Reflections on Hip Fracture Recovery From Older Adults Enrolled in a Clinical Trial

Abstract

This study describes patients’ perspectives on recovery during participation in a randomized controlled trial that tested a postoperative hip fracture management program (B4 Clinic), compared with usual care, on mobility. Semistructured qualitative interviews were conducted with 50 older adults with hip fracture (from both groups) twice over 12 months. A total of 32 women (64%) and 18 men (36%) participated in the study with a mean age at baseline of 82 (range = 65-98) years. A total of 40 participants reported recovery goals at some point during their recovery from hip fracture but only 18 participants realized their goals within 12 months. Recovering mobility, returning to prefracture activities, and obtaining stable health were the most commonly reported goals. Participants described good social support, access to physiotherapy, and positive perspective as most important to recovery. These factors were influenced by participants’ knowledge, resources, and monthly contact with study staff (perceived as a form of social support). The most frequently reported barriers to participants’ recovery were the onset of complications, pain, and limited access to physiotherapy. Potential implications of these findings include design and modification of new or preexisting fracture programs, prioritizing patient engagement and enhanced knowledge for future clinical research in hip fracture recovery.

“Life Goes On.” Everyday Tasks, Coping Self-Efficacy, and Independence: Exploring Older Adults’ Recovery From Hip Fracture

“…This intervention was designed to follow up with patients postoperatively over the telephone as a means to enhance their motivation and self-efficacy; to build realistic expectations; to assist them in translating their goals into action, fine-tuning their goals, and mobilizing social support; and to encourage them to continue in the journey of recovery. We have established the feasibility (Langford et al, 2015), and now the acceptability, of this rehabilitation intervention, and the older adults' responses further emphasized three instrumental components of recovery: the importance of social support, physical activity, and personal outlook (Schiller et al, 2015;Sims-Gould et al, 2017;Stott-Eveneshen et al, 2017). The unique contribution of these findings is threefold: older adults identified catalysts for the early recovery process (first 4 months), reported the impact of other health conditions/injuries (multimorbidity) on hip fracture recovery, and placed a strong emphasis on psychosocial elements as motivators to maximize the recovery process.…”

“…These findings provide valuable information for future interventions in older adults with hip fracture—interventions that integrate a holistic approach to injury and recovery and acknowledge the central role of psychosocial health. Taken together, the accumulating evidence (Schiller et al, 2015; Sims-Gould et al, 2017; Stott-Eveneshen et al, 2017) suggests the need to move beyond providing only “education” and prioritize the psychosocial elements necessary to enhance fracture recovery in older adults.…”

A relação do escore de Lee com a mortalidade pós-operatória em pacientes com fraturas de fêmur proximal

“…15 Similarly, age has already been indicated as a predictor of negative outcome in other studies. 16 17 18 19 A higher number of more serious comorbidities, such as osteoporosis, atherosclerosis, heart disease, diabetes, and cerebral and renal failures are more commonly found in elderly patients. Our study is consistent with the literature, since serum creatinine levels and age individually showed a statistical correlation with mortality.…”

“…15 Da mesma fora, a idade é um dado já indicado como preditivo de desfecho negativo, demonstrado em outros estudos. 16 17 18 19 Comorbidades mais sérias e em número maior, como osteoporose, aterosclerose, doenças cardíacas, diabetes, e insuficiências cerebral e renal são mais comumente encontradas nos pacientes idosos. O presente estudo está em concordância com a literatura, visto que os valores da dosagem sérica de creatinina e a idade, individualmente, apresentaram correlação estatística com a mortalidade.…”

Development of a Questionnaire to Assess Patient Priorities in Hip Fracture Care

“…Most research regarding the identification of patient priorities in hip fracture care and recovery (largely accomplished outside of the United States) points to the need for consideration of the complexity of the patient's medical and cognitive status. 8,[10][11][12][13][14] Further, there is great variation in the patient demographics of those experiencing and recovering from hip fracture, which further complicates the identification of a single set of priorities for all hip fracture patients and points to the need to understand how best to incorporate health care proxies. [15][16][17] Given the growing incidence of hip fractures, the known variation in physiological and neurological wellness in this population, 15 and the lack of knowledge regarding patient priorities during recovery from hip fracture, we sought to gather pilot data on the priorities of patients who have sustained hip fractures.…”