Dementia and chronic hip disease are both more prevalent with advancing age. Given this, the number of people with both dementia and hip disease is likely to increase in an ageing population such as the UK. This article raises questions about how people with dementia and chronic hip disease are conceptualized in the context of evidence-based medicine, and whether this conceptualization may limit unfairly their access to surgical services. The published clinical research discourse at the interface of hip disease and dementia is taken as an ‘evidence-base’, and is evaluated in terms of its suitability for informing professional decisions about viability for surgery. The analysis suggests that the outcomes criteria used to determine patient viability serve to discriminate unfairly against people with dementia. If such discrimination exists, it necessarily militates against the promotion of health-related citizenship rights of the cognitively impaired, creating an evidence-based culture that encourages a problematic model of cognitive citizenship.
Ackermann, R.J. , Vogel, R.L. , Johnson, L.A. , Ashley, D.W. and Solis, M.M. (1995). Surgery in nonagenarians: Morbidity, mortality, and functional outcome . Journal of Family Practice, 40, 129-135 .
2.
Berghmans, R.L.P. (1997). Editorial comment: Ethical hazards of the substituted judgement test in decision-making concerning the end of life of dementia patients . International Journal of Geriatric Psychiatry, 12, 283-287 .
3.
Bowman, A.M. (1997). Sleep satisfaction, perceived pain and acute confusion in elderly clients undergoing orthopaedic procedures . Journal of Advanced Nursing, 26, 550-564 .
4.
Bray, T.J. (1997). Femoral neck fracture fixation . Clinical Orthopaedics and Related Research, 339, 20-31 .
5.
Callahan, C.M. , Drake, B.G. , Heck, D.A. and Dittus, R.S. (1994). Patient outcomes following tricompartmental total knee replacement: A meta-analysis . Journal of the American Medical Association, 271, 1349-1357 .
6.
Colenda, C.C. , Rapp, S.R. , Leist, J.C. and Poses, R.M. (1996). Clinical variables influencing treatment decisions for agitated dementia patients: Survey of physician judgments . Journal of the American Geriatrics Society, 44, 1375-1379 .
7.
Crawford, R.W. and Murray, D.W. (1997). Total hip replacement: Indications for surgery and risk factors for failure . Annals of the Rheumatic Diseases, 56, 455-457 .
8.
Dautzenberg, P.L.J. , Hooyer, C. , Schonwetter, R.S. , Dermout, K.M.T. , Veer, J.K. and Duursma, S.A. (1996). Dementia in resuscitation policy: A prospective study on a psychogeriatric ward in a Dutch general teaching hospital . Age and Ageing, 25, 234-238 .
9.
Davis, M.A. (1981). Sex differences in reporting osteoarthritic symptoms: A sociomedical approach . Journal of Health and Social Behavior, 22, 298-310 .
10.
Department of Health . (2001). National service framework for older people. London: HMSO .
11.
Dieppe, P. , Basler, H.-D. , Chard, J. , Croft, P. , Dixon, J. , Hurley, M. , Lohmander, S. and Raspe, H. (1999). Knee replacement surgery for osteoarthritis: Effectiveness, practice variations, indications and possible determinants of utilization . Rheumatology, 38, 73-83 .
12.
Eccles, J.T. (2001). Commentary: Mental capacity and medical decisions . Age and Ageing, 30, 5-7 .
13.
Elad, P. , Treves, T.A. , Drory, M. , Verchovsky, R. , Klimovitsky, S. , Ben-Laish, S. , Yaron, S. , Ginzburg, K. and Korczyn, A.D. (2000). Demented patients’ participation in a clinical trial: Factors affecting the caregivers’ decision . International Journal of Geriatric Psychiatry, 15, 325-330 .
14.
Elwyn, G. , Edwards, A. , Eccles, M. and Rovner, D. (2001). Decision analysis in patient care . Lancet, 358, 571-574 .
15.
Feldt, K.S. , Ryden, M.B. and Miles, S. (1998). Treatment of pain in cognitively impaired compared with cognitively intact older patients with hip-fracture . Journal of the American Geriatrics Society, 46(9), 1079-1085 .
16.
Ferrell, B.A. (1995). Pain evaluation and management in the nursing home . Annals of Internal Medicine, 123, 681-687 .
17.
Frankel, S. , Eachus, J. , Pearson, N. , Greenwood, R. , Chan, P. , Peters, T. , Donovan, J. , Smith, G.D. and Dieppe, P. (1999). Population requirement for primary hip-replacement surgery: A cross-sectional study . Lancet, 353, 1304-1309 .
18.
Hadorn, D.C. and Holmes, A.C. (1997). The New Zealand priority criteria project. Part 1: Overview . British Medical Journal, 314, 131-134 .
19.
Hargreaves, S. (2000). Burden of ageing population may be greater than anticipated . Lancet, 355, 2146 .
20.
Harris, W.H. and Sledge, C.B. (1990a). Total hip and total knee replacement (first of two parts). New England Journal of Medicine, 323, 725-731 .
21.
Harris, W.H. and Sledge, C.B. (1990b). Total hip and total knee replacement (second of two parts). New England Journal of Medicine, 323, 801-807 .
22.
Harrison, S. (1998). The politics of evidence-based medicine in the United Kingdom . Policy and Politics, 26(1), 15-31 .
23.
Hawker, G.A. , Wright, J.G. , Coyte, P.C. , Williams, J.I. , Harvey, B. , Glazier, R. and Badley, E.M. (2000). Differences between men and women in the rate of use of hip and knee arthroplasty . New England Journal of Medicine, 342, 1016-1022 .
24.
Hawker, G. , Wright, J. , Coyte, P. , Paul, J. , Dittus, R. , Croxford, R. , Katz, B. , Bombardier, C. , Heck, D. , and Freund, D. (1998). Health-related quality of life after knee replacement: Results of the knee replacement patient outcomes research team study . Journal of Bone and Joint Surgery, 80A, 163-173 .
25.
Hensinger, R.N. (1992). Editorial: The principles of medical ethics in orthopaedic surgery . Journal of Bone and Joint Surgery, 74A, 1439-1440 .
26.
Heruti, R.J. , Lusky, A. , Barell, V. , Ohry, A. and Adunsky, A. (1999). Cognitive status at admission: Does it affect rehabilitation outcome of elderly patients with hip fracture?Archives of Physical and Medical Rehabilitation, 80, 432-436 .
27.
High, D.M. (1992). Research with Alzheimer’s Disease subjects: Informed consent and proxy decision making . Journal of the American Geriatrics Society, 40(9), 950-957 .
28.
Jennings, A.G. and de Boer, P. (1999). Should we operate on nonagenarians with hip fractures?Injury, 30, 169-172 .
29.
Johnston, R.C. , Fitzgeral, d, R.H. , Harris, W.H. , Poss, R.Müller, M.E. and Sledge, C.B. (1990). Clinical and radiographic evaluation of total hip replacement . Journal of Bone and Joint Surgery, 72, 161-168 .
30.
Katz, J.N. , Wright, E.A. , Guadagnoli, E. , Liang, M.H. , Karlson, E.W. and Cleary, P.D. (1994). Differences between men and women undergoing major orthopedic surgery for degenerative arthritis . Arthritis and Rheumatism, 37, 687-694 .
31.
Laupacis, A. , Bourne, R. , Rorabeck, C. , Feeny, D. , Wong, C. , Tugwell, P. , Leslie, K. , and Bullas, R. (1993). The effect of elective total hip replacement on health-related quality of life . Journal of Bone and Joint Surgery, 75A, 1619-1626 .
32.
Luchins, D.J. and Hanrahan, P. (1993). What is appropriate health care for end-stage dementia?Journal of the American Geriatrics Society, 41, 25-30 .
33.
Mancuso, C.A. , Ranawat, C.S. , Esdaile, J.M. , Johanson, N.A. and Charlson, M.E. (1996). Indications for total hip and total knee arthroplasties . Journal of Arthroplasty, 11, 34-46 .
34.
Marson, D.C. , Hawkins, L. , McInturff, B. and Harrell, L.E. (1997a). Cognitive models that predict physician judgments of capacity to consent in mild Alzheimer’s Disease . Journal of the American Geriatrics Society, 45, 458-464 .
35.
Marson, D.C. , McInturff, B. , Hawkins, L. , Bartolucci, A. and Harrell, L.E. (1997b). Consistency of physician judgments of capacity to consent in mild Alzheimer’s Disease . Journal of the American Geriatrics Society, 45, 453-457 .
36.
Mitchell, S.L. , Berkowitz, R.E. , Lawson, F.M.E. and Lipsitz, L.A. (2000). A cross-national survey of tube-feeding decisions in cognitively impaired older persons . Journal of the American Geriatrics Society, 48, 391-397 .
37.
Molloy, D.W. , Guyatt, G.H. , Alemayehu, E. , McIlroy, W. , Willan, A. , Eisemann, M. , Abraham, G. , Basile, J. , Penington, G. , McMurdo, M.E.T. , Finucane, P. , Zelmanowicz, A. and Hyland, M. (1991). Factors affecting physicians’ decisions on caring for an incompetent elderly patient: An international study . Canadian Medical Association Journal, 145, 947-952 .
38.
Naylor, C.D. , Williams, J.I. and the Ontario Panel on Hip and Knee Arthroplasty . (1996). Primary hip and knee replacement surgery: Ontario criteria for case selection and surgical priority . Quality in Health Care, 5, 20-30 .
39.
NIH Consensus Development Panel on Total Hip Replacement . (1995). Total hip replacement (NIH consensus conference). Journal of the American Medical Association, 273, 1950-1956 .
40.
Peterson, M.G.E. , Hollenberg, J.P. , Szatrowski, T.P. , Johanson, N.A. , Mancuso, C.A. and Charlson, M.E. (1992). Geographic variations in the rates of elective total hip and knee arthroplasties among Medicare beneficiaries in the United States . Journal of Bone and Joint Surgery, 74A, 1530-1539 .
41.
Pilgrim, D. and Rogers, A. (2000). A sociology of mental health and illness, 2nd edn.Buckingham & Philadelphia, PA: Open University Press .
42.
Post, S.G. (1998). The fear of forgetfulness: A grassroots approach to an ethics of Alzheimer’s Disease . Journal of Clinical Ethics, 9, 71-80 .
43.
Post, S.G. and Whitehouse, P.J. (1995). Fairhill guidelines on ethics of the care of people with Alzheimer’s Disease: A clinical summary . Journal of the American Geriatrics Society, 43, 1423-1429 .
44.
Ryynänen, O. , Myllykangas, M. , Kinnunen, J. and Takala, J. (1997). Doctors’ willingness to refer elderly patients for elective surgery . Family Practice, 14, 216-219 .
45.
Sabat, S.R. (2001). The experience of Alzheimer’s Disease: Life through a tangled veil. Oxford & Malden, MA: Blackwell .
46.
Sloss, E.M. , Solomon, D.H. , Shekelle, P.G. , Young, R.T. , Saliba, D. , MacLean, C.H. , Rubenstein, L.Z. , Schnelle, J.F. , Kambery, C.J. and Wenger, N.S. (2000). Selecting target conditions for quality of care improvement in vulnerable older adults . Journal of the American Geriatrics Society, 48, 363-369 .
47.
Stradling, J.R. and Davies, R.J.O. (1997). Editorial: The unacceptable face of evidence-based medicine . Journal of Evaluation in Clinical Practice, 3, 99-103 .
48.
Tanenbaum, S.J. (1999). Evidence and expertise: The challenge of the outcomes movement to medical professionalism . Academic Medicine, 74(7), 757-763 .
49.
Tierney, W.M. , Fitzgerald, J.F. , Heck, D.A. , Kennedy, J.M. , Katz, B.P. , Melfi, C.A. , Dittus, R.S. , Allen, D.I. , Freund, D.A. and the Knee Replacement Patient Outcomes Research Team . (1994). Tricompartmental knee replacement: A comparison of orthopaedic surgeons’ self reported performance rates with surgical indications, contraindications, and expected outcomes . Clinical Orthopaedics and Related Research, 305, 209-217 .
50.
Upshur, R.E.G. (2002). If not evidence, then what? Or does medicine really need a base?Journal of Evaluation in Clinical Practice, 8(2), 113-119 .
51.
Van Dortmont, L.M.C. , Douw, C.M. , van Breukelen, A.M.A. , Laurens, D.R. , Mulder, P.G.H. , Wereldsma, J.C.J. and van Vugt, A.B. (2000). Outcome after hemi-arthroplasty for displaced intracapsular femoral neck fracture related to mental state . Injury, 31, 327-331 .
52.
Watson, R. (2001). European countries face similar problems of demographic ageing and higher patient expectations . British Medical Journal, 323, 1388 .
53.
Zuckerman, J.D. , Skovron, M.L. , Koval, K.J. , Aharonoff, G. and Frankel, V.H. (1995). Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip . Journal of Bone and Joint Surgery, 77A, 1551-1556 .
