Preferences for end-of-life care in geriatric trauma surgery patients with immobilising fractures – a prospective cohort study

TL;DR

This study explores how elderly trauma surgery patients with fractures have planned for end-of-life care and found that few have discussed their preferences, despite a strong interest in doing so.

Contribution

The study highlights the underutilized opportunity for end-of-life discussions in geriatric trauma patients and their unmet desire to express preferences.

Findings

Only 8% of patients had discussed preventive care during their initial hospital admission.

65% of patients wished to die at home, but 67% had not shared this preference with anyone.

59% of patients had advance directives, but these were often vaguely worded and not thoroughly discussed.

Abstract

The risk of immobilising fractures is increased in elderly individuals. This acute event, combined with subsequent bedriddenness, has been shown to increase mortality by approximately 24% within one year. Despite advanced age, conversations with relatives or treating physicians about the last phase of life are rarely held.

The objective of this study is to examine the extent to which elderly individuals have addressed their own end-of-life preferences and made suitable provisions.

A prospective cohort study was conducted in a supraregional trauma centre. Recruitment occurred from May 2023 to May 2024. A descriptive data analysis was performed using a specially designed questionnaire with 25 questions. In addition to demographic parameters, the questionnaire included parameters such as the existence of an advance directive, health care discussions held in the clinical setting, and the preferred place of death.

A total of 138 patients were screened, of whom 51 could be included in the study. The study revealed that a mere 8% (n=4) of respondents had engaged in a discussion regarding preventive care during their initial admission to the clinic. However, it was observed that 51% (n=26) of patients expressed a willingness to participate in such a discussion and that their recent fracture had a direct impact on their inclination to seek preventive consultation.

Furthermore, 65% (n=33) of those surveyed expressed a desire to die at home, although 67% (n=22) of them had not disclosed this wish to anyone.

The data indicates that 59% (n=30) of individuals have already designated an advance directive and health care proxy, though these documents frequently entail only general wording and have not been thoroughly discussed.

A significant proportion of patients have already given thought to the place they would prefer to die but without engaging in dialogue with others about this wish. Considering these findings, it is incumbent upon the treating physicians and nursing staff to initiate discussions concerning early care planning, thereby facilitating the articulation of patients' wishes in acute palliative scenarios. This approach ensures that these wishes are duly considered and acted upon.

German Clinical Trials Register (DRKS00031589), Registration date: 03 April 2023.

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