One in five people sustaining a hip fracture die within 4 months.1 A palliative care approach is appropriate for people with advanced non-malignant as well as malignant disease.2 Thus a hip fracture in a frail older person could reasonably trigger a palliative care approach: anticipating and planning for physical, social, psychological and spiritual needs and end of life care. This might result in better care planning, help avoid futile treatment, and decrease healthcare costs in the last year of life.

Annually there are around 75 000 hip fractures in the UK and 300 000 in USA.3 4 This is projected to rise to 101 000 in the UK annually by 2020, with associated health and social costs of £2.2 billion.3 Although the operative treatment of hip fractures is increasingly technically successful, this injury is a major precipitant of disability and loss of independence, and carries a five- to eightfold increased risk in all-cause mortality at 3 …