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The recovery process after a hip fracture of healthy patients, 65 years and older - perceptions, abilities, and strategies

Gesar, Berit LU (2018) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2018(66).
Abstract
Background: A hip fracture is a common cause of morbidity, functional disability, and decreased health-related quality of life (HRQOL). With demographic changes showing a growing proportion of older people, hip fractures will be an increasing challenge for healthcare services in the future. Hip fractures threaten the independence of individuals in their everyday lives. In Sweden, more than one third of those who sustain a hip fracture are healthy and live independently before the hip fracture, but of that number, 40 percent do not regain pre-fracture functional capability. In terms of adults who lived independently and who are at risk of declined functions after a hip fracture, the recovery process should improve their chances to recover,... (More)
Background: A hip fracture is a common cause of morbidity, functional disability, and decreased health-related quality of life (HRQOL). With demographic changes showing a growing proportion of older people, hip fractures will be an increasing challenge for healthcare services in the future. Hip fractures threaten the independence of individuals in their everyday lives. In Sweden, more than one third of those who sustain a hip fracture are healthy and live independently before the hip fracture, but of that number, 40 percent do not regain pre-fracture functional capability. In terms of adults who lived independently and who are at risk of declined functions after a hip fracture, the recovery process should improve their chances to recover, to avoid disability, and to maintain independence.
Aim: The overall aim of this study was to garner knowledge about the views of patients, their experiences, perceptions, and strategies for recovery after hip fracture surgery in order to design a feasibility study for an intervention.
Method: Studies I and II were explorative interviews with an inductive qualitative design. Study III was a register/questionnaire study with patient-reported outcome measures. Study IV, a feasibility study protocol with a single-case experimental design, is based on the results from studies I, II, and III. The purpose of this feasibility study will determine whether the intended intervention is appropriate for further testing in a full-scale intervention. The sample is previously healthy independent living older adults in Sweden.
Results: Initially at the acute hospital, all the patients believed in recovery and in re-establishing everyday life. However, the conviction patients had in terms of regaining everyday life transited into a sense of passivity about whether and how they would recover. This was due to adapting to the culture of the ward at the acute hospital.
The follow-up interviews four months later showed that the hip fracture still had consequences for everyday life. The physical restraints had psychological; while conversely, the psychological effects influenced physical recovery. The register questionnaire study (III) showed that after four months, only 21 percent of the previously healthy adults assessed themselves as almost fully or fully recovered. Different age groups reported different challenges on the two observed occasions.
Conclusion: This thesis demonstrates that previously healthy older adults who lived independently before do not receive sufficient support after a hip fracture. These patients should have the potential to recover to previous function capability and to re-establish their everyday lives. Person-centred care provided by an inter-professional team could result in optimal individual outcomes for this patient group
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Abstract (Swedish)
Background: A hip fracture is a common cause of morbidity, functional disability, and decreased health-related quality of life (HRQOL). With demographic changes showing a growing proportion of older people, hip fractures will be an increasing challenge for healthcare services in the future. Hip fractures threaten the independence of individuals in their everyday lives. In Sweden, more than one third of those who sustain a hip fracture are healthy and live independently before the hip fracture, but of that number, 40 percent do not regain pre-fracture functional capability. In terms of adults who lived independently and who are at risk of declined functions after a hip fracture, the recovery process should improve their chances to recover,... (More)
Background: A hip fracture is a common cause of morbidity, functional disability, and decreased health-related quality of life (HRQOL). With demographic changes showing a growing proportion of older people, hip fractures will be an increasing challenge for healthcare services in the future. Hip fractures threaten the independence of individuals in their everyday lives. In Sweden, more than one third of those who sustain a hip fracture are healthy and live independently before the hip fracture, but of that number, 40 percent do not regain pre-fracture functional capability. In terms of adults who lived independently and who are at risk of declined functions after a hip fracture, the recovery process should improve their chances to recover, to avoid disability, and to maintain independence.
Aim: The overall aim of this study was to garner knowledge about the views of patients, their experiences, perceptions, and strategies for recovery after hip fracture surgery in order to design a feasibility study for an intervention.
Method: Studies I and II were explorative interviews with an inductive qualitative design. Study III was a register/questionnaire study with patient-reported outcome measures. Study IV, a feasibility study protocol with a single-case experimental design, is based on the results from studies I, II, and III. The purpose of this feasibility study will determine whether the intended intervention is appropriate for further testing in a full-scale intervention. The sample is previously healthy independent living older adults in Sweden.
Results: Initially at the acute hospital, all the patients believed in recovery and in re-establishing everyday life. However, the conviction patients had in terms of regaining everyday life transited into a sense of passivity about whether and how they would recover. This was due to adapting to the culture of the ward at the acute hospital.
The follow-up interviews four months later showed that the hip fracture still had consequences for everyday life. The physical restraints had psychological; while conversely, the psychological effects influenced physical recovery. The register questionnaire study (III) showed that after four months, only 21 percent of the previously healthy adults assessed themselves as almost fully or fully recovered. Different age groups reported different challenges on the two observed occasions.
Conclusion: This thesis demonstrates that previously healthy older adults who lived independently before do not receive sufficient support after a hip fracture. These patients should have the potential to recover to previous function capability and to re-establish their everyday lives. Person-centred care provided by an inter-professional team could result in optimal individual outcomes for this patient group
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Please use this url to cite or link to this publication:
author
supervisor
opponent
  • professor Olofsson, Birgitta, Umeå University
organization
publishing date
type
Thesis
publication status
published
subject
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2018
issue
66
pages
99 pages
publisher
Lund University: Faculty of Medicine
defense location
Föreläsningssal 5, Centralblocket, Universitetssjukhuset i Lund
defense date
2018-05-31 13:00:00
ISSN
1652-8220
ISBN
978-91-7619-632-8
language
Swedish
LU publication?
yes
additional info
ISSN: 1652-8220 Lund University, Faculty of Medicine Doctoral Dissertation Series 2018:66
id
806e0170-cfde-408d-b37d-f55431e71b02
date added to LUP
2018-05-07 10:28:32
date last changed
2019-11-19 13:49:36
@phdthesis{806e0170-cfde-408d-b37d-f55431e71b02,
  abstract     = {Background: A hip fracture is a common cause of morbidity, functional disability, and decreased health-related quality of life (HRQOL). With demographic changes showing a growing proportion of older people, hip fractures will be an increasing challenge for healthcare services in the future. Hip fractures threaten the independence of individuals in their everyday lives. In Sweden, more than one third of those who sustain a hip fracture are healthy and live independently before the hip fracture, but of that number, 40 percent do not regain pre-fracture functional capability. In terms of adults who lived independently and who are at risk of declined functions after a hip fracture, the recovery process should improve their chances to recover, to avoid disability, and to maintain independence.<br/>Aim: The overall aim of this study was to garner knowledge about the views of patients, their experiences, perceptions, and strategies for recovery after hip fracture surgery in order to design a feasibility study for an intervention.<br/>Method: Studies I and II were explorative interviews with an inductive qualitative design. Study III was a register/questionnaire study with patient-reported outcome measures. Study IV, a feasibility study protocol with a single-case experimental design, is based on the results from studies I, II, and III. The purpose of this feasibility study will determine whether the intended intervention is appropriate for further testing in a full-scale intervention. The sample is previously healthy independent living older adults in Sweden.<br/>Results: Initially at the acute hospital, all the patients believed in recovery and in re-establishing everyday life. However, the conviction patients had in terms of regaining everyday life transited into a sense of passivity about whether and how they would recover. This was due to adapting to the culture of the ward at the acute hospital.<br/>The follow-up interviews four months later showed that the hip fracture still had consequences for everyday life. The physical restraints had psychological; while conversely, the psychological effects influenced physical recovery. The register questionnaire study (III) showed that after four months, only 21 percent of the previously healthy adults assessed themselves as almost fully or fully recovered. Different age groups reported different challenges on the two observed occasions.<br/>Conclusion: This thesis demonstrates that previously healthy older adults who lived independently before do not receive sufficient support after a hip fracture. These patients should have the potential to recover to previous function capability and to re-establish their everyday lives. Person-centred care provided by an inter-professional team could result in optimal individual outcomes for this patient group<br/>},
  author       = {Gesar, Berit},
  isbn         = {978-91-7619-632-8},
  issn         = {1652-8220},
  language     = {swe},
  month        = {05},
  number       = {66},
  publisher    = {Lund University: Faculty of Medicine},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {The recovery process after a hip fracture of healthy patients, 65 years and older - perceptions, abilities, and strategies},
  url          = {https://lup.lub.lu.se/search/files/42801888/Berit_Gesar_webb.pdf},
  volume       = {2018},
  year         = {2018},
}