Coping strategies of older adults with a recent hip fracture within inpatient geriatric rehabilitation

Figures & data

Table 1. Characteristics of the study population; additionally specified for participants with predominantly active and/or passive coping.

	All participants (n = 72)		Predominantly Active Coping (PAC) group (n = 24)^†		Predominantly Passive coping (PPC) group (n = 17)^‡
Socio-demographics
Age in years; mean (SD)	82.3	(7.7)	83.1	(7.3)	78.4	(8.4)
Female gender; n (%)	56	(77.8)	17	(70.8)	15	(88.2)
Living alone prior to fracture; n (%)	46	(63.9)	14	(58.3)	12	(70.6)
General health aspects
Functional Comorbidity Index (total score; 0-18); median (IQR)	3.00	(1.0-5.0)	4.00	(2.0-6.0)	3.00	(2.0-4.75)
Health related quality of life (EQ5D-VAS; 0-100); median (IQR)	60.0	(50.0-70.0)	70.0	(52.5-78.8)	60.0	(45.0-70.0)
Average pain in past week (NPRS; 0-10); median (IQR)	6.0	(4.0-8.0)	6.0	(5.0-7.0)	5.0	(4.5-7.0)
(Neuro)psychological factors
MMSE score (0-30); median (IQR)	27.0	(25.0-29.0)	27.0	(24.0-29.0)	27.0	(24.5-29.5)
Participants with GDS-8 score ≥ 3; n (%)*	10	(14.1)	2	(8.3)	5	(31.3)
Participants with HADS-A score ≥ 7; n (%)	16	(22.2)	3	(12.5)	10	(58.8)
Participants with prescription for pain medication*
Paracetamol; n (%)	58	(86.6)	21	(91.3)	14	(82.4)
NSAID’s; n (%)	7	(10.4)	1	(4.3)	2	(11.8)
Morphine; n (%)	26	(38.8)	8	(34.8)	8	(47.1)
Patients with prescription for psychotropic medication*
Antidepressants; n (%)	6	(9.0)	3	(13.0)	1	(5.9)
Benzodiazepine; n (%)	4	(6.0)	1	(4.3)	–	–
Antipsychotics; n (%)	4	(6.0)	1	(4.3)	1	(5.9)

Notes: *numbers do not add up to final numbers due to missing data, valid % is shown. † Predominantly active coping (PAC) group: comprising of individuals with high (n = 19) or extremely high active (n = 5) coping based on the Active Tackling subscale of the Utrecht Coping List (UCL). ‡ Predominantly passive coping (PPC) group: comprising of individuals with high passive coping (n = 17) based on the Passive Reacting subscale of the UCL (no participants had extremely high passive coping).

SD = standard deviation; IQR = interquartile range; EQ5D-VAS = instrument of Euro-QoL group defining patient’s self- rated health on vertical visual analogue scale; NPRS = Numeric Pain Rating Scale; MMSE = Mini Mental State Examination; GDS-8 = 8-item Geriatric Depression Scale; HADS-A = Hospital Anxiety and Depression Scale; NSAID’s = Non-Steroidal Anti-inflammatory Drugs.

Table 2. Active Tackling and Passive Reacting coping at onset of inpatient geriatric rehabilitation.

UCL - Active Tackling Scale
Total score all participants (7-28); median (IQR)	18.0	(14.0-22.0)
Classification based on norm tables; participants n (%)	72	(100)
Extremely low active coping	12	(16.7)
Low active coping	7	(9.7)
Average active coping	29	(40.3)
High active coping	19	(26.4)
Extremely high active coping	5	(6.9)
UCL - Passive Reacting Scale
Total score all participants (7-28); median (IQR)	9.0	(8.0-11.0)
Classification based on norm tables; participants n (%)	72	(100)
Extremely low passive coping	15	(20.8)
Low passive coping	17	(23.6)
Average passive coping	23	(31.9)
High passive coping	17	(23.6)
Extremely high passive coping	0	(0.0)

Notes: UCL = Utrecht Coping List. Total score for both subscales (Active Tackling and Passive Reacting) range 7-28, with a higher score representing a greater extent of use of this coping strategy. Classification into five categories (extremely low, low, average, high, extremely high use of the coping strategy), is based on norm-tables for UCL (age and gender specific). IQR = interquartile range.

Figure 1. Active Tackling versus Passive Reacting coping within individual participants.

Table 3. Association between active and passive coping with symptoms of depression, anxiety, pain and health related quality of life.

	UCL - Active Tackling Scale			UCL - Passive Reacting Scale
	Predominantly Active Coping^† (n = 24)	Residual group^‡ (n = 48)	P value	Predominantly Passive Coping § (n = 17)	Residual group^‡ (n = 55)	P value
Participants with GDS-8 ≥ 3; (% of the group)	8.3	17.0	0.477	31.3	9.1	0.040
Participants with HADS-A ≥; 7 (% of the group)	12.5	27.1	0.232	58.8	10.9	< 0.001
Participants with NPRS ≥ 4; (% of the group)	87.5	75.0	0.356	88.2	76.4	0.495
EQ5D-VAS score (range 0-100); median(IQR)*	70.0 (52.5-78.8)	60.0 (50.0-70.0)	0.091	60.0 (45.0-70.0)	65.0 (50.0-75.0)	0.125

Notes: * P values are based on Fisher Exact test, except for the EQ5D-VAS, where Mann-Whitney test was used. † Predominantly active coping group: comprising of individuals with high (n = 19) or extremely high active (n = 5) coping based on the Active Tackling subscale of the Utrecht Coping List (UCL). ‡ Residual group: the remaining part of the group, with participants that scored extremely low, low or average on the specific UCL subscale, either Active Tackling Scale or Passive Reacting Scale.

^§Predominantly passive coping group: comprising of individuals with high passive coping (n = 17) based on the Passive Reacting subscale of the UCL (no participants had extremely high passive coping). GDS-8 = 8-item Geriatric Depression Scale; HADS-A = Hospital Anxiety and Depression Scale; NPRS = Numeric Pain Rating Scale; EQ5D-VAS = instrument of Euro-QoL group defining patient’s self- rated health on vertical visual analogue scale; IQR = interquartile range.

Table

UCL - Active Tackling Scale

Undertake immediate action in response to problems

Perceive problems as a challenge

A broad approach to problems

Stay calm in difficult situations

Consider different solutions for problems

Goal-oriented approach to problems

Structured evaluation of problems

UCL - Passive Reacting Scale

Self-isolation / social withdrawal

Pessimistic approach

Worry about the past

Substance (ab)use to reduce tension

Fantasy as escape strategy

Being pre-occupied by problems

Feeling unable to act