Surgery or No Surgery for Dementia Patients?

A patient in her 70s falls and breaks a hip. She also suffers from dementia. The medical team debates which treatment would be better for this patient—surgery on the hip or some sort of non-surgical management.

A recent study described in the JAMA Internal Medicine publication found that nursing home patients with dementia who had a hip fracture had improved survival rates if they underwent surgical repair compared to those who received non-surgical management.

Patients with surgical management had reduced pain and fewer pressure ulcers. The use of antipsychotics and physical restraints did not differ significantly between the two groups.

Of the 3,083 patients who were included in the study, 85% underwent surgical repair. At 6 months of follow-up 31.5% of patients who underwent surgery had died compared to 53.8% of those without surgery.

Among the survivors at 6 months, there was less documented pain for the surgically managed group as well as fewer pressure ulcers. There was no difference in antipsychotic use or physical restraint use between the groups.

Hip fractures in the older population remain an important cause of morbidity and mortality. Surgical management has resulted in superior outcomes for most patients. The study found that patients with dementia had improved mortality with surgical repair of hip fracture, as well as improved pain and lower rates of pressure ulcers. Rates of physical restraints and antipsychotic uses were not different between the groups.