Abstract
Background:
Hip fractures in older adults often lead to significant functional decline, dependence, and psychological distress. Fear of falling (FOF) is a common postoperative concern that may restrict mobility, delay rehabilitation, and worsen recovery, particularly among frail individuals. However, in frail older adults with hip fractures, the relationship between FOF and postoperative activities of daily living (ADLs) is not well established.
Purpose:
We sought to examine the prevalence of FOF and its relationship with frailty and ADLs after hip fracture surgery.
Methods:
We conducted a prospective descriptive cross-sectional study in the orthopedics and traumatology clinic of a tertiary university hospital between April 2024 and March 2025. Inclusion criteria were age 65 years or older, radiologically confirmed hip fracture caused by a fall, first hip fracture treated surgically, Mini-Cog score ≥3 indicating preserved cognitive function, Edmonton Frail Scale (EFS) score ≥5 indicating frailty, and provision of written informed consent. Exclusion criteria were major concomitant orthopedic trauma or pathological fracture, postoperative admission to the intensive care unit (ICU), death during ICU stay, and missing or incomplete data during follow-up. Data were collected using the EFS, Falls Efficacy Scale—International, a daily Likert-type FOF scale, and the Barthel Index. Assessments included pre-fracture recall and daily evaluations during the first 4 postoperative mobilization days.
Results:
Of 177 patients included in the study, the mean age was 77.2 years, and 67.8% were women. Pre-fracture FOF was moderate to high. ADL independence declined markedly on the first postoperative day and gradually improved thereafter. FOF peaked during the first mobilization and decreased over subsequent days. Higher FOF was significantly associated with greater frailty and lower postoperative Barthel Index scores. Regression analysis identified FOF, frailty, time to first mobilization, and number of chronic diseases as independent predictors of postoperative functional independence.
Conclusions:
This cross-sectional study found that FOF was highly prevalent after hip fracture surgery and was associated with frailty and reduced functional independence. The findings suggest that integrating routine FOF assessment and early targeted interventions into postoperative care may support safer mobilization and enhance recovery in frail older adults who sustain a hip fracture.
Level of Evidence:
Level IV, prospective cross-sectional study.
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