"A hip fracture is an insult to the system, and that changes many metabolic functions," adds Jay Magaziner, Ph.D., chair of the department of epidemiology and public health at the University of Maryland School of Medicine in Baltimore and an expert on hip fractures. "There is something about this kind of injury that amplifies things."
You can, however, improve the odds of a good recovery. The first thing to do is repair the hip as soon as possible. A recent study in the Canadian Medical Association Journal finds that the risk of death from a hip fracture declined by 19 percent when surgery was performed within three days of the break.
Assuming reasonably good health at the time of the fracture, standard care consists of surgery within 48 hours, for a total of four to six days in the hospital, followed by two to six weeks in a subacute rehabilitation facility, with another three to four weeks of outpatient or home-based rehabilitation.
Then the real work begins — a point lost on many who have endured a hip fracture.
"It's not the fall, but the response to the fall," says Patti League, R.N., lead trainer of A Matter of Balance, a program that works with older adults to reduce their fear of falling. "How do you live after the services end? How do you keep your fear of falling again in check? In short, how do you get your life back?"
The answers are both simple and complex. Simple in that you must take advantage of all services available until you are back to where you were before the fracture. Complex in that older adults are fighting a powerful bias that says partial recovery is okay.
"We like to say it's only a broken bone, and bones heal," says Rebecca Craik, Ph.D., chair of the department of physical therapy at Arcadia University in Glenside, Pennsylvania. "But when you're an older adult, the bar is often set too low. 'It's good enough just to be home. It's time in your life to rest.' Patients and their caregivers often don't push to get where they were before the surgery."
Part of the problem, Magaziner says, is that after a few months, just as the patient gains the ability to endure the intense physical therapy that will restore pre-fracture mobility and functionality, the infrastructure for care evaporates. What's needed, he believes, is continuing, reimbursed, multicomponent intervention tailored to each patient. In the meantime, those who have suffered a hip fracture can do much on their own.