Hip Fracture: 5 Ways to Regain Independence
Each year, more than 300,000 Americans ages 65 and older are hospitalized after a hip fracture—a break in the top of the thighbone (the femur) below the hip joint—according to the Centers for Disease Control and Prevention.
Nearly all the fractures happen from a fall and are a result of osteoporosis, or low bone mass.
The year after a hip fracture is a critical time—it’s estimated that 12 to 37 percent of patients don’t survive during that period. Most deaths occur in the first three to six months after sustaining a fracture. Only about one-third of people who break a hip ever fully regain the independence they had before their fracture, according to a study published by the Journal of General Internal Medicine in September 2016.
Being age 85 or older, having dementia, and having two or more chronic diseases made it even less likely that patients would return to full function. Unsurprisingly, patients who were frail or beginning to show signs of a loss of independence were the most unlikely to recover fully from a hip fracture.
The rate of hip fracture begins to increase at age 50, doubling every five to six years. “Older women, in particular, are at risk because osteoporosis—which is more common in women—weakens bones and makes them more susceptible to breaking,” says John A. Flynn, M.D., M.Ed., medical director of the Spondyloarthritis Center at Johns Hopkins University School of Medicine in Baltimore. “The hip bone can become so weak that a fall from a standing position, or even a twist of the leg, can cause a fracture.”
Here are five things you can do to ensure the best outcome after sustaining a hip fracture:
1. Don’t delay surgery
Most hip fractures require surgical repair to reposition the hip bone. “The goal is to perform surgery as soon as safely possible—within the first two days of hospital admission—to reduce your risk of complications and help you recover more quickly,” Flynn says. “However, surgery might not be an option if you are very ill and can’t withstand anesthesia or the medical procedure or if you were confined to bed or a wheelchair before sustaining the fracture.”
Delaying surgery may delay your recovery. The more time you spend immobile, the more likely you are to develop complications such as blood clots, urinary tract infections, pressure sores, and pneumonia. In fact, blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism) are leading causes of death in patients who have fractured their hip, which is why your doctor will likely prescribe a blood thinner. He or she may also prescribe an antibiotic to guard against infection.
Studies show that surgical repair performed in the first 24 to 48 hours after injury can reduce the risk of death within one year. It’s also associated with reduced pain and a shorter hospital stay.
If you have any other medical conditions, such as heart failure, pneumonia, angina, or chronic obstructive pulmonary disease (COPD), your procedure could be riskier. In such cases, your surgery may be delayed up to 72 hours to stabilize your condition.
2. Get up and move
Hip surgery can have complications, especially in elderly patients. Both postoperative pain and some of the narcotic pain relievers used to manage it can cause delirium. Lying in bed for too long after surgery carries the risk of developing complications similar to those if surgery is delayed: pressure sores, blood clots, infection, and pneumonia. If you’re using a urinary catheter after surgery, ask to have it removed within 24 hours of your procedure to avoid infection.
Recovering from a hip fracture can take anywhere from three months to a year. You’ll be encouraged to get out of bed with assistance the first day after surgery and walk within one to three days. Inpatient rehab takes about one week. After seven days, the expectation is that you’ll be able to go home with an assistive device such as a walker and gradually transition to a less supportive device such as a cane.
You might instead be discharged to a rehabilitation facility if you don’t have someone who can assist you at home or you have complex medical problems that may lengthen your recovery time.
3. Make physical therapy a priority
A physical therapist will teach you exercises to strengthen your hip and help you get back to your normal activities.
You’ll continue with physical therapy at home or in outpatient rehab for up to three months. Studies show that intensive home physical therapy improves functional outcome. Your health insurance may not cover expenses for this length of time. It’s important to learn the exercises so you can do them on your own if you can’t afford rehabilitation therapy.
Some people can walk normally at this time, but others find that they need an assistive device indefinitely.
4. Bulk up your bones
After you’ve had one hip fracture, you’re at increased risk for a second, and the risk is greater for women ages 80 and older.
To prevent another fracture, your doctor should prescribe medicines like bisphosphonates to shore up your bones and evaluate your bone density with a dual-energy X-ray absorptiometry (DXA) scan. You might also need to take calcium and vitamin D daily.
Speak up if your doctor doesn’t suggest drugs to prevent future fractures—they’re essential for your long-term recovery. According to a 2016 AARP report, only 23 percent of women were evaluated or treated for osteoporosis in the year after their hip fracture even though osteoporosis plays a role in most fractures.
Proper nutrition is also important. Many hip-fracture patients are malnourished before their injury, which can hinder healing. A 2001 Mayo Clinic study found that getting protein supplementation while in the hospital was associated with a shorter hospital stay, fewer complications, and weight gain.
Try not to skip meals in the hospital. If you wear dentures, make sure you bring them with you on the day of your surgery so they’ll be readily available. If you have no appetite, consider high-calorie supplement drinks.
Before you’re discharged from the hospital, ask whether you can meet with a dietitian who can evaluate your eating habits and help ensure that you’re not deficient in nutrients such as calcium and vitamin D.
5. Heed your doctor’s advice
You’ll need to guard against injury for one to three months after your surgery. You’ll be advised to avoid crossing your legs, sitting for extended periods, lifting or pushing heavy objects, and bending over.
Your doctor should also assess your fall risk and advise you about how to prevent future falls. Staying active is one way to prevent falls and strengthen your bones, so it’s important to follow your outpatient rehabilitation plan.
Many patients become less active at home because they’re afraid of experiencing another fall and fracture, but the opposite is true: Building up strength is key to avoiding falls and achieving a successful recovery.