More than 70% of patients receiving surgery for hip fracture are women, yet they are less likely than men to receive geriatric care during hospitalisation.
Published in CMAJ (Canadian Medical Association Journal), this study of 22 661 patients aged 66 and older examined individuals who had emergency hip fracture surgery between 2014 and 2016. And even though 71.3% of the participants were women, the researchers found that 8% of women received geriatric care compared to 10% of men.
Women not receiving geriatric care
Previous studies have presented that older patients who receive geriatric care when hospitalised for hip fracture surgery are less likely to die after surgery and spend less time in hospital, and that anaesthesiology consultations can help to avoid cancelled surgeries and may decrease length of stay.
For these reasons, both practices are recommended by Health Quality Ontario and the Ontario Ministry of Health and Long-Term Care.
Senior author Dr. Daniel McIsaac, associate scientist and anesthesiologist at The Ottawa Hospital, Canada explains: “Overall, we found that geriatric care for these vulnerable hip fracture patients was not routinely provided.
“However, given that 70% of hip fractures occur in women, and what we know about the positive effect of providing geriatric care to older hip fracture patients, increasing access to this care should be a top priority.”
“A person’s sex or gender should not play a role in whether evidence-based care is provided.”
Sociocultural biases may be at play
Women from low-income neighbourhoods were also less likely to receive geriatric care than men from similar neighbourhoods. Moreover, women with dementia were less likely than men with dementia to receive an anaesthesiology consultation before surgery.
The researchers suggest that sociocultural biases may be at play. Another possibility is that men have a higher risk of death after hip fracture surgery than women, which may influence how physicians decide to apply the resources available.
“Understanding that there are issues with sex- and gender-based equality is a first and important step toward improving outcomes,” says McIsaac.
However, his group suggests that to ensure women and men have equal, and ultimately increased, access to geriatric care in the future, further research is required to understand factors driving this inequality and how to address them.