with a hip fracture.
BACKGROUND
Hospice patients are at risk for falls and hip fracture with little clinical information to guide clinical decision making.


OBJECTIVE
To examine whether surgery is done and survival of hip fracture surgery among persons receiving hospice services.


METHODS
This was an observational cohort study from 1999 to 2007 of Medicare hospice beneficiaries aged 75 years and older with incident hip fracture. We studied outcomes among hospice beneficiaries who did and did not have surgical fracture repair. Main outcomes included the trends in the proportion of those undergoing surgery, the site of death, and six-month survival.


RESULTS
Between 1999 and 2007, approximately 1% (n=14,400) of patients aged 75 years and older admitted with a diagnosis of their first hip fracture were receiving hospice services in the 30 days before that admission and 83.4% underwent surgery. Among patients on hospice at the time of the hip fracture, 8.8% died during the initial hospitalization and an additional two-thirds died within the first six months on hospice. The median survival from hospital admission was 25.9 days for those forgoing surgery compared with 117 days for those who had surgery, adjusted for age, race, and other covariates (P<0.001).


CONCLUSIONS
Despite being on hospice services, the majority underwent surgery with improved survival. Sixty-six percent of all individuals on hospice at the time of the fracture died in the first six months, with the majority returning to hospice services.
Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, and Davis School of Gerontology, University of Southern California, Los Angeles, California, USA. nleland@usc.edu
Natalie E
NE
Leland
Joan M
JM
Teno
Pedro
P
Gozalo
Julie
J
Bynum
Vince
V
Mor
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D006738:Hospices; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D019637:Orthopedic Procedures; D012959:Socioeconomic Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology