Operative Versus Nonoperative Management of Hip Fractures in Older Adults: Clinical Outcomes and Palliative Alignment

Hip fractures in older adults present considerable challenges in health outcomes and management. Deciding between surgical and nonsurgical treatment is especially complex in patients with serious comorbidities, those receiving palliative care, or individuals nearing the end of life. This review compares operative versus nonoperative treatment of hip fractures, discussing the implications related to mortality, quality of life (QOL), and harm versus burden. While surgical treatment is often considered the standard of care, it carries significant risks in frail older adults, such as postoperative infections, pain, and anesthesia-related complications. This review explores whether nonoperative treatment for hip fractures in frail older adults or those nearing the end of life can be a viable alternative without increasing harm. Evidence suggests that a comparable or even superior quality of life can be achieved nonoperatively in these patients through pain management and palliative care. While nonoperative management is linked to higher short-term mortality, it may better align with older patients' goals by emphasizing comfort and quality of life. These findings underscore the importance of an individualized, patient centered, and shared decision-making approach when caring for these patients. Considering patients' goals, frailty, cognitive status, and prognosis is key to optimizing outcomes. By adopting a more holistic approach, palliative medicine will have increasing importance in supporting older adults who suffer from hip fractures.