Title : Optimizing hip fracture surgery outcomes in geriatric patients with cognitive decline
Abstract:
Introduction: The prevalence of dementia is projected to rise to 139 million worldwide by 2050. Geriatric patients with mild cognitive decline or dementia have been found to have an increased rate of hip fractures, as well as a 180-day postoperative mortality rate of 26.5% or more after undergoing hip fracture surgery. The present study, therefore, evaluates the current literature regarding optimal surgical and treatment approaches to inform best practice and improve outcomes.
Methods: A comprehensive narrative review of 13 included studies was utilized to identify optimal surgical and treatment approaches in patients ≥ 65 years with cognitive decline or dementia, who underwent hip fracture surgery. Studies evaluating preoperative care, surgical approaches, pain management, postoperative care, rehabilitation, and overall function were analyzed to synthesize outcomes.
Results: Key domains identified. Assessment: validated tools for cognition (IQCODE, MMSE), functional status (BI), delirium (CAM), depression (GDS), nutrition (GNRI), co-morbidities (CCI), and palliative care discussions (PPS) for holistic clinical decision-making. Surgical approach: direct anterior total hip arthroplasty with a dual mobility cup yielded comparable outcomes in dementia and FNF patients; Pain management: femoral nerve block reduced opioid use but did not significantly lower delirium risk. Care coordination: family-centered care models improved patient health ratings and caregiver self-efficacy.
Conclusion: Standardized assessments are essential before surgery and palliative care discussions. Postoperative delirium was a consistent cause of accelerated cognitive decline. Further research is needed on delirium prevention, non-opioid analgesia, rehabilitation adherence, and surgical technique comparison across all hip fracture types in this population. Multidisciplinary collaboration, care models, and family caregiver education are essential to maximize surgical outcomes, overall function, patient safety, and quality of life.
