title: High Levels of Geriatric Palliative Care Needs in Hip Fracture Patients Before the Hip Fracture.
abstract: Most hip fracture care models are grounded in curative models where the goal is to return the patient to independent function. In many instances, however, hip fractures contribute to continued functional decline and mortality. Although the negative impact of hip fractures is appreciated once they have occurred, what is less understood is what proportion of older adults have high illness burden before experiencing hip fracture and might benefit from geriatric palliative care.
  
  
  
  Using data from the Health and Retirement Study linked to Medicare claims (January 1992 through December 2010), we sought to understand the extent of premorbid illness burden before hip fracture.
  
  
  
  Characteristics were based on the interview before hip fracture. Features used to indicate need for geriatric palliative care included evidence of functional and medical vulnerability, pain, and depression.
  
  
  
  Eight hundred fifty-six older adults who experienced a hip fracture were compared to 851 age-, gender-, and race-matched controls. Older adults with hip fractures had significantly more premorbid functional vulnerability (activities of daily living dependent 25.7% vs. 16.1% [P < 0.001]; dementia 16.2% vs. 7.3% (P < 0.001); use of helpers 41.2% vs. 28.7% [P < 0.001]). They also experienced more medical vulnerability (multimorbidity 43% vs. 29.8% [P < 0.001]; high health care utilization 30.0% vs. 20.9% [P < 0.001]; and poor prognosis 36.1% vs. 25.4% [P < 0.001] in controls). There was no difference in premorbid pain and depression between subsequent hip fracture patients and controls.
  
  
  
  A significant proportion of older adults have evidence of functional and medical vulnerability before hip fracture. For these individuals, integration of geriatric palliative care may be particularly important for optimizing quality of life and addressing the high morbidity experienced by this population.
authors: Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Jewish Home of San Francisco Center for Research on Aging, San Francisco, California, USA. Electronic address: Christine.Ritchie@ucsf.edu.
authors: Christine S
authors: CS
authors: Ritchie
authors: Icahn School of Medicine at Mount Sinai, New York, New York and the James J Peters VA Medical Center, Bronx, New York, USA.
authors: Amy S
authors: AS
authors: Kelley
authors: Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Veterans Affairs Medical Center, San Francisco, California, USA.
authors: Irena
authors: I
authors: Stijacic Cenzer
authors: Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Veterans Affairs Medical Center, San Francisco, California, USA.
authors: Alexander K
authors: AK
authors: Smith
authors: Department of Physiological Nursing, UCSF, San Francisco, California, USA.
authors: Margaret L
authors: ML
authors: Wallhagen
authors: Division of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Veterans Affairs Medical Center, San Francisco, California, USA.
authors: Kenneth E
authors: KE
authors: Covinsky
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D003704:Dementia / Q000150:complications / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D000076322:Multimorbidity; D010146:Pain / Q000453:epidemiology; D010166:Palliative Care; D010342:Patient Acceptance of Health Care; D062706:Prodromal Symptoms; D035862:Vulnerable Populations
keywords: Hip fracture; geriatric palliative care; multimorbidity