Assessment of Surgical and Non-surgical Outcomes in Patients with Dementia and Hip Fractures.

Abstract

Introduction: The aging population is associated with increased osteoporosis and risk of hip fractures. Cognitive decline has recorded exponential increases in the last decades, with the rise in life expectancy.

Material and methods: We conducted a prospective study on 65 patients over 65 years old associated with dementia and hip fractures. We used pre-and post-treatment variables such as age, type of fracture, type of treatment, Charlson Comorbidity Index (CCI), EQ-5D-5L score, and the Harris hip score (HHS) to assess pain, mobility, and mortality. We performed follow-ups at 6 months, 1 year, 2 years, and 3 years.

Results: Patients with dementia typically arrive at the hospital without any previous analgesic treatment and receive lower doses due to poor pain recognition. The 6-month mortality rate was 48.22% and increased to 78.46% at 3 years. The best survival rates were in patients with bipolar prosthesis and Gamma nails, with a 3-year survival rate of 40% and 50%, respectively.

Conclusions: Patients with dementia have a higher mortality rate compared to cognitively intact patients and the treatment decisions require a multidisciplinary team and individualized recommendations for each patient, due to high surgical risk in the elderly.