NEWS Nearly half of the oldest old adults died within one year of sustaining a hip fracture. A new doctoral thesis from Umeå University shows that not only the risk of sustaining a hip fracture, but also mortality following the injury and the prospects for recovery, are influenced by physical health, medical conditions and psychological well-being rather than age alone, highlighting the need for more person-centred care.
The risk of sustaining a hip fracture, as well as survival and recovery after injury, is influenced by physical health, existing medical conditions, and mental well-being.
ImageMostphotos“An important and striking finding was the high mortality rate among the oldest old adults following a hip fracture. I also found that dementia in combination with depressive symptoms was associated with increased mortality,” says Erika Olofsson, doctoral student at the Department of Nursing at Umeå University.
Hip fracture is a serious injury that affects approximately 17,000 people each year in Sweden, primarily older adults. The injury can result in long-term functional impairment, loss of independence and an increased risk of death. At the same time, older adults are a heterogeneous group with substantial differences in health, life circumstances and recovery potential. Chronological age alone therefore does not determine how vulnerable a person is or how life after a hip fracture may develop.
In her thesis, Erika Olofsson investigated factors associated with hip fracture and mortality among people aged 85 years and older. She also examined how older adults themselves experience recovery after a hip fracture.
The results showed that the risk of sustaining a hip fracture at very advanced age was roughly the same for women and men, but that the associated risk factors differed between the sexes. Among women, a higher degree of independence in everyday activities was associated with an increased risk.
Erika Olofssonis a doctoral student at the Department of Nursing at Umeå University..
ImageMattias Pettersson“This challenges the idea that hip fractures primarily affect the frailest older adults. The findings suggest that a higher level of activity may also increase exposure to situations where falls can occur,” says Erika Olofsson.
Mortality following hip fracture was high among the oldest old adults. The risk of death was not linked solely to chronological age, but rather to underlying diseases and vulnerability. Depression, previous stroke and subtrochanteric fracture (a fracture in the upper part of the femur) were associated with increased mortality.
Erika Olofsson also investigated how dementia and depression were related to mortality during the first three years after a hip fracture. The results showed that dementia, both as an individual condition and in combination with depression, was associated with increased mortality at all follow-up points. In contrast, no statistically significant association was found between depression alone and mortality.
Through repeated interviews with older adults during the first year after a hip fracture, recovery emerged as a dynamic process in which progress could be followed by setbacks. The ability to manage everyday activities, fear of falling again, support from family members and the pursuit of independence were central aspects of how recovery was experienced. For several participants, difficulties remained one year after the fracture.
A key message of the thesis is that hip fracture in later life should not be understood solely as an orthopaedic injury or as a consequence of old age. The risk of sustaining a fracture, mortality after the injury and the experience of recovery are all linked to a range of factors, including physical functioning, medical conditions and psychological well-being.
“The same hip fracture can have very different consequences for different individuals. Care and support therefore need to be based on each person's unique situation,” says Erika Olofsson.
On Friday, 20 November, Erika Olofsson, Department of Nursing, Umeå University, will defend her doctoral thesis entitled Hip Fracture – Associated Factors, Mortality, and Experience of Recovery. The public defence will take place at 9:00 a.m. in Aula Biologica. Principal supervisor is Birgitta Olofsson. The opponent is Professor Cecilia Fagerström, Department of Health and Caring Sciences, Linnaeus University.
