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Fracture patients have higher death rate with dementia  The rate of death for patients with end-stage dementia is higher six months after being hospitalized for pneumonia or a hip fracture compared with patients who do not have dementia, according to a recent article in The Journal of the American Medical Association (JAMA). R. Sean Morrison, M.D., and Albert L. Siu, M.D., from the Mount Sinai School of Medicine in New York examined data from patients who were 70 years of age or older who were hospitalized with hip fracture or pneumonia in a large New York City hospital between Sept. 1, 1996, and March 1, 1998.  Of the patients that met the researchers’ criteria and were hospitalized for hip fractures, 38 patients were diagnosed with end-stage dementia and 59 were determined to not have dementia.  Of the patients who met their criteria and were hospitalized for pneumonia, 39 patients were diagnosed with end-stage dementia and 80 were determined to not have dementia.  Patients in the study with dementia were rated as having severe to very severe dementia on the Global Deterioration Scale. Patients with this rating need assistance to perform all daily living activities such as bathing, dressing and feeding and they cannot remember the names of their close relatives or spouses, for example. The researchers found that patients in the study with dementia had at least four times the mortality rate as patients without dementia.  The percentage of end-stage dementia patients who died six months after being hospitalized for pneumonia was 53 percent compared with 13 percent of patients without dementia. The percentage of end-stage dementia patients who died six months after being hospitalized for a hip fracture was 55 percent compared with 12 percent of patients without dementia.  Despite the differences in mortality, the researchers did not find any significant difference in care received by the two groups.  Patients with end-stage dementia received the same amount of painful or uncomfortable procedures as patients without dementia. No documentation regarding goals of care, including withholding or withdrawing life-sustaining treatment, was found for 90 percent of end-stage dementia patients.  “These data suggest that advanced dementia is not viewed as a terminal diagnosis by physicians or families, perhaps because physicians and families may not be aware of the poor short-term prognosis for these patients,” the authors write. According to the authors, “Hip fracture and pneumonia serve as useful models for this study because they are common illnesses in elderly patients, are seen in both cognitively intact and advanced dementia patients, and are associated with considerable pain and other symptoms.”  “Given the high probability of death following pneumonia or hip fracture in the setting of end-stage dementia, we encourage physicians to initiate discussions with patients’ surrogates about achievable goals for medical care and establish treatment plans consistent with these goals to minimize preventable pain and discomfort for these patients,” the researchers write.