Fear impedes older patients' recovery from hip surgery

Falling and breaking a hip can have a devastating effect on older people’s lives. Alongside pain, depression and loss of cognitive functioning, it’s been known for some time that fear of falling is one of several factors that can impede their recovery after hip surgery. But now Alistair Burns and colleagues report that of these factors, fear might well be the most important, with clear implications for rehabilitation.

One hundred and eighty-seven patients undergoing hip surgery (average age 80 years) were assessed on several physical and psychological measures six weeks after their operation. Functional recovery was assessed six months later, for example by seeing how long it took patients to get up and walk three metres and back again.

Consistent with previous research, the more pain, depression, loss of cognitive functioning or fear of falling experienced by patients after their operation, the less functional recovery they were likely to show at 6 months. But that’s when these factors were examined individually. Crucially, when these factors were considered all together, only fear of falling and loss of cognitive functioning were related to functional recovery six months after surgery. One way in which fear of falling affects rehabilitation is that it deters patients from practicing walking again.

“Treatment of depression is important to improve quality of life in this particularly frail patient group, but our results suggest that adding cognitive-behavioural interventions aimed to reduce fear of falling is essential to improve functional outcome”, the researchers said.
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Voshaar, R.C.O., Banerjee, S., Horan, M., Baldwin, R., Pendleton, N., Proctor, R., Tarrier, N., Woodward, Y. & Burns, A. (2006). Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people. Psychological Medicine, 36, 1635-1645.

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