Fear of falling and changed functional ability following hip fracture among community-dwelling elderly people: an explanatory sequential mixed method study

Abstract

Purpose: The aims of the study were to assess self-reported fear of falling (FOF) and functional ability among community-dwelling elderly people 3–6 months post hospital discharge after a hip fracture, to investigate the association between FOF and functional ability, and to explore the lived experience of FOF and disability when recovering from a hip fracture. Method: A sequential explanatory mixed method design was used in a “face-to-face” survey assessing FOF (Falls Efficacy Scale-International, FES-I), avoidance of activities (Modified survey of Activities and Fear of Falling, mSAFFE), functional ability (Functional Recovery Score, FRS), and mobility (New Mobility Score, NMS) followed by in-depth interviews of four participants. Interviews were analyzed using systematic text condensation. Results: Among the 33 participants 58% had a high degree of FOF and avoided more activities, needed more assistance in activities of daily living, and were less mobile than participants who had a low degree of FOF (p < 0.0001). According to the informants FOF reduced their functional ability and seriously altered their lives. Conclusions: FOF was common and significantly associated with activity avoidance, disability, and affected the lives of elderly recovering from a hip fracture. Some patients were physically incapacitated by FOF.

Implications for Rehabilitation

• Fear of falling can affect post discharge recovery following a hip fracture and is a factor limiting functional ability in elderly patients.

• Fear of falling should be addressed in clinical practice and future research as fear of falling-screening at hospital discharge might be beneficial in tailoring rehabilitation efforts to the individual patient.

• Older patients recovering from hip fracture need to perform activities of daily living independently and overcome fear of falling to sustain quality of life and contain costs to society.

Keywords::

• Hip fracture
• elderly
• activities of daily living
• mobility and activity avoidance

Acknowledgments

We thank all participants, the heads of the Departments of Orthopedic Surgery at Herlev University Hospital and Bispebjerg University hospital for making this study possible, and Tobias Clausen from Herlev University Hospital for his assistance in the data analyses.

Declaration of Interest: The authors have declared that no conflict of interest exists.