Abstract
Hip fracture (HF) patients are among the most vulnerable of hospitalised patients. In this chapter, we will illustrate why the psychological status of patients is important in the management and outcome of hip fracture, how it should be assessed and how it could be positively influenced by the orthogeriatric team. The chapter aims to provide an overview of the causes of negative psychological status, provide advice on strategies that can be used to identify those at risk and give examples of assessments and interventions to aid diagnosis and treatment. The focus will be on problematic aspects but will also comment on how positive dimensions in psychology, such as motivation, can impact on patient recovery.
You have full access to this open access chapter, Download chapter PDF
Similar content being viewed by others
Keywords
13.1 Introduction
The psychological status and wellbeing of those who suffer a hip fracture has an important impact on physical health status, recovery, motivation, and rehabilitation. An appreciation of how psychological wellbeing affects care and progress is important in providing high-quality care that optimises outcomes. The aim of this chapter is to provide an overview of the causes of negative psychological status, provide advice on strategies for identifying those at risk, and give examples of assessments and interventions to aid diagnosis and treatment.
Following a significant fragility fracture, many patients are unable to regain the same functional abilities they had previously. This can lead to a loss of independence in performing daily activities, as well as a significant increase in the risk of suffering further fractures. Most significant fragility fractures are hip fractures, consequently most research relating to fragility fractures has examined outcomes and interventions relating to hip fractures. For this reason, this chapter will focus on hip fracture, but the reader should bear in mind that the same principles apply to other significant fractures.
13.1.1 Why Is Psychological Status Important in the Management of Hip Fracture?
Hip fractures are associated with reduced health-related quality of life (QoL). Buckling and colleagues [1] found that pre-existing need of care, limited function, and depression are independent factors associated with lower QoL during the postoperative period. To appreciate the impact of osteoporosis and osteoporotic fracture treatment, it is important to understand the full impact that osteoporotic fractures have on QoL as this can predict mortality, as well as physical and psychological functioning [2].
13.1.2 Why Is Psychological Status Important in the Outcome of Hip Fracture?
Depression at the time of hip fracture has been estimated at between 9% and 47% (mean 29%) [3]. Following hip fracture, the psychological fallout can be considerable for the patient in terms of negative emotional experiences, reduced level of self-esteem, and tendency to depression.
The presence of negative emotional experiences in older adults who have suffered hip fractures is linked to low psychological tolerance, anxiety, perioperative pain, limited lower limb movements, and high prognostic expectation.
Mental health status at the time of surgery has been reported as being an important determinant of outcome and is associated with poorer functional recovery and higher mortality rates [4]. Conversely, it has been suggested that participants with high psychological resilience were able to achieve a greater gain in recovery compared with participants with low psychological resilience [5]. It has also been suggested that pre-fracture dependence in ADL is a stronger predictor of further functional decline—resulting in institutionalisation or death—than pre-fracture dementia [6]. That the increased occurrence of negative psychological emotions and states, such as anxiety and depression, are likely to be due to several factors such as insufficient knowledge about fractures, psychological preparation for surgery, sequelae of surgery, and concern about the cost of medical services [7]. Negative psychological experiences and states are further aggravated by long recovery times after surgery, reduced mobility, and postoperative pain [8, 9].
13.1.3 Why Is Psychological Status Important in the Rehabilitation from Hip Fracture?
Anxiety associated with fear of falling can have a negative influence on psychological wellbeing as well as on balance. Fear of falling affects walking speed so can negatively impact recovery [10].
Approximately one in five people who are not depressed at the time of their fracture become so after 8Â weeks [11]. Depression has been reported to affect long-term functional recovery following hip fracture [12]. The negative effect of depression on daily living activities can even emerge 6Â months from the time of injury.
A patient’s active participation in the rehabilitation process can have a positive effect on recovery, but the presence of depression disrupts this process because of reluctance, negative thoughts, slowed speech, decreased movement, and impaired cognitive function common with major depressive disorder. Depression in older adults with hip fracture negatively affects daily function. Psychological status influences recovery [13]. The emotional responses to a hip fracture predict both psychological and physical functioning over time offering an opportunity to enhance recovery through appropriate support [14].
Rehabilitation after hip fracture is negatively affected if function is restricted due to fear of falling (FOF) (Chap. 4) [15]. Anxiety about the possibility that a fall may occur again is associated with a low level of self-efficacy and results in the onset of an anxiety state [16]. In turn, anxiety can cause insecurity and lack of confidence in the individual’s own abilities, so they choose not to risk falling and therefore not to move [17,18,19]. The psychological consequences of falling might be even more disabling than the fall itself [20]. The negative impact of falling on quality of life has been reported to be higher than the impact of stroke or cancer [21]. FOF is both a risk factor for falls and a consequence of a fall. It has been associated with subsequent poorer quality of life, functional decline, depression, and frailty [22, 23]. This may initiate a vicious cycle that reduces participation in activities, impairs rehabilitation outcomes, increases social isolation, provokes new trauma, exacerbates developing deficits, and impairs overall recovery [23,24,25,26].
It is essential to consider psychological status and support as part of the interdisciplinary care approach and to develop clinical practice in this area.
13.2 Learning Outcomes
At the end of the chapter, and following further study, the practitioner will be able to:
-
Identify patients at risk of low psychological health
-
Apply evidence-based tools to assist in the diagnosis and assessment of psychological health
-
Discuss management strategies and priorities in the patient from the psychological perspective
-
Use positive aspects of psychology to increase the possibilities of recovery in the patients
13.3 How Should the Psychological Status Be Assessed?
Table 13.1 illustrates the variety of aspects that it is important to evaluate to obtain a complete assessment of patients’ wellbeing during the different stages of the illness and recovery.
13.3.1 Psychological Evaluation
The recovery process that follows surgery can vary depending on the patients’ comorbidities, cognitive and functional status, and their psychosocial state. Wellbeing means much more than physical health so psychological assessment is an essential aspect of comprehensive assessment (CGA) for all orthogeriatric patients (see Chap. 6) in evaluating different negative and positive dimensions to assess patients’ psychological status when following a bio-psycho-social approach.
13.3.1.1 Quality of Life
Health-related Quality of Life (QoL) is recognised as an important measure of health status [27]. It is a broad, multidimensional construct that includes domains such as physical, psychological, and social function [28], which facilitates identification of specific aspects of QoL and targeting of associated interventions. Some people suffer from loss of QoL [29] and wellbeing [30] while others move to nursing home facilities [31]. Wellbeing and self-efficacy are important resources for both health and illness and should be considered when exploring ways of promoting recovery [32]. The importance of patients’ perception of the care they receive has been highlighted [33] and, without QoL data, the burden of osteoporotic fractures is likely to be underestimated [34].
The EQ-5D has been recommended for the assessment of QoL in older adults [35]. Although this instrument shows good psychometric properties in older patients, assessing the QoL of cognitively impaired patients is difficult. In people with mild and moderate dementia, these tests yield good validity and good-to-average test–retest reliability for the descriptive system, but not for the Visual Analogue Scale (VAS) which is part of the questionnaire. Proxy assessment is sometimes the only way to gather information regarding QoL when patients are unable to respond because of cognitive difficulties. Family caregivers, however, tend to overestimate health limitations concerning less visible items (such as pain and anxiety/depression). Healthcare professionals often rate patients at the same level for all five domains (some problems with everything). No consensus has been reached as to the most appropriate proxy to apply, but proxy assessment of EQ-5D seems to be the best option when assessing QoL in patients with advanced dementia. QoL should be assessed using the EQ-5D method on admission to determine pre-fracture QoL and in post-admission 90-day and 1-year follow-up. In patients affected by severe dementia, EQ-5D should be completed by a proxy, if one is available [36].
13.3.1.2 Fear of Falling
Fear of falling is linked to self-efficacy—the belief people have about their capability to perform certain tasks [37]. After hip fracture, older people have reported that their lives have changed physically, personally, and socially [38]. During hip fracture rehabilitation, older people have been shown to struggle to take control of their future lives by trying to balance risk-taking and help-seeking [39]. They are aware that, on the one hand, it might prove risky to move around and that they were afraid of falling but, on the other, they wanted to be active and were trying to do things. They were determined to regain independence. Giving information to patients and including them in discussions regarding their progress is essential.
13.3.1.3 Pain
Assessment of pain is considered in Chaps. 7 and 8. Pain can also initially be assessed using the EQ-5D test; however, as previously discussed, the VAS used in the EQ-5D is not reliable in cognitively impaired patients [35]. The VAS within EQ-5D rates overall body pain, while practitioners are also interested in pain at the site of the fracture. The Verbal Rating Scale (VRS) performs well with patients with dementia, and it provides more information about fracture-site pain [40]. Liem et al. [36] agree that this test should be used on the second day after surgery or, in cases of conservative treatment, the second day after admission, and at 90Â days and 1Â year after admission.
13.3.1.4 Activities of Daily Living
Activities of daily living (ADLs) are an important health outcome for orthogeriatric patients. Recovery of pre-fracture health and functional levels is one of the main goals of care. It is important to assess deterioration in functional level over time. A vast selection of ADL measurement tools is available, but the Katz Activities of Daily Living Scale [41], is the most widely used. In many cases, it can prove difficult to assess pre-injury ADLs accurately at the time of admission. In such cases, consulting a proxy can be useful, who will typically be a family member, friend, or caregiver. ADLs should be assessed on admission to evaluate pre-fracture status. During patient follow-up, ADLs should then be assessed after 90Â days and 1Â year following admission.
13.3.1.5 Depression
Depression is the most common psychological disorder following hip fracture although it is difficult to assess [42]. An independent relationship exists between low functional capacity and depression symptoms in older people [43]. Social isolation often occurs in older adults who cannot walk well enough to perform daily living activities, and social isolation is an independent risk factor for depression [44]. A vicious cycle of low ADL function is, therefore, created between pre-existing depression and an increase in depression from feelings of inadequacy when performing daily activities. The Geriatric Depression Scale (GDS) may be a valuable instrument with which to assess depression [45]. Depression has been observed more often in women and those whose spouses have died [11]. Depression should be assessed on admission to evaluate its pre-fracture status. During patient follow-up, it should be assessed after 90Â days, 1 and 2Â years from the date of admission.
13.3.1.6 Stress
The is a link between osteoporosis, fragility fractures, and psychological stress [46]. Relaxation strategies can be used to decrease stress and are described in the last section of this chapter. The Perceived Stress Scale [47] can be useful when assessing stress which should be appraised at discharge and 90Â days after admission.
13.3.1.7 Anxiety
Anxiety has emerged as one of the most important aspects of patient assessment on admission [26]. The Short Anxiety Screening Test [48] has been shown to be an easy and valuable tool for the assessment of anxiety in this group of patients. Anxiety should also be assessed upon discharge and 90Â days after admission.
13.3.1.8 Psychological Wellbeing
The concept of subjective well-being (SWB) has multiple components. It is affected by positive (e.g. happiness), negative (e.g. depressive symptoms), and cognitive components (e.g. life satisfaction). These multiple components are affected by different social determinants and develop differently at various life stages [49]. The Psychological General Well-Being Index (PGWBI) [50] is a useful test for the investigation of patients’ and caregivers’ psychological wellbeing which should be assessed after admission and at 90 days and 1 year after admission. Reinforcing and increasing positive psychological components, such as resilience, motivation, and internal locus of control, can facilitate recovery.
13.4 How Can Psychological Status Be Influenced Positively by the Orthogeriatric Team?
It is clear that social and psychological elements (both negative and positive) can influence the outcomes of recovery and rehabilitation [51, 52]. The psychological state of the patient plays a key role in rehabilitation [53] so it is crucial that they receive adequate psychological care.
Shi et al. [54] highlighted the importance of systematic and standardised psychological care following hip fracture. Specifically, they compared the outcomes of psychological care devoted to older adults who had suffered a hip fracture with the outcomes of routine psychological care alone provided for a control group. Systematic and standardised psychological care, carried out during the perioperative period, positively benefited the psychological state of patients, relieving symptoms of anxiety and depression significantly.
The main aspects of the psychological care were:
-
1.
A good practitioner–patient relationship: nurses and other practitioners talked with patients while maintaining a caring, kind, and sincere attitude. Through encouragement and suggestions, practitioners kept both patients and their families informed about the importance of the perioperative period and guided them in precautions to be taken. Nurses also explained the anaesthetic program, surgical procedures, and potential risks of surgery and the importance of subjective factors was emphasised.
-
2.
In-depth interview between patients and nurses: through dialogue, patients expressed their psychological difficulties and negative emotions. This enabled nurses and other practitioners to have greater awareness of their state of mind. It was also explained to patients that negative thoughts and emotions can have a negative influence on treatment and prognosis and nurses tried to clarify patients’ doubts and uncertainties.
-
3.
Relaxation and concentration: patients were asked to relax, assuming a comfortable position, while maintaining focused attention. When they experienced negative emotions, anxieties, or fears, nurses helped them by identifying their causes, so that they could intervene with strategies aimed at limiting their onset as much as possible.
-
4.
Listening to music: the benefits, goals, and directions related to listening to music were explained. Playing music occurred only if patients were willing to listen. Three main genres of music were used: classical, soft, and stimulating. The volume of music was adjusted according to the patients’ perceived level of wellbeing and relaxation. Music was played twice a day, in the morning and evening.
-
5.
Limiting the influence of negative emotions of family members: negative emotions expressed by family members can have an influence on patients, especially on the process of rehabilitation and functional recovery. It is, therefore, important for family members to provide psychological and emotional support as well as material support throughout the treatment period to help strengthen patients’ self-confidence in themselves and their ability to recover.
Although the study discussed was a short-term follow-up conducted with a limited sample of patients, the results indicated the benefits of offering individualised psychological care. Healthcare practitioners should listen to patients’ thoughts and opinions and learn about their feelings and emotions. Emotional and psychological support, health education and the use of music can be effective tools in caring for older adults with hip fractures. Through increased communication between practitioners and patients, support from family members and the promotion of positive emotions and confidence in treatment, patients can increase their ability to cope with problems.
Dedicated psychological care for patients who have suffered hip fractures should be structured to focus on patients’ wellbeing and quality of life following surgery. Attention should also be paid to the physical pain that each patient may experience differently, physical, and psychological rehabilitation, and emotional support. Psychological adjustment to one’s physical condition, emotional awareness, and maintaining a state of calm and wellbeing are factors that contribute to improving postoperative quality of life.
The different negative and positive dimensions that are important to evaluate and the instruments most likely to be appropriate at each stage discussed should be addressed by the orthogeriatric team following a bio-psycho-social approach. The inclusion of a psychologist in the team can help in the assessment of the patients’ psychological wellbeing, using the tools we have detailed above, but can also enable psychological counselling. During counselling, the psychologist can obtain more qualitative data to help tailor interventions based on emerging needs and the resources available as well as give feedback to patients and their caregivers on the problems and the strengths that emerged in the assessment. It has been demonstrated that twice-weekly counselling for about 45 min had a positive influence on hip fracture patients’ depressive and anxiety symptoms [55].
Similar results were shown for ‘psychological support therapy’ (PST). This had a significant impact on patients who had sustained a femur fracture, contributing to pain reduction and improvement in psychological status, as well as patients’ quality of life and nurses’ job satisfaction [56]. The outcomes of PST, which was applied in addition to routine care for 41 adults following femur fracture, were compared with the outcomes of routine psychological care alone for a control group.
The PST intervention involved:
-
1.
A psychological support group, consisting of nurses with solid nursing skills and physicians with extensive clinical experience. Psychologists created the group by choosing members with psychological intervention skills, especially the ability to recognise and understand patients’ emotions, reduce negative emotions, and promote positive ones, while being able to communicate effectively with patients.
-
2.
Older adults who with fractures often do not fully understand the details of surgical procedures leading to misunderstandings and facing the surgery with a negative state of mind. Team members informed patients and answered all their questions clearly and patiently. Practitioners were also required to understand the needs of patients and deliver individualised interventions. The team assessed the psychological status of patients, interviewed them, observed changes in their behaviours, understood the emotions felt by patients after sustaining a fracture, and offered targeted psychological support according to their needs.
-
3.
The team provided fracture-related information through communication modes adapted to the patient’s level of education and the ability to understand. The impact of functional exercise on rehabilitation was explained, including both patients and their family so that worries and doubts were relieved, resulting in reduction in anxiety. These patients risk much longer and more frequent hospital stays than other adults. Comprehensive discharge-planning programmes (Chap. 16) can improve these outcomes. On admission to care facilities, early multidimensional assessment (Chap. 6) can provide indications of how to address patient needs more effectively. Greater psycho-educational support can be provided during the rehabilitation phase during which there is more time to focus on this.
-
4.
The importance of nurses strengthening communication with patients and the need to provide psychological care for them according to their individual needs was stressed. Nurses also explained to patients the relationship between their emotional state and maintaining a positive attitude and confidence in their care.
-
5.
Patients were encouraged to maintain communication with the world outside the hospital and to access support from family members. At the same time, family members were encouraged to spend more time with them, talking to them and listening to them to help them adapt to their condition and reduce any negative emotional states.
-
6.
Patients’ favourite genres of music, such as light or relaxing music, and TV series were played to divert patients’ attention from their condition, entertain them, reduce their pain, and reduce their anxiety and negative thoughts.
-
7.
Patients who had successfully recovered after a fracture were invited to share their experiences to encourage other patients to have a positive approach toward rehabilitation.
The PST programme made it possible to assess patients’ psychological state, analyse the factors that contributed to the development of negative thoughts and emotions, conduct psychological counselling, and help nurses and patients communicate effectively. This strengthened patients’ trust in healthcare personnel, who played an active role in accelerating the rehabilitation process following a fracture. In this type of therapy, healthcare practitioners can [57]:
-
encourage patients to create a healthy psychological state
-
explain to patients the impact that a negative state of mind can have on the rehabilitation process
-
encourage patients to take the initiative in expressing themselves
-
respond to their questions and concerns
-
help patients take a positive view toward their health problems and reduce their negative thoughts and attitudes
-
alleviate worries and anxieties
-
encourage patients to develop the habit of self-regulating their emotions
Psychological support therapy can also contribute to:
-
improving patients’ ability to cope with pain
-
reducing psychological pressure
-
increasing confidence in the process of recovery and rehabilitation
-
strengthening psychological and physiological adaptation by increasing tolerance to stimuli
Nurses can also encourage patients to maintain active communication with family members so that they have a social support network [58].
The results of the studies discussed here lead to an appreciation of the importance of psychological evaluation and support in care for older adults affected by fragility fractures. As part of the integrated and multidisciplinary approaches to care, practitioners who can demonstrate the appropriate psychological skills to assess the psychological wellbeing of patients and their caregivers are essential.
Summary and Main Points for Learning
-
Negative emotional experiences in older adults who have suffered hip fractures are associated with low psychological tolerance, anxiety, perioperative pain, limited lower limb movements, and high prognostic expectation.
-
Mental health status at the time of surgery has been reported as an important determinant of outcome, with mental health disorders associated with poorer functional recovery and higher mortality rates.
-
The recovery process that follows surgery varies depending on the patients’ comorbidities, cognitive and functional status, and their psychosocial state. Wellbeing in this sense means more than health as such. It is important to evaluate different negative and positive dimensions to assess patients’ psychological status when following a bio-psycho-social approach.
-
Nurses encourage patients to maintain active communication with family members so that they have a social support network.
-
Psychological support therapy for older fracture patients has been used to assess their psychological state, analyse the factors that contribute to the development of negative thoughts and emotions, provide psychological counselling for patients, and help nurses and patients communicate effectively to increase patients’ trust in health professionals, who play an active role in accelerating the post-fracture rehabilitation process.
13.5 Suggested Further Study
Being able to empathise with patients, especially from an emotional perspective, is vital in providing excellent care that includes psychosocial aspects.
Access the following open access (free to download) article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925874/.
Tutton E, Saletti-Cuesta L, Langstaff D, Wright J, Grant R, Willett K (2021) Patient and informal carer experience of hip fracture: a qualitative study using interviews and observation in acute orthopaedic trauma. BMJ Open. 11(2):e042040. https://doi.org/10.1136/bmjopen-2020-042040.
Read the article, but particularly focus on the quotations that highlight patient and family emotional experiences of hip fracture. Ask yourself the following questions:
-
What can I see in the patient and family words (the quotations) in this chapter that suggests that having a hip fracture is an exceptionally difficult emotional experience?
-
In what way does my team take this emotional experience into account during care providing?
-
Having read the article and this chapter, what I can I now see is important in the way we provide care that would better support psychological wellbeing in our patients and their families?
References
Bueckling B, Struewer J, Waldermann A, Horstmann K, Schubert N, Balzer-Geldsetzer M et al (2014) What determines health-related quality of life in hip fracture patients at the end of acute care? A prospective observational study. Osteoporos Int 25:475–484
Kao S, Lai KL, Lin HC, Lee HS, Wen HC (2005) WHOQOL-BREF as predictors of mortality: a two-year follow-up study at veteran homes. Qual Life Res 14:1443–1454
Fenton FR, Cole MG, Engelsmann F, Mansouri I (1997) Depression in older medical inpatients. Int J Geriatr Psychiatry 12:389–394
Holmes JD, House AO (2000) Psychiatric illness predicts poor outcome after surgery for hip fracture: a prospective cohort study. Psychol Med 30:921–929
Fang Tan CY, Sen Fang HO, Ling Koh EY, Low LL (2021) The effect of psychological resilience on functional outcomes in post-operative hip fracture patients in a Singapore community hospital. Proc Singapore Healthc 30(1):28–35
Krogseth M, Wyller TB, Engedal K, Juliebø V (2014) Delirium is a risk factor for institutionalization and functional decline in older hip fracture patients. J Psychosom Res 76:68–74
Peeters CM, Visser E, Van de Ree CL, Gosens T, Den Oudsten BL, De Vries J (2016) Quality of life after hip fracture in the elderly: a systematic literature review. Injury 47:1369–1382
Zachwieja E, Butler AJ, Grau LC, Summers S, Massel D, Orozco F et al (2019) The association of mental health disease with perioperative outcomes following femoral neck fractures. J Clin Orthop Trauma 10:S77–S83
Zhong M, Liu D, Tang H, Zheng Y, Bai Y, Liang Q et al (2021) Impacts of the perioperative fast track surgery concept on the physical and psychological rehabilitation of total hip arthroplasty: a prospective cohort study of 348 patients. Medicine 100:e26869
Delbaere K, Sturnieks DL, Crombez G, Lord SR (2009) Concern about falls elicits changes in gait parameters in conditions of postural threat in older people. J Gerontol A Biol Sci Med Sci 64(2):237–242
Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M et al (1982) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17:37–49
Alarcón T, González-Montalvo JI, Gotor P, Madero R, Otero A (2011) Activities of daily living after hip fracture: profile and rate of recovery during 2 years of follow-up. Osteoporos Int 22:1609–1613
Fredman L, Hawkes WG, Black S, Bertrand RM, Magaziner J (2006) Elderly patients with hip fracture with positive affect have better functional recovery over 2 years. J Am Geriatr Soc 54:1074–1081
Langer JK, Weisman JS, Rodebaugh TL, Binder EF, Lenze EJ (2015) Short term affective recovery from hip fracture prospectively predicts depression and physical functioning. Health Psychol 34:30–39
Visschedijk J, Achterberg W, Van Balen R, Hertogh C (2010) Fear of falling after hip fracture: a systematic review of measurement instruments, prevalence, interventions, and related factors. J Am Geriatr Soc 58:1739–1748
Jiang XY, Chen Y, Yang ML, Zhu XL (2016) Predictors of falls efficacy scale responses among nursing home residents in China. International Journal of Nursing Sciences 3(1):24–28
Gagnon N, Flint AJ, Naglie G, Devins GM (2005) Affective correlates of fear of falling in elderly persons. Am J Geriatr Psychiatr 13(1):7–14
Chu CL, Liang CK, Chow PC, Te Lin Y, Tang KY, Chou MY et al (2011) Fear of falling (FF): psychosocial and physical factors among institutionalized older Chinese men in Taiwan. Arch Gerontol Geriatr 53(2):232–236
Ribeiro O, Santos ÂR (2015) Psychological correlates of fear of falling in the elderly. Educ Gerontol 41(1):69–78
Jorstad EC, Hauer K, Becker C, Lamb SE (2005) Measuring the psychological outcomes of falling: a systematic review. J Am Geriatr Soc 53:501–510
Salkeld G, Cameron ID, Cumming RG et al (2000) Quality of life related to fear of falling and hip fracture in older women: a time trade off study. Br Med J 320:341–345
Bower ES, Wetherell JL, Petkus AJ et al (2016) Fear of falling after hip fracture: prevalence, course, and relationship with one-year functional recovery. Am J Geriatr Psychiatry 24:1228–1236
Petrella RJ, Payne M, Myers A et al (2000) Physical function and fear of falling after hip fracture rehabilitation in the elderly. Am J Phys Med Rehabil 79:154–160
Oude Voshaar RC, Banerjee S, Horan M et al (2006) Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people. Psychol Med 36:1635–1645
Painter JA, Allison L, Dhingra P et al (2012) Fear of falling and its relationship with anxiety, depression, and activity engagement among community-dwelling older adults. Am J Occup Ther 66:169–176
Kornfield SL, Lenze EJ, Rawson KS (2017) Predictors of posttraumatic stress symptoms and association with fear of falling after hip fracture. J Am Geriatr Soc 65:1251–1257
Testa MA, Simonson DC (1996) Assessment of quality-of-life outcomes. N Engl J Med 334:835–840
World Health Organization (1984) WHO constitution. World Health Organization, Geneva
Roth T, Kammerlander C, Gosch M, Luger TJ, Blauth M (2010) Outcome in geriatric fracture patients and how it can be improved. Osteoporos Int 21:S615–S619
Randell AG, Nguyen TV, Bhalerao N, Silverman SL, Sambrook PN, Eisman JA (2000) Deterioration in quality of life following hip fracture: a prospective study. Osteoporos Int 11:460–466
Bertram M, Norman R, Kemp L, Vos T (2011) Review of the long-term disability associated with hip fractures. Inj Prev 17:365–370
Rasmussen B, Uhrenfeldt L (2014) Lived experiences of self-efficacy and wellbeing in the first year after hip fracture: a systematic review protocol of qualitative evidence. JBI Database Syst Rev Implement Rep 12:73–84
Garratt A, Schmidt L, Mackintosh A, Fitzpatrick R (2002) Quality of life measurement: bibliographic study of patient assessed health outcome measures. BMJ 324:1417–1421
Xenodemetropoulos T, Devison S, Ioannidis G, Adachi JD (2004) The impact of fragility fracture on health-related quality of life. The importance of antifracture therapy. Drugs Aging 21:711–730
Hutchings L, Fox R, Chesser T (2011) Proximal femoral fractures in the elderly: how are we measuring outcome? Injury 42:1205–1213
Liem IS, Kammerlander C, Suhmb N, Blauth M, Roth T, Gosch M et al (2013) Identifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures. Int J Care Injured 44:1403–1412
Bandura A (2010) Self-efficacy. In: Weiner EB, Craighead EW (eds) The corsini encyclopedia of psychology, 4th edn. Wiley, Hobuken, NJ
Jellesmark A, Herling SF, Egerod I, Beyer N (2012) Fear of falling and changed functional ability following hip fracture among community-dwelling elderly people: an explanatory sequential mixed method study. Disabil Rehabil 34:2124–2131
McMillan L, Booth J, Currie K, Howe T (2013) ‘Balancing risk’ after fall-induced hip fracture: the older person’s need for information. Int J Older People Nurs 9:249–257
Pesonen A, Kauppila T, Tarkkila P, Sutela A, Niinisto L, Rosenberg PH (2009) Evaluation of easily applicable pain measurement tools for the assessment of pain in demented patients. Acta Anaesthesiol Scand 53:657–664
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919
Nightingale S, Holmes J, Mason J, House A (2001) Psychiatric illness and mortality after hip fracture. Lancet 357:1264–1265
Bostrom G, Condradsson M, Rosendahl E, Nordstrom P, Gustafson Y, Littbrand H (2014) Functional capacity and dependency in transfer and dressing are associated with depressive symptoms in older people. Clin Interv Aging 9:249–257
Djernes JK (2006) Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatr Scand 113:372–387
Atay İM, Aslan A, Burç H, Demirci D, Atay T (2016) Is depression associated with functional recovery after hip fracture in the elderly? J Orthop 13:115–118
Kelly RR, McDonald LT, Jensen NR, Sidles SJ, LaRue AC (2019) Impacts of psychological stress on osteoporosis: clinical implications and treatment interactions. Front Psych 10:200
Cohen S, Kamarck T, Mermelstein R (1994) A global measure of perceived stress. J Health Soc Behav 24:385–396
SinoffG OL, Zlotogorsky D, TamirA. (1999) Short anxiety screening test—a brief instrument for detecting anxiety in the elderly. Int J Geriat Psychiatry 14:1062–1071
Keyes CLM (2002) The mental health continuum: from languishing to flourishing in life. J Health Soc Behav 43:207–222
Dupuy HJ (1994) The psychological general well-being (PGWB) index. In: Wenger N (ed) Assessment of quality of life in clinical trials of cardiovascular therapies. Le Jacq, New York
Repper J, Perkins R (2003) Social inclusion and recovery: a model for mental health practice. Bailliere Tindall, London
Roberts G, Wolfson P (2006) New directions in rehabilitation: learning from the recovery movement. In: Roberts G, Davenport S, Holloway F, Tatton T (eds) Enabling recovery: the principles and practice of rehabilitation psychiatry. Gaskell, London
Givens JL, Sanft TB, Marcantonio ER (2008) Functional recovery after hip fracture: the combined effects of depressive symptoms cognitive impairment and delirium. J Am Geriatr Society 56:1075–1079
Shi G, Zhang J, Han Y, Cui C, Liang D, Wang A (2020) Effect of psychological nursing on postoperative quality of life, pain, and rehabilitation in patients with femoral fractures. Int J Clin Exp Med 13(9):7146–7153
Gambatesa M, D’Ambrosio A, D’Antini D, Mirabella L, De Capraris A, Iuso S et al (2013) Counseling, quality of life, and acute postoperative pain in elderly patients with hip fracture. J Multidiscip Healthc 6:335–346
Li Q, Wang Y, Shen X (2022) Effect of psychological support therapy on psychological state, pain, and quality of life of elderly patients with femoral neck fracture. Front Surg 9:865238
Huang L, Zhang C, Xu J, Wang W, Yu M, Jiang F et al (2021) Function of a psychological nursing intervention on depression, anxiety, and quality of life in older adult patients with osteoporotic fracture. Worldviews Evid-Based Nurs 18:290–298
Bishnoi S, Huda N, Islam S, Pant A, Agarwal S, Dholariya R (2021) Association between psychological status and functional outcome in surgically managed fractures around hip in geriatric patients—a prospective study. Malays Orthop J 15:18–25
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Open Access This chapter is licensed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.
The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
Copyright information
© 2024 The Author(s)
About this chapter
Cite this chapter
Eleuteri, S., de Lima, M.E.B. (2024). Psychological Wellbeing. In: Hertz, K., Santy-Tomlinson, J. (eds) Fragility Fracture and Orthogeriatric Nursing . Perspectives in Nursing Management and Care for Older Adults. Springer, Cham. https://doi.org/10.1007/978-3-031-33484-9_13
Download citation
DOI: https://doi.org/10.1007/978-3-031-33484-9_13
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-33483-2
Online ISBN: 978-3-031-33484-9
eBook Packages: MedicineMedicine (R0)