Fate Worse Than Death? A Broken Hip

From the WebMD Archives

Feb. 8, 2000 (New York) -- Women in their 70s and 80s consider a hip fracture akin to a death sentence, according to a new study in the Feb. 5 issue of the British Medical Journal. The study concludes that 80% of women surveyed would rather be dead than in a nursing home as a result of falling and breaking a hip.

"This study is a wake-up call to start thinking about hip fractures at a young age," says Joan Lappe, RN, PhD. "We really have to make an effort to prevent osteoporosis because probably the worst outcome is hip fracture. The nursing home experience often is not a pleasant one, and even when they don't end up in a nursing home, statistics show that only half of people who have a hip fracture are able to walk independently after a bad fracture." Lappe, who is an associate professor at Creighton University School of Nursing and Medicine in Omaha, Neb., reviewed the study for WebMD.

Researchers led by Glenn Salkeld, MPH, from the University of Sydney in New South Wales, Australia, interviewed 194 women aged 75 and older who were considered at risk for hip fracture because they still lived in their own homes and had fallen two or more times, or had fallen at least once significantly enough to require treatment in the hospital during the previous year.

The women were asked to rate their health and to assess whether their current health was better, worse, or the same as it had been 12 months earlier. They were then asked to rank aspects of their health from best to worst and asked how much of their remaining life they would "trade off" for shorter periods of good health rather than longer periods of lower quality of life.

"Nearly all women would trade off almost their entire life expectancy to avoid the state of being admitted to a nursing home," Salkeld and colleagues write. "Eighty percent of respondents said they would rather be dead." The authors say comments made during the interviews suggest that fears about what can happen after a hip fracture are based on experiences of parents, friends, and siblings as well as the poor outcomes of hip fracture reported in the medical literature. Studies show that approximately 20% of elderly people who fracture a hip die within 1 year, and many who do recover need assistance with everyday activities.

In an editorial accompanying the study, Shanthi N. Ameratunga, MBChB, MPH, of the University of Auckland in New Zealand, writes that while the findings are disturbing, it is not unique for older people to prefer death to disability from a chronic condition. According to Ameratunga, the study indicates that prevention and management of falls and hip fractures in elderly people should be a priority.

Salkeld and colleagues write that a number of techniques designed to intervene before an older person fractures a hip are effective and should be implemented in frail older women. Lappe agrees.

"Everyone -- men and women, children and adults -- should be getting adequate calcium and vitamin D and weight-bearing activity throughout their lifetime," Lappe tells WebMD. "Even people in nursing homes should be doing exercise because it does two things: It may help maintain bone mass, and it helps with muscle strength and coordination so you are less apt to fall." Adequate protein in the diet is also important, since studies have documented low protein intake among those with falls. Home health nurses also can assist elderly people who are still living in their own homes by checking their home for trouble spots -- such as furniture or other items that block or interfere with safely walking through a room -- and even suggesting brighter colors for furniture or draperies to help those with dim eyesight see their surroundings more clearly.

Vital Information:

  • In a recent study, women in their 70s and 80s reported that they would rather be dead than in a nursing home as a result of a broken hip.
  • Hip fractures are an adverse outcome of osteoporosis, and prevention of this disease should be a top priority.
  • To prevent osteoporosis, people should consume adequate amounts of calcium, vitamin D, and protein, and perform weight-bearing exercises.