Impact of Age on Consent in a Geriatric Orthopaedic Trauma Patient Population

Madeline M McGovern; Michael F McTague; Erin Stevens; Juan Carlos Nunez Medina; Esteban Franco-Garcia; Marilyn Heng

doi:10.1177/21514593211003065

Impact of Age on Consent in a Geriatric Orthopaedic Trauma Patient Population

Geriatr Orthop Surg Rehabil. 2021 Mar 30:12:21514593211003065. doi: 10.1177/21514593211003065. eCollection 2021.

Authors

Madeline M McGovern¹, Michael F McTague², Erin Stevens³, Juan Carlos Nunez Medina⁴, Esteban Franco-Garcia⁴, Marilyn Heng²

Affiliations

¹ Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
² Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA.
³ Department of Internal Medicine, Division of Palliative Medicine, Ohio State University, Columbus, Ohio, USA.
⁴ Division of Palliative Care & Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.

Abstract

Introduction: Persistent misconceptions of frailty and dementia in geriatric patients impact physician-patient communication and leave patients vulnerable to disempowerment. Physicians may inappropriately focus the discussion of treatment options to health care proxies instead of patients. Our study explores the consenting process in a decision-making capable orthogeriatric trauma patient population to determine if there is a relationship between increased patient age and surgical consent by health care proxy.

Methods: Patients aged 65 and older who underwent operative orthopaedic fracture fixation between 1 of 2 Level 1 Trauma Centers were retrospectively reviewed. Decision-making capable status was defined as an absence of patient history of cognitive impairment and a negative patient pre-surgical Confusion Assessment Method (CAM) and Mini-Cog Assessment screen. Provider of surgical consent was the main outcome and was determined by signature on the consent form.

Results: 510 patients were included, and 276 (54.1%) patients were deemed capable of consent. In 27 (9.8%) of 276 decision-capable patients, physicians obtained consent from health care proxies. 20 of these 27 patients (74.1%) were 80 years of age or older. However, in patients aged 70 to 79, only 7 health care proxies provided consent. (p = 0.07). For every unit increase in age, the log odds of proxy consent increased by .0008 (p < 0.001). Age (p < 0.001), income level (p = 0.03), and physical presence of proxy at consult (p < 0.001) were factors associated with significantly increased utilization of health care proxy provided consent. Language other than English was a significant predictor of proxy-provided consent (p = 0.035). 48 (22%) decision-making incapable patients provided their own surgical consent.

Discussion: The positive linear association between age and health care proxy provided consent in cognitively intact geriatric orthopaedic patients indicates that increased patient age impacts the consenting process. Increased physician vigilance and adoption of institutional consenting guidelines can reinforce appropriate respect of geriatric patients' consenting capacity.

Keywords: geriatric; hip fracture; informed consent.