• Christine S Ritchie, Amy S Kelley, Stijacic CenzerIrenaIDivision of Geriatrics, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California, USA; Veterans Affairs Medical Center, San Francisco, California, USA., Alexander K Smith, Margaret L Wallhagen, and Kenneth E Covinsky.
• 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.
• J Pain Symptom Manage. 2016 Oct 1; 52 (4): 533538533-538.

ContextMost 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.ObjectivesUsing 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.MethodsCharacteristics 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.ResultsEight 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.ConclusionsA 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.Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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