Predictors of Posttraumatic Stress Symptoms and Association with Fear of Falling After Hip Fracture

Abstract

Background Common fall-related injuries including hip fracture may put elderly individuals at risk for the development of posttraumatic stress disorder (PTSD). Similar to Fear of Falling (FoF), PTSD could negatively impact physical recovery due to behavioral avoidance. Methods We examined rates of partial and full posttraumatic stress disorder (pPTSD and fPTSD) and compared them to rates of FoF in 456 individuals age 60 and older who were admitted as inpatients for surgical hip fracture repair after a fall. PTSD and FoF were assessed four and twelve weeks postsurgery. We also analyzed baseline characteristics including depression, stress, pain, cognitive functioning, and anesthesia type as potential predictors of PTSD symptoms 12 weeks postsurgery. Results No patient met criteria for fPTSD at either week four or twelve. Similarly, rates of pPTSD were low at twelve weeks postsurgery (7.4%), in contrast to high rates of FoF symptoms at the same time point (58.5%). Higher ratings of stress and depressive symptoms at baseline were associated with higher levels of PTSD symptoms 12 weeks postsurgery. Conclusions Hip fracture, despite its considerable morbidity, does not induce fPTSD and infrequently induces pPTSD. Patients with higher ratings of stress and depression symptoms after hip fracture repair may be more likely to develop PTSD symptoms.

Risk of Hospitalized Falls and Hip Fractures in 22,103 Older Adults Receiving Mental Health Care vs 161,603 Controls: A Large Cohort Study

“…65 Our study advances the field demonstrating the increased risk of falls requiring hospitalization in older adults with bipolar disorder. For stress-related disorders, although previous research has suggested that some cases could arise as a consequence of both a fall and hip fracture and lead to worse outcomes, 66 previous research has also reported that older adults with depressive symptoms, that is, a potentially related group, have an increased risk of hip osteoporosis, 30 self-report falls, 38 and fractures. 67 Our data indicate that people with clinical depression specifically have a 2.2 and 3.9 increased risk of hospitalized falls and hip fractures, respectively.…”

Concerns for Older Adult Patients with Acute Hip Fracture

“…Of the 152 patients in this study, 72.4% were concerned about postoperative recovery, rehabilitation, and re-fracture; 63.2% were concerned about recovery of walking; and 52.6% were concerned about return to work and daily life activities. Kornfield, et al 19 reported that anxiety about re-fracture is highly associated with post-traumatic stress disorder and that hip fracture in older adults causes great psychological and physical stress and increased mortality and morbidity. In the future, based on the results of this and other studies, it is necessary to establish protocols for preventing re-fracture and interventions to relieve the stress caused by hip fracture in the elderly.…”

Important perioperative factors, guidelines and outcomes in the management of hip fracture

“…This may lead to depression and the literature in this area is rapidly expanding ( Cristancho et al 2016 ). It may also result in variants of post-traumatic stress disorder, albeit infrequently ( Kornfield et al 2017 , Salkeld et al 2000 ).…”