Following hip fracture and subsequent surgery, many older people suffer a decline in mobility, independence and quality of life. Social and psychological factors such as fear of falling, self-efficacy, perceived control and coping strategies are now thought to be important in the recovery from hip fracture. There is, however, limited information on how treatments impact on these factors. Furthermore, there is little information on who can best provide these interventions.
The authors of this review looked for evidence on the effectiveness of treatments which specifically focused on improving independence with daily activities (such as dressing, home chores, going shopping and interacting in the community) or had a focus on psychological and social issues in older people recovering from hip fracture. We were able to identify nine studies involving 1400 people who had sustained a hip fracture. Findings from three trials testing approaches taken while the patients were still in hospital using strategies such as reorientation, cognitive behavioural therapy and intensive occupational therapy did not show changed outcomes. Two trials tested specialist gerontological nurse-led care, which was delivered largely in the community. One of these, which included discharge planning, found some evidence of a reduction of poor outcome (defined as death, readmission or failure to return home) at three months from specialist-nurse led care, but the other trial found no differences in functional outcomes at 12 months compared with usual care. Trials testing other post-hospital interventions including group education programs after discharge and home rehabilitation (provided by a study physiotherapist and nursing staff) provided no evidence that these improved outcomes. This suggests that the transition between acute, rehabilitation and community care requires further attention. In all, the studies were too small and their quality too varied to recommend changes in practice.