Background 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. Methods 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. Results 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. Conclusions 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.

中文翻译：

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改善体弱老年人髋部骨折后临终决策和姑息治疗的策略：范围界定审查


背景 尽管手术是髋部骨折后的金标准，但对于体弱的老年患者来说，康复和生存率的潜力较低。一些患者可能会从姑息治疗中获得更多益处。本次综述的目的是确定可用的策略，以改善体弱的髋部骨折患者的临终决策和姑息治疗，并综合他们的支持水平。方法 我们对科学文献和灰色文献进行了范围审查，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)。数据是根据预期寿命有限和髋部骨折患者的方法框架合成的。每个推荐策略的研究项目数量及其证据水平都以表格形式列出。结果 在确定的 10 591 项中，有 34 项符合条件。大多数纳入的文章都是原创研究 (n = 15)。一半的文章和 CPG 重点关注干预类别 (55%)，例如护理讨论和舒适护理的目标，其次是临终决策过程中要考虑的因素 (25%) 和预后评估 (20%) ），主要是通过预期寿命的估算。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很低。结论 本次范围审查强调，对老年体弱髋部骨折患者的临终关怀仍有待研究。确定的策略可以优先用于未来的研究，以改善目标人群的福祉，同时促进可持续资源管理。