Findings

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Most hip fractures at or near home
Fracture and chronic condition(s)
Importance of mental health
Needing help
Challenges

According to national information based on hospital records (see Data sources), during the 2003/2004 fiscal year, 23,621 Canadians aged 60 or older were discharged from acute care hospitals after being treated at least once for a hip fracture (data not shown).  They accounted for 3% of all patients in this age group discharged from such hospitals over this period.

In addition to the expense of initial hospitalization, the ongoing health and social services care for individuals with fractured hips is very costly; one study has placed the cost at $650 million annually.¹  For many people, hip fractures result in a permanent loss of function, dependency on others, or a move out of the community to an institution.  However, according to a recent Canadian study, 59% of patients continued to reside in households one year after a hip fracture.¹  Although significant declines in independence and increases in need for support were noted, these people were able to rejoin the household population.¹

This article presents a profile of Canadians aged 60 or older who had sustained a hip fracture and were living in a household during the year after that fracture.  The information is based on nationally representative data from the 2003 Canadian Community Health Survey (CCHS) (see Data sources).

Most hip fractures at or near home

To assess the burden of hip fracture, the outcomes for people aged 60 or older who had suffered a hip fracture are compared with those for four other groups in the same age range (Table 1).  Those who had sustained another type of fracture that could potentially impair mobility and functionality make up two of these groups.  Another comprises those who were coping with the effects of a stroke that had occurred sometime in the past, as stroke is another major source of disability in older adults.  And, finally, a “control group” captures those who reported no fracture in the past year and no effects of a stroke. 

The median age of the adults who had suffered a hip fracture was 80—older than those in any of the other comparison groups.  Over a third of the people (37%) who had sustained a hip fracture in the past year were living alone at the time of the survey (data not shown).  (Information on individuals’ living arrangements at the time of the fracture is not available from the CCHS.)  Most of their hip fractures (53%) had occurred at or close to home, often while they were doing household chores or other unpaid work (38%; data not shown).  Nearly all the hip fractures (93%) had resulted from a fall, and just over half (53%) of those injured had tripped, slipped or stumbled on some type of surface other than snow or ice.  These findings are consistent with those reported in a previous study of injuries among seniors.²

Fracture and chronic condition(s)

Two-thirds of people aged 60 or older (66%) who had suffered a hip fracture also reported having arthritis or rheumatism, as did approximately half of those who had some other kind of limb fracture (Table 2).  The presence of arthritis is not unexpected in either group, as the condition is relatively common at older ages and has been implicated as a risk factor for fall-related fractures in the elderly.³  By comparison, individuals who were living with the effects of a stroke and those who reported no serious injury/fracture were much less likely to have reported arthritis or rheumatism than were those who had fractured a hip.  

About 7 in 10 members of the hip fracture group (71%) also had at least one of 17 selected chronic conditions captured by the CCHS.  More than a third (37%) reported two or more such conditions.  The presence of chronic conditions was similar in the other comparison groups, except stroke survivors, who were more likely to have at least one, as well as more than one, chronic condition.

Importance of mental health

The people who lived in households after a hip fracture must have retained enough functionality and mental resilience, and had sufficient support, to do so.  Indeed, the odds of household residents aged 60 or older who had sustained a hip fracture reporting “very good” or “excellent” mental health were similar to those for people without a serious injury or the effects of a stroke (Table 3).  A similar pattern emerged for being “somewhat” to “very satisfied” with life in general.  Feelings of community connection may have played a role.  The odds of reporting excellent or very good mental health were 80% higher for those declaring a “very strong” sense of community belonging, compared with those whose attachment to the community was not as strong.

Despite positive feelings about their mental health and satisfaction with life in general, the odds of seniors who had fractured a hip reporting their general health as “fair” or “poor” were nearly three times as high as those for the reference group (no fracture and no effects of stroke), and their odds of feeling that their health was “somewhat worse” or “much worse” than it had been a year earlier were five times as high—even when taking into account the effects of other potentially confounding variables. 

Needing help

It is likely that compromised independence plays a role in negative self-perceived health among the hip fracture group.  Among adults aged 60 or older who had had such an injury, the odds of needing help with various activities of daily living (ADL) or with activities that were instrumental to daily living (IADL) were four times as high as those for their non-injured counterparts.  For ADL involving personal care such as bathing or dressing, the odds of needing help were eight times as high (Table 4).

Consistent with their needs for assistance, the odds that the hip fracture group was receiving government-subsidized home care were 10 times those of the non-injured group, and over three times those of stroke survivors.  The adults who had fractured a hip in the 12 months before the CCHS interview may have been more closely tied to health care and social assistance providers than were those who had had a stroke at some (unknown) time in the past.

Challenges

If hip fractures are viewed as part of a continuum that begins with efforts to prevent such injuries in the first place, then this examination of CCHS respondents represents the later effects of the injury, but not the end of the story. For older Canadians, avoiding a move to an institution can be a goal worth pursuing.

The population aged 60 or older examined in this analysis likely represents the “best” hip fracture cases discharged from acute care hospitals since they subsequently rejoined the household population.  Despite their relatively higher perceptions of poor health and dependence on others, they were still just as likely as uninjured adults these ages to report very good or excellent mental health and being somewhat or very satisfied with life.  This is important, as evidence suggests that good mental health is protective against institutionalization.⁸  Perhaps the very strong sense of community belonging reported by those who had suffered a hip fracture may provide the thread.