Faculty of Nursing, Université Laval, 1050 Avenue de la Médecine, Québec City, Quebec G1V 0A6, Canada.
Population Health and Optimal Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec City, Quebec GIV 1Z4, Canada.
Age Ageing. 2024 Jul 2;53(7). doi: 10.1093/ageing/afae134.
Although surgery is the gold standard following a hip fracture, the potential for rehabilitation and survival rates are low in frail older patients. Some patients may derive more benefit from palliative care. The objectives of this review were to identify the available strategies to improve end-of-life decision-making and palliative care for frail patients with hip fractures and to synthetise their level of support.
We conducted a scoping review of the scientific and grey literature, searching seven databases and websites of associations. We included all study designs, expert opinion articles and clinical practice guidelines (CPGs). Data were synthetised according to the Approach to Patient with Limited Life Expectancy and Hip Fracture framework. The number of research items and their level of evidence were tabulated for each of the recommended strategies.
Of the 10 591 items identified, 34 were eligible. The majority of included articles were original research studies (n = 15). Half of the articles and CPGs focused on intervention categories (55%) such as goals of care discussion and comfort care, followed by factors to consider in the end-of-life decision-making process (25%) and prognosis assessments (20%), mainly through the estimation of life expectancy. The level of evidence for these strategies remains low, given the limited number of prospective studies supporting them.
This scoping review highlighted that end-of-life care in frail older patients with a hip fracture remains understudied. The strategies identified could be prioritised for future research to improve the well-being of the target population while promoting sustainable resource management.
尽管手术后是髋部骨折的金标准，但体弱老年患者的康复和生存率仍然较低。一些患者可能从姑息治疗中获益更多。本综述的目的是确定改善体弱髋部骨折患者临终决策和姑息治疗的现有策略，并综合评估其支持程度。
我们对科学和灰色文献进行了范围综述，检索了七个数据库和协会网站。我们纳入了所有研究设计、专家意见文章和临床实践指南（CPG）。根据预计生存时间有限的患者与髋部骨折框架，对数据进行综合分析。为每个推荐策略列出了研究项目的数量及其证据水平。
在 10591 项中，有 34 项符合条件。纳入的文章大多是原始研究（n=15）。一半的文章和 CPG 侧重于干预类别（55%），如治疗目标讨论和舒适护理，其次是临终决策过程中需要考虑的因素（25%）和预后评估（20%），主要通过估计预期寿命。鉴于支持这些策略的前瞻性研究数量有限，这些策略的证据水平仍然较低。
本范围综述强调，体弱老年髋部骨折患者的临终关怀仍研究不足。确定的策略可以优先进行未来的研究，以改善目标人群的福祉，同时促进可持续的资源管理。
