Hip Fractures in the Elderly: A Comprehensive Guide
Everything to know about hip fratures in the elderly.
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It may be surprising how common hip fractures occur, especially in people over 65. According to the CDC, about 300,000 people in the United States sustain a hip fracture every year.
A hip fracture can cause significant pain, decreased mobility, and a lengthy recovery. In addition, the deconditioning that occurs due to the fracture has adverse consequences on an individual's quality of life.
Performing everyday activities, such as household chores, can become difficult. Engaging in hobbies and recreational activities can also be impacted since mobility may be decreased. In some cases, an individual who suffers a hip fracture never returns to their previous level of functioning.
Overview
A hip fracture is a break in the upper part of the femur where it meets the pelvic bone. The femur, commonly called the thigh bone, is the strongest and largest bone in the body. However, in older adults, as their bones weaken, hip fractures occur more easily from trauma to the area. In fact, most hip fractures are in people 65 or over.
Hip fractures are most common in older adults for a variety of reasons, including medical conditions that affect balance. In addition, weak bones from osteoporosis are most common in the elderly. This can make it easier to fracture the hip bone, even with a minor fall.
Common causes of hip fracture include:
- Falls
- Motor vehicle accidents
- Repetitive motions (may lead to a stress fracture)
Hip fractures include partial, hairline, and full breaks. They are severe injuries that cause significant pain and require immediate medical attention.
Symptoms of hip fractures in the elderly include:
- Severe pain in the groin or hip
- Inability to put weight on the leg of the affected side
- Swelling and bruising in the hip area
- Outward turning of the leg on the affected side
The article below will explore the causes, consequences, treatment options, and recovery process for hip fractures in the elderly.
Causes of Hip Fractures in the Elderly
Falls
Falls account for the majority of hip fractures in older people. Research shows that 83% of deaths from hip fractures happen because of falls. Additionally, 88% of emergency room visits and hospital stays for hip fractures are also due to falls. Several factors may contribute to falls in older adults, such as:
Vision issues
Vision may play a role in missing hazards and tripping, altering depth perception and affecting balance.
Cognitive Conditions
Cognitive conditions, such as dementia, can affect how someone walks, increasing their risk of falling.
Medication side effects
Various medications can cause numbness, lightheadedness, and fatigue, increasing the risk.
Environmental hazards
Depending on where someone lives, environmental hazards may include icy or wet conditions that make sidewalks slippery, poorly lit stairs or pathways, and clutter.
Osteoporosis
Osteoporosis contributes to many hip fractures. Osteoporosis is a condition that involves the weakening of the bones. Weak bones are more likely to break when an individual sustains an injury.
Women lose bone mass and density faster than men due to the decline in estrogen that occurs as they age. This is why fractures occur much more commonly in females. According to the International Osteoporosis Foundation, about 75% of all hip fractures occur in females.
Risk factors for developing osteoporosis include:
- Advanced age
- Female gender
- Lack of calcium in the diet
- Being small and thin boned
- Physical inactivity
- Smoking
- Heavy alcohol use
Contributing factors
Other factors contributing to falls include poor nutrition, which may lead to vitamin D deficiency and an increased risk of weak bones.
Certain medical conditions can also lead to muscle weakness and poor balance, such as:
- Parkinson's disease
- Peripheral neuropathy
- Stroke
Consequences of Hip Fractures in the Elderly
A hip fracture can significantly impact mobility, independence, and overall quality of life. As reported by the International Osteoporosis Foundation, hip fractures are often associated with an increased degree of dependency. After sustaining a hip injury, up to 20% of people require long-term care nursing.
Additionally, the consequences of a hip fracture in the elderly may include:
Mortality
Barring complications such as infection, a hip fracture is usually not life-threatening. However, the consequences of a hip fracture can increase a person's risk of death, especially in the elderly.
A review in the World Journal of Orthopedics found that the one-year mortality rate after a hip fracture is 22%.
Morbidity
Why do hip fractures cause death in the elderly? The higher risk of death often comes from complications. These can happen because of less mobility and possible surgery issues. Potential complications include:
- Pneumonia
- Blood clots and pulmonary embolisms
- Pressure ulcers
- Infections leading to sepsis
Loss of Independence
Hip fractures cause a decrease in mobility, which can continue and lead to deconditioning. It may be difficult for elderly individuals to return to their baseline after recovery. This often leads to difficulty performing activities of daily living and an increased reliance on help from caregivers.
A 2020 observational study involved 224 hip fracture patients from two trauma hospitals. Researchers collected various data such as ability to perform daily care, level of depression, and overall quality of life. Researchers found that after a hip fracture, individuals experience a considerable decline in their ability for self-care, mobility, and functional capacity.
Treatment Options for Hip Fractures
Non-surgical Treatment
Surgery is usually needed after a hip fracture. However, in the case of mild fractures, non-surgical treatment may be an option. Hip fracture treatment without surgery in elderly patients may include options such as:
- Pain management
- Physical therapy
- And using assisted devices.
Surgical Treatment
Treatment for hip fractures in elderly patients usually involves surgery. The type of surgery needed may depend on the severity and type of fracture. Options typically include:
Open reduction and internal fixation
This procedure involves the surgeon putting pins, screws, plates, or metal rods into the femur. This helps hold the bone pieces in place while the patient heals. Some individuals have the hardware removed when their hip heals, and some live with the fasteners forever. This surgical procedure is typically used for an open or displaced hip fracture.
Hip replacement
Some individuals over the age of 65 who sustain a hip fracture need a hip replacement. This involves a total or partial replacement of the joint. It may be necessary if the fracture causes decreased blood supply to the ball part of the hip joint.
Rehabilitation
Post-surgical rehabilitation often includes a combination of therapy and pain management, including:
Physical therapy
Physical therapists work with patients to help improve strength, balance, and mobility. For instance, therapists may help patients learn how to:
- Get in and out of bed.
- Move from sitting to standing.
- And walk with an assistive device such as a walker.
Occupational therapy
Occupational therapists also help the elderly recover from hip fractures. They help patients learn to perform activities of daily living, such as bathing and dressing while recovering.
Pain management
Managing pain after a hip fracture is essential. It helps a person begin therapy and move quickly. Pain management may include IV opioid medication shortly after surgery.
As tolerated, a patient will switch to oral medications. Eventually, medications such as non-steroidal anti-inflammatory drugs may help with recovery.
Recovery and Prevention
Regarding broken hip recovery and the elderly, the process can vary based on their age and overall health. A study in the journal Osteoporosis International looked at data from 173 patients over 65. These patients were recovering from a hip fracture.
Researchers found that the recovery timeline for a hip fracture, as defined by functional tests, was about six months. However, subjectively, some study participants marked their full recovery at about nine months.
The stages of recovery usually include:
- Acute phase: The acute phase of recovery involves surgery or immediate treatment. This phase typically lasts a week or two and may be partially impatient.
- Early rehabilitation: The early rehabilitation phase involves progressive weight-bearing and physical therapy to improve strength and help regain independence. It typically lasts about six weeks and may continue in an inpatient rehabilitation program, outpatient services, or an individual home.
- Moderate to late rehabilitation phase: The later phase involves increased physical and occupational therapy. It may include working on advanced movements, such as climbing stairs and transitioning to full weight bearing. This phase may last for up to 6 months.
- Maintenance phase: The maintenance phase is ongoing after a hip fracture. It involves a gradual return to the previous or desired activities. Individuals focus on the ability to maintain strength, mobility, and balance.
Potential challenges exist during any of the above phases. For example, loss of independence may cause an individual with a hip fracture to become anxious or depressed. Practical considerations, such as where someone will live during recovery, may also exist.
Family and caregivers can play an important role after a hip fracture in an elderly person, such as:
- Encouraging as much independence as possible
- Aiding with activities of daily living, such as cooking, clearing, and household chores
- Helping with transportation to doctor's appointments and rehab
- Encouraging compliance with physical therapy exercises
- Providing a compassionate listening ear to help someone express their concerns after a hip fracture
Prevention Strategies
There are several things an individual can do to reduce the risk of falls and potential hip fractures, such as the following:
Enroll in a fall prevention program
Hospitals, community centers, and senior centers offer fall prevention programs. These programs often combine practical tips with exercises to improve balance.
Home modifications
Home modifications involve evaluating your home to determine fall hazards and making needed modifications, such as:
- Removing loose rugs
- Keeping hallway steps and walkways will light
- Decreasing clutter in high-traffic areas
- Adding handrails to stairs
- Installing grab bars, shower seats, and bathmats to decrease falls in the bathroom
- Making sure electrical cords are tucked away so they do not cross walking paths
Use assistive devices as needed
If balance or mobility issues are a concern, use assistive devices such as walkers or a cane.
Exercise
Regular exercise, including strength training, can improve bone strength and balance and decrease fall risk. If unsure what exercises to do, speak to your healthcare provider.
Have regular checkups
Regular checkups with a healthcare provider can identify changes in vision and problems with balance. They can also review medications that may lead to side effects that increase the risk of falling.
Conclusion
Hip fractures in elderly people are often due to falls in individuals with osteoporosis. Hip fractures can lead to potential complications, such as:
- Blood clots
- Pneumonia
- And infections, which increase a person's risk of death within one year post-fall.
Treatment for hip fractures usually includes surgery and a rehabilitation phase, which involves occupational and physical therapy to increase mobility and independence.
Preventing a hip fracture is vital to maintaining independence in an older adult. Proactive steps to prevent falls may include balance and fall prevention classes, home modifications, and regular exercise.
Individuals who suspect they have sustained a hip fracture after a fall should seek immediate medical attention. Also, people who think they are at high risk for falls should talk about prevention methods with their doctor.
Related Resources
About the Author
MaryAnn DePietro CRT is a licensed respiratory therapist with over 15 years of clinical experience in critical care, emergency medicine, and pulmonary rehabilitation. She is also an American Council on Exercise certified personal trainer and holds specialty certifications in orthopedics, senior fitness, and weight management. MaryAnn has a degree in Rehabilitation from Penn State University and a degree in respiratory therapy.
In addition to her clinical experience, she has written extensively about all things medical, as well as health, fitness, and aging for various websites, magazines, and newspapers.
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