Health and social interventions to restore physical function of older adults post-hip fracture: a scoping review

Abstract

ObjectivesDespite inpatient rehabilitation, many older adults post-hip fracture have difficulty returning to their prefracture levels of function and activity. This scoping review aims to identify interventions for community-dwelling older adults discharged from inpatient rehabilitation and examine the function and activity outcomes associated with these interventions.DesignThis scoping review followed Arksey and O’Malley’s five-stage framework.Data sourcesWe searched MEDLINE, CINAHL, PsycINFO, EMBASE and Ageline electronic databases for English-language articles published between January 1946 and January 2020.Eligibility criteriaWe included studies with health and social interventions involving community-dwelling older adults and their caregivers after hip fracture and inpatient rehabilitation. The interventions were selected if initiated within 60 days post-hip fracture surgery.Data extraction and synthesisTwo independent reviewers screened abstracts and full texts and extracted the data based on the inclusion criteria. A third reviewer adjudicated any disagreement and collated the extracted data.ResultsOf the 24 studies included in the review, most studies (79%) used exercise-based interventions, over half (63%) included activities of daily living training and/or home assessment and environment modification as intervention components, and three studies used social intervention components. Over half of the interventions (58%) were initiated in the inpatient setting and physiotherapists provided 83% of the interventions. Only seven studies (29%) involved tailored interventions based on the older adults’ unique needs and progress in exercise training. Six studies (25%) enrolled patients with cognitive impairment, and only one study examined caregiver-related outcomes. Exercise-based interventions led to improved function and activity outcomes. 29 different outcome measures were reported.ConclusionWhile exercise-based multicomponent interventions have evidence for improving outcomes in this population, there is a paucity of studies, including social interventions. Further, studies with standardised outcome measures are needed, particularly focusing on supporting caregivers and the recovery of older adults with cognitive impairment.

Trajectories of social support are associated with health outcomes and depressive symptoms among older Taiwanese adults with diabetes following hip‐fracture surgery

“…or therapists, or enhancing support from family and friends should be considered. 7 We also recommend focusing on patients with poor and declining social support not only because scores for outcomes of physical function and HRQoL were low, but also because these patients had low scores for nutritional status and high scores for depressive symptoms, which are often overlooked. Appropriate geriatric psychiatric interventions could reduce depressive symptoms.…”

“…5 One study reported patients with hip fracture who received a 12-month intervention of high-intensity weightlifting exercises with social support following hospital discharge had lower mortality, fewer nursing home admissions, and less dependency in activities of daily living (ADLs) than those receiving usual care. 6 Auais et al 5 and Omar et al 7 noted a lack of studies on social support and outcomes for patients with hip fracture, with existing studies averaging only 12 months for follow-up, while there is some evidence that patients may experience declines in ADLs and physical functions beyond 1 year after hip-fracture surgery. 8,9 A scoping review of 24 studies on interventions for older adults following hospital discharge contained only three studies that examined social interventions.…”

“…8,9 A scoping review of 24 studies on interventions for older adults following hospital discharge contained only three studies that examined social interventions. 7 Age is a risk factor for hip fracture and diabetes mellitus (DM) can also increase hip fracture risk and complications due to abnormal bone metabolism. 10 A systematic review of 17 studies demonstrated an increase in the prevalence of low-energy hip fractures for older adults with DM compared with those without DM.…”

“…Auais et al 5 . and Omar et al 7 . noted a lack of studies on social support and outcomes for patients with hip fracture, with existing studies averaging only 12 months for follow‐up, while there is some evidence that patients may experience declines in ADLs and physical functions beyond 1 year after hip‐fracture surgery 8,9 .…”

“…noted a lack of studies on social support and outcomes for patients with hip fracture, with existing studies averaging only 12 months for follow‐up, while there is some evidence that patients may experience declines in ADLs and physical functions beyond 1 year after hip‐fracture surgery 8,9 . A scoping review of 24 studies on interventions for older adults following hospital discharge contained only three studies that examined social interventions 7 …”