The independent contributions to recovery from hip fracture of psychosocial factors including depression, personality, social connectedness, and self-rated health were studied in 219 women age 59 and older (mean age 78.5) who were community dwelling prior to fracture. Initial assessments were conducted shortly after surgery and follow up assessments 2, 6, and 12 months later. By 12 months, 15 patients had died and 15 had entered a nursing home. Substantial declines in physical functioning though not psychosocial status were observed. Only 21 per cent (compared to 81 per cent prefracture) reported walking independently; fewer than 30 per cent had regained reported prefracture levels of physical function. The proportion with elevated depression scores at 12 months was 20 per cent, down from 51 per cent following surgery; 64 per cent rated their

One hundred ninety-six older. White females were followed for 12 months after hip fracture. We examined the effects of persistently elevated depressive symptoms, measured by the Center for Epidemiological Studies Depression (CES-D) scale during a postsurgery interview and 2, 6, and 12 months later, on ambulation, overall physical function, and return to prefracture physical function 12 months after fracture. Age, prefracture physical function, and cognitive status were predictors of recovery. Controlling for these factors, persons consistently reporting few depressive symptoms were three times more likely than those with persistently elevated CES-D scores to achieve independence in walking, nine times more likely to return to prefracture levels in at least five of seven physical function measures, and nine times more likely to be in the highest quartile of overall physical function. These findings emphasize the importance of persistently elevated depressive symptoms for recovery. Routine screening, evaluation, and treatment of depression or depressed mood may be beneficial to the recovering hip fracture patient.

IPC appears feasible, acceptable, and effective in short-term depressive symptom reduction and in improvement in self-rated health. Implementation of IPC interventions for subdysthymic hospitalized elderly is recommended.

BACKGROUND.The purpose of the current study was to identify unmet psychosocial needs of cancer survivors, understand the distribution of needs across subgroups, and compare unmet needs in 2005 with those identified by Houts et al. in 1986.METHODS.Using a sequential mixed methods design, qualitative interviews were conducted with 32 cancer survivors or family members to identify the psychosocial needs of people from the time of cancer diagnosis through survivorship. These data were used to modify a needs assessment that was mailed to a stratified random sample of survivors obtained from the Pennsylvania Cancer Registry.RESULTS.A total of 614 survivors returned usable questionnaires. Nearly two‒thirds of respondents reported experiencing at least 1 unmet psychosocial need, particularly emotional, physical, and treatment‒related needs. It is likely that unmet needs in insurance, employment, information, and homecare increased during the 20‒year interval between surveys. Demographics associated with increased unmet need included later stage of disease at the time of diagnosis, younger age, more comorbidities, and lower income.CONCLUSIONS.Unmet psychosocial need remains high despite 20 years of effort to address psychosocial issues. This may be due to a mismatch between needs and services. Unmet need may be related to access issues, a lack of awareness of resources, “new” needs that have arisen in a changing healthcare climate, and patient preferences for types of service. Cancer treatment staff should be especially alert for psychosocial problems in younger individuals with an additional illness burden. Cancer 2007. © 2007 American Cancer Society.

Cancer survivors who experienced unmet needs within the existing cancer treatment and support system were more likely to use CAM to help with cancer problems. Research is needed to determine if appropriate CAM use decreases unmet needs among cancer survivors.