Worldwide, an increase in the number of hip fractures is expected because of population aging. In the Netherlands, after hospitalisation for a hip fracture, approximately 40% of older adults receive short-term geriatric rehabilitation. Many of them live alone, have multiple co-morbidities and do not regain their premorbid functional abilities.
The average duration of rehabilitation in a hospital since the moment of hip fracture is 1 month. The duration of functional recovery after injury varies from 6 months to 1 year.
Much literature on hip fracture recovery has focused on risk factors that explain functional decline or on intervention strategies for improving mobility. However, studies are missing related to older adults’ experiences that focus on the transition from inpatient rehabilitation to return to everyday life at home. Insight into these perspectives might help to improve the rehabilitation.
A group of researchers from the Netherlands considered the question: What aspects of the recovery process after hip fracture do community-dwelling older adults perceive as the most beneficial for their return to everyday life?
The study participants identified the restrictions which must be overcome in the process of recovery from injury:
All study participants stated that their mobility has become more limited. They had difficulty lifting from a chair and maintaining balance. “I walk a little bit in the neighborhood, but I don’t go any further”, said one of the patients.
A majority of the participants had to use mobility aids, which they had not used before the hip fracture. Some participants perceived the need for mobility aids as a lack of improvement and as representing the consequences of aging, thus making them feel old. Although the use of mobility aids provided greater safety when walking, they generally expressed that it also limited them in their mobility and restricted them in doing everyday activities. One lady said,“Before this, I could walk normally, but now I have to walk with the help of a walker. I’m chained to the walker”.
Some of the participants indicated that they were tired much sooner than before and that they had less energy. This tiredness limited and restricted their activities. Others expressed that activities were taking up much more time, and because of their lower energy levels, they had to balance their activities.
“Activities take up much more time; I did the gardening in a single day, and now I need three or four days because I get tired a lot sooner, and therefore, I divide up the activities”, said the victim.
Almost all of the participants expressed concerns about falling again, which influenced their activities. One lady put it like this: “I’m worried to fall again; I have to have something to hold on to everywhere I walk”. As a result of these worries about falling, a majority of them were very careful and focused on planning their activities.
In general, the recovery process was characterized by older patients as regular practical experiments that either led to improvement, or ended in failure. Although all participants experienced physical and psychological limitations in varying degrees, there were many ways to cope with them. Trial hands-on exercises were central to the healing process for all. Everyone adjusted as he could.
All elderly respondents who had a hip fracture felt that moving home from the hospital was very difficult. They were addicted to the help of other people and felt insecure when they started doing something. As one participant said, “The change of going home was disappointing at first. All of a sudden, you have to do it all by yourself, and there is no protection around you.”
Resources that helped the victims recover the authors of the research summarized as follows.
“My own will helped me most to do activities again; I think it is my own motivation. Because I can’t accept help that is not necessary; what I can do myself I want to do myself”, the participant commented.
Many participants expressed the opinion that their attitude towards life and the habit of thinking positively strongly influenced recovery.“Don’t give up. The most helpful thing was my own positive approach and me, who truly wanted to go for it. Keep on going with what you still can do”.
Most of the participants highly appreciated conversations with others rehabilitating themselves and found such contacts very useful for recovery. Half of the victims received home rehabilitation assistance which included several visits by a health worker and some telephone calls. Here are the mechanisms by which such communications have influenced the recovery process.
Talking with the doctor during the visits, the victims could discuss their difficulties: “I truly appreciated that there was a follow-up because you suddenly go from being at the nursing home to being at home all on your own, and so it was very nice that there was somebody I could talk to about what was disappointing or what was going well”.
Others expressed the support of the therapist as rebuilding or boosting self-confidence: “The aftercare has been important; we discussed what I had done, and I felt more confident in doing difficult activities”.
All the participants fell repeatedly at home under certain circumstances. One lady said about the help of a therapist who visited her: “She observed that I was dreading to go to the bathroom where I had my fall and where I had been lying on the floor for a long time. Therefore, she said to me: ‘Shall we go to the bathroom?’, and that was very important to me”.
Other participants mentioned the practical tips and the practice of difficult activities at home with the therapist as very helpful. One lady stated, “She was interested in the activities I wanted to do; she gave me tips and stimulated me to do these things again. It truly helped me. Also, it helps that you can ask questions about things you come upon when you have to do it yourself again”.
Today, there are many sensory devices that in addition to the above can be useful in recovering from a hip fracture.
Feedback from today's fitness bracelets has helped some of the victims understand the amount of movement and actions performed. This created the motivation to move more times from time to time: “It motivated me to move more, for example, in the evening when I didn’t want to go on my home trainer, I thought by myself, I want to do it anyway because it is good to move. And when you had a look at the sensor data, it gave you such a good feeling, I’ve done so much”.
The recovery process often leads elderly people to do their daily activities in the same way as they did before the break. The results of the study identified three groups of resources that turned out to be useful during rehabilitation: “myself”, “supporting and coaching” and “technological support”.
Coaching provides emotional tone, increases self-confidence, with the result that participants feel more relaxed and brave. Myself affects the mechanisms of positive thinking and people's own motivation, which strongly influences recovery. Technology motivates patients to be more active.
The findings suggest that participants choose those adaptation methods that they can better incorporate into their daily activities, despite their physical or psychological limitations. This conclusion is consistent with the theses of the new popular concept, in which health is seen as a dynamic ability to adapt and manage their own well-being.
Finally, the researchers emphasize the great value of subsequent rehabilitation after discharge from the hospital. Personalized approach focused on the daily functioning of each individual elderly person in his own life is important.
Compiled on the basis of the report «Everyday life after a hip fracture: what community-living older adults perceive as most beneficial for their recovery» by Margriet Pol, Sebastiaan Peek, Fenna van Nes, Margo van Hartingsveldt, Bianca Buurman and Ben Kröse. © Age and Ageing. First published on May'3 2019.