Older adults’ perceptions of early rehabilitation and recovery after hip fracture surgery: a UK qualitative study

Abstract

Purpose

To explore older adult’s perceptions of early rehabilitation and recovery after hip fracture, as a complement to the UK standards for acute physiotherapy after hip fracture.

Methods

In-depth semi-structured interviews with 15 adults aged 60 years or more in hospital after hip fracture surgery. A thematic analysis approach with interpretation informed by Bury’s biographical disruption theoretical framework.

Results

Participants voiced the importance of self-determination, professional support, meaningful feedback, and social capital after hip fracture. Collaborative working with staff was required for meeting the UK standards. Participants voiced anxieties about their hip fracture when considered in conjunction with their age and co-existing conditions, anticipating a disruption to their previous physical and social activities. This new, more dependent, life situation was not acceptable to participants.

Conclusions

This study suggests hip fracture alone, was not perceived as a biographical disruption by older adults although it is presented as a potential tipping point in the loss of independence, contributing to the wider disruption of advancing age and co-existing conditions. For successful implementation of the UK standards, goal setting should consider patients in the wider context of their advancing age and co-existing conditions to empower them to define a fresh narrative of self.

Implications for rehabilitation

• Hip fracture was perceived as a potential tipping point in the loss of independence, contributing to the wider disruption of advancing age and co-existing conditions.

• Participants expressed uncertainty over their ability to recover their previous identity in the absence of professional support and/or social capital.

• Healthcare professionals need to educate and empower older adults to take charge of their own recovery.

• For successful implementation of the UK standards for acute physiotherapy, there is a need to contextualize goal setting to empower patients to define a fresh narrative of self.

Keywords:

• Hip fracture
• rehabilitation
• recovery
• qualitative
• expectations
• biographical disruption

Acknowledgements

We would like to thank the participants who took part in the interviews.

Disclosure statement

Katie Jane Sheehan has received funding from the National Institute of Health Research, the Chartered Society of Physiotherapy UK, and UK Research and Innovation for work around hip fracture care not related to this manuscript. All other authors report no conflicts of interest.