Factors associated with concerns about falling and activity restriction in older adults after hip fracture: a mixed-methods systematic review

TY - JOUR

T1 - Factors associated with concerns about falling and activity restriction in older adults after hip fracture

T2 - a mixed-methods systematic review

AU - Guerra, Stefanny

AU - Ellmers, Toby

AU - Turabi, Ruqayyah

AU - Law, Magda

AU - Chauhan, Aishwarya

AU - Milton-Cole, Rhian

AU - Godfrey, Emma

AU - Sheehan, Katie J.

N1 - Publisher Copyright: © The Author(s) 2024.

PY - 2024/4

Y1 - 2024/4

N2 - Purpose: To investigate factors contributing to concerns about falling and activity restriction in the community among older adults who had a hip fracture. Methods: A mixed method systematic review with a convergent segregated approach. We searched Medline, Embase, PsycInfo, PEDRo, CINAHL and the Cochrane library. Results were synthesised narratively considering physical, psychological, environmental, care, and social factors and presented in tables. Critical appraisal was completed in duplicate. Results: We included 19 studies (9 qualitative, 9 observational, 1 mixed methods) representing 1480 individuals and 23 factors related to concerns about falling and activity restriction. Physical factors included falls history, comorbidities, balance, strength, mobility and functionality. Psychological factors included anxiety and neuroticism scores, perceived confidence in/control over rehabilitation and abilities, and negative/positive affect about the orthopaedic trauma, pre-fracture abilities and future needs. Environmental factors included accessibility in the home, outdoors and with transport. Social and care factors related to the presence or absence of formal and informal networks, which reduced concerns and promoted activity by providing feedback, advice, encouragement, and practical support. Conclusion: These findings highlight that to improve concerns about falling and activity restriction after hip fracture, it is important to: improve physical and functional abilities; boost self-confidence; promote positive affect; involve relatives and carers; increase access to clinicians, and; enhance accessibility of the home, outdoors and transport. Most factors were reported on by a small number of studies of varying quality and require replication in future research.

AB - Purpose: To investigate factors contributing to concerns about falling and activity restriction in the community among older adults who had a hip fracture. Methods: A mixed method systematic review with a convergent segregated approach. We searched Medline, Embase, PsycInfo, PEDRo, CINAHL and the Cochrane library. Results were synthesised narratively considering physical, psychological, environmental, care, and social factors and presented in tables. Critical appraisal was completed in duplicate. Results: We included 19 studies (9 qualitative, 9 observational, 1 mixed methods) representing 1480 individuals and 23 factors related to concerns about falling and activity restriction. Physical factors included falls history, comorbidities, balance, strength, mobility and functionality. Psychological factors included anxiety and neuroticism scores, perceived confidence in/control over rehabilitation and abilities, and negative/positive affect about the orthopaedic trauma, pre-fracture abilities and future needs. Environmental factors included accessibility in the home, outdoors and with transport. Social and care factors related to the presence or absence of formal and informal networks, which reduced concerns and promoted activity by providing feedback, advice, encouragement, and practical support. Conclusion: These findings highlight that to improve concerns about falling and activity restriction after hip fracture, it is important to: improve physical and functional abilities; boost self-confidence; promote positive affect; involve relatives and carers; increase access to clinicians, and; enhance accessibility of the home, outdoors and transport. Most factors were reported on by a small number of studies of varying quality and require replication in future research.

KW - Activity avoidance

KW - Balance confidence

KW - Fear avoidance

KW - Fear of falling

KW - Fragility fracture

UR - http://www.scopus.com/inward/record.url?scp=85186240944&partnerID=8YFLogxK

U2 - 10.1007/s41999-024-00936-9

DO - 10.1007/s41999-024-00936-9

M3 - Review article

C2 - 38418713

AN - SCOPUS:85186240944

SN - 1878-7649

VL - 15

SP - 305

EP - 332

JO - European Geriatric Medicine

JF - European Geriatric Medicine

IS - 2

ER -