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February 28-March 01, 2019 | Paris, France
Palliative Care, Obstetrics and Gynecology
Stroke and Clinical Trials
International Conference on
Joint Event on
International Conference on
&
Journal of Research and Reports in Gynecology and Obstetrics | Volume: 3
Advanced care planning in elderly patients admitted with neck of femur fractures – are standards
being met?
Georgia Lamb
and
Jenna Bhimani
St Mary s Hospital, UK
Background:
A fractured neck of femur is the leading cause
of injury-related mortality in elderly patients, with around
one third of patients dying within 1 year. The Gold Standards
Framework recommend that advance care planning (ACP)
should be carried out for patients with general frailty and
co-existing conditions that mean they are expected to die
within 12 months.
Methodology:
We assessed the standards of ACP in
patients over 65 admitted to a surgical rehabilitation ward
with neck of femur fractures over a 3-month period. 57
patients were included in this study. Patient notes were
analyzed for documentation of a discussion regarding
patient wishes, resuscitation status including ceilings of care
and communication of advanced care plans in discharge
summaries. In order to identify those patients most in need
of ACP, frailty scores were calculated using the Rockwood
frailty score.
Results:
Out of 57 patients, 30 were classified as frail and 9
as severely frail. 33 patients had a documented resuscitation
status, of who three were for full escalation. 77% of
patients with DNAR decisions had further ceilings of care
documented and 30% had ACP discussions. Of those without
recorded resuscitation statuses, 40% were classified as frail
and 78% had more than 3 comorbidities. Only 2 patients in
this cohort had ACP. Of those patients that did have ACP, 63%
received inpatient palliative. 81% of the patients who had
ACP subsequently had this documented on their discharge
summary.
Conclusions:
Complete ACP is only being undertaken in 11%
of patients in a cohort with an expected 1-year mortality of
30%. Frail patients at increased risk of mortality did not have
resuscitation decisions documented. On admission with a
neck of femur fracture, frail multimorbid patients should
be recognized and this injury act as a prompt for ACP in the
elderly.
Speaker Biography
Georgia Lamb is a junior doctor working in Care of the Elderly Medicine at St Mary’s
Hospital, London, UK. Her research interest is Care of the Elderly Medicine.
e:
georgia.e.lamb@gmail.comGeorgia Lamb et al.
, Res Rep Gynaecol Obstet, Volume 3
DOI: 10.4066/2591-7366-C1-003