Caregivers’ misperception of the severity of hip fractures

Abstract

PurposeThe aim of our study was to evaluate how the caregiver of a hip fracture patient perceives the patient’s health status and autonomy in the period immediately preceding the acute event and whether these judgments are actually in line with the prognosis predicted by the medical team caring for the patient in the rehabilitation structure.Patients and methodsWe enrolled 147 patients of both sexes, aged ≥65 years, who were referred to our center following surgical treatment of hip fractures of various nature. At the beginning of the rehabilitation program, each patient’s caregiver was asked to complete the Blaylock Risk Assessment Screening Score (BRASS) questionnaire. The same questionnaire was compiled contemporaneously by the doctor taking care of the patient.ResultsAnalysis of the data shows that the caregivers tend to assign lower scores than the doctor, with a mean difference in agreement with the Bland–Altman plot of −2.43, 95% CI=−2.93 to −1.93, t-test P<0.001. Furthermore, differences in objectivity emerge in the evaluation of the clinical problems of the patient in a borderline clinical condition.ConclusionThis study revealed that caregivers systematically misperceive the clinical situation of hip fracture patients prior to the acute event. Altered perception of such an important factor can lead to a general lack of satisfaction with the outcome achieved by the patient at the end of the rehabilitation process. We therefore believe that an adequate, effective communication between the people making up the health care team and the patient’s social and family network is the foundation of the rehabilitation process. It is precisely on this foundation that the individual’s care and assistance need to be assembled.

Qualitative Evaluation of a Novel Educational Tool to Communicate Individualized Hip Fracture Prognostic Information to Patients and Surrogates: My Hip Fracture (My-HF)

“… 30 - 33 There has been far less attention to addressing the gap in patient and caregiver understanding of HF prognosis. 10 , 11 While the internet provides many publicly available resources that discuss HF treatment and recovery, 34 , 35 these resources are not tailored to the prognosis or risk of the individual patient. Alternatively, the ACS-NSQIP risk calculator provides individualized information regarding prognosis but is not designed for patients or SDMs with limited medical knowledge or numeracy.…”

Psychosocial vulnerability of Mexican informal caregivers in fall-related hip fractures

“…The results from our study reveal a state of socioeconomic vulnerability and a lack of readiness to provide redistribution of the caregiver's attention; brief family interventions can benefit the adaptive process 5,18,19 .…”

“…The average score of the measurement of caregivers' abilities for providing care to hip-fractured patients revealed the possibility that relatives overvalued these abilities at the beginning of their new role, a phenomenon widely described in prior studies 19 . The latter could have both positive and negative impacts on caregiving.…”

“…Although new caregivers may anticipate during the period immediately succeeding the acute event that the fracture will become a turning point in their lives, predicting the economic burden caregiving represents may be difficult 5,19 . From the fracture's treatment to the transition of care from hospital to home and the rehabilitation process, adequate care is often achieved at the expense of the family's financial health 20 .…”

“…Taking into account that informal caregiving inevitably demands significant changes in the caregiver's life that range from adjustments in family dynamics to reduced participation in the labor force and increased household expenses, it is necessary to meticulously evaluate the relative's willingness to become a caregiver and attitude toward caregiving 5,7,8,19 . Despite the significant modifications that occur with caregiving chores, assessment by the health providers of the relatives' knowledge, understanding, or proficiency of the tasks they are expected to perform is not routinely done 26 .…”