# A Layered Examination of the Patient Experience to Elucidate the Role of Palliative Care in Surgical Care for Seriously Ill Older Adults

> **NIH NIH R01** · BRIGHAM AND WOMEN'S HOSPITAL · 2024 · $480,575

## Abstract

Project Abstract
 Our current project, “A Layered Examination of the Patient Experience to Elucidate the Role of Palliative
Care in Surgical Care for Seriously Ill Adults” (R01 AG070252-01A1) has contributed insights into the role of
palliative care for seriously ill older adults undergoing elective surgeries. However, quantitative data from this
project reveals that more than half of major surgical procedures for seriously ill older adults are unplanned (i.e.,
urgent, emergent), rather than elective, and that hip fracture is one of the most common surgical conditions
among this group. Furthermore, our prior work shows that most older adults with hip fracture have palliative
care needs preceding injury. These findings highlight a key area of research, particularly for persons living with
dementia (PLWD), as over 60% of surgery among PLWD is unplanned, and the risk of hip fracture in PLWD is
2.7 times greater than those without dementia. Specifically, we have identified critical knowledge gaps at the
intersection of surgery and palliative care that would benefit from supplemental funding: 1) The frequency with
which seriously ill older adults and PLWD receive palliative care and its association with long-term outcomes in
the setting of unplanned surgical care is unexamined. 2) Contextual factors influencing palliative care delivery
during inpatient care for hip fracture and, particularly for PLWD, are undescribed. 3) There is insufficient
evidence about deliberations for surgery and outcomes among adults who do not have surgery to guide
improvements in the caregiver experience or shared decision making.
 Building upon the methodologies, resources, and procedures utilized in our current project, this
supplemental work examines the role of palliative care in unplanned surgical care for hip fracture among
seriously ill older adults, with a specific focus on PLWD. Aim 1 will identify a retrospective cohort of older
seriously ill adults (≥66) with hip fractures in a large regional health system and use natural language
processing in electronic health data linked to Medicare Claims to identify inpatient palliative care processes
(goals of care discussions, healthcare proxy documentation, caregiver assessments, specialty palliative care,
hospice referrals). We will evaluate associations between inpatient palliative care and healthcare utilization
within one-year post-discharge, and sub-analyses to assess this relationship among PLWD. Aim 2 uses
ethnographic observations to obtain an in-depth understanding of contextual factors influencing palliative care
delivery for older adults with serious illness and PWLD with hip fractures. Observations will focus on decisions
for surgery, caregiver involvement, and transitions to post-acute care. Responding to the National Institutes of
Health’s call for research related to experiences of PLWD, geriatric palliative care, and emergency care for
older adults, findings from the proposed studies will guide surgical and...

## Key facts

- **NIH application ID:** 10939440
- **Project number:** 3R01AG070252-04S2
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Zara R Cooper
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $480,575
- **Award type:** 3
- **Project period:** 2021-08-01 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10939440

## Citation

> US National Institutes of Health, RePORTER application 10939440, A Layered Examination of the Patient Experience to Elucidate the Role of Palliative Care in Surgical Care for Seriously Ill Older Adults (3R01AG070252-04S2). Retrieved via AI Analytics 2026-06-13 from https://api.ai-analytics.org/grant/nih/10939440. Licensed CC0.

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