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

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

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

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.

Original languageEnglish
Pages (from-to)583-591
Number of pages9
JournalAmerican Journal of Hospice and Palliative Medicine
Volume41
Issue number6
Early online date5 Jul 2023
DOIs
Publication statusPublished - Jun 2024

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the ZonMw (843004120) and Osteosynthesis and Trauma Care Foundation (2019-PJKP).

Publisher Copyright:
© The Author(s) 2023.

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