Older adults` perception of their own capacity to regain pre-fracture functions after hip fracture surgery- a longitudinal study

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1 Older adults` perception of their own capacity to regain pre-fracture functions after hip fracture surgery- a longitudinal study Berit Gesar, RN, PhD-Student; Lund University, Department of Clinical Sciences, Orthopaedics, Lund, Sweden.

2 BACKGROUND Hip fracture is a sudden traumatic event threatening many aspects of life (Magaziner et al. 2000) The recovery process after surgery consists of both physical and psychological aspects (Crotty et al. 2010)

3 BACKGROUND Psychological factors are quite unexplored in recovery phase after hip fracture surgery (Taylor et al. 2010) Patient perspective is important in healthcare decision making (McCance et al. 2011)

4 PROBLEM TO FACE Patients affected by a hip fracture are heterogeneous In Sweden 40 % of previous healthy persons, 65 years and older, do NOT regain their pre-fracture function after hip fracture surgery

5 AIMS Study I To explore healthy older patients perception of their own capacity to regain pre-fracture function in the acute phase (the first two to five days) after hip fracture surgery. 4 Months Study II To reveal how previously healthy people, aged 65 years and older, describe how they have adapted to daily life, four months after a hip fracture.

6 Study I & STUDY II DESIGN Explorative Inductive Qualitative longitudinal design based on Interviews Participants Previous healthy persons, year affected by a hip fracture

7 METHOD STUDY I Individual Interviews (n=30), 2-5 days post hip fracture surgery 4 Months Study II Individual Interviews (n=26), at home

8 ANALYSIS Study I Manifest Inductive Content Analysis (Elo & Kyngäs, 2008) Study II Conventional Inductive Content Analysis (Hsieh & Shannon, 2005)

9 FINDINGS Study I TO END UP IN A NEW SITUATION WITH OR WITHOUT CONTROL Initially the patients expressed that they believed in recovery and thought nothing would be altered Since they had to adapt to the ward culture at the hospital they became passive became insecure about their future life situation

10 FIVE SUBCATEGORIES No problems, I will manage this Need for appraisal Context as a negative influence When and how to recover Uncertainty

11 I think I will recover, get through this successfully and will go on with my life as before. I don`t think the hip fracture will affect anything in my life situation at all, not at all, no, no (Woman, 78 years)

12 . Here I am like a.. well someone who does what they instruct me to do, I do not decide anything here. I believe they have taken it from me. I think I will return to earlier function, but now I will., I will you know.i constantly have to ask for support. I would prefer to be independent (Woman, 93 years)

13 I do not think it is good for me to stay at the hospital but you have to cope with that. They have their special procedures they have to follow I would like to take it easier not to feel the stress and that you have to cope with certain things that you cannot handle when you have recently undergone an operation the hip fracture has made me grow old it is like turning a new page in a book (Woman, 89 years)

14 FINDINGS STUDY II The hip fracturean interruption that has consequences on everyday life The hip fracture had forced the persons into a life transition; Physical impairments affected psychologically and conversely Psychological effects affected physically

15 FOUR SUBCATEGORIES The effect of the hip fracture impinge on the physical recovery Uncertainty and fear of falling again as well as the loneliness effect psychologically Being at a point of decision: To adapt to every life or try to make changes to become independent To generate a strong driving force and determination is the ground for recovery after an operation

16 I do not have enough energy.neither do I rely on my capacity anymore because I feel unsteady. I do not think I can trust this leg yet I have to take it well balanced, not fast moving... I am not as cocky as before, nothing could stop me then.. now I have to prepare everything very carefully but it seldom turns out as I planned (Woman, 96 years)

17 The feeling of not being able to keep things up as before suppresses me.. I thought it would go faster I have always tackled myself out of battles successfully. I am now forced to have patience. I have to put up with some disabilities but I hope gradually to recover. I will not be in a great hurry about it because I am an old person.it is rare, if ever, that I think about the future. If it remains this way. well, there are several people in this situation (Man,83 years)

18 I have internal power to become as I was before. I am a realist and I am healthy, without cormobodities that could have made it more complicated. Neither am I confused. What matters is to have the ability to put things in order, I have an independent nature and decide on everyday tasks on my own. I am persistent, goal-oriented. Now I use just one crutch. I am so grateful things have gone so well (Woman, 83 years)

19 SOLUTIONS STUDY i & STUDY II WHY..do some individuals and patients in this subgroup recover and others do not? WHAT? Findings in these studies shows that ward culture and person related factors may fill a gap..

20 FUNDAMENTALS OF NURSING CARE Kitson et al. 2013

21 Thank You Gesar, B., Hommel, A., Hedin, H., Bååth, C. International Journal of Orthopaedic and Trauma Nursing (2016) Gesar,B., Bååth,C., Hedin,H., Hommel, A. International Journal of Orthopaedic and Trauma Nursing (2016)

22 Supervisors Ami Hommel,RN, Associate Professor; Department of Health Sciences, Lund University, Sweden Carina Bååth, RN, PhD. Faculty of Health, Sciences, and Technology. Department of Health Sciences, Karlstad University, Sweden Hanne Hedin, MD, PhD; Department of Orthopaedic, Falun Hospital, Falun, Sweden