Factors associated with concerns about falling and activity restriction in older adults after hip fracture: a mixed-methods systematic review

We conducted a mixed-method systematic review on factors related to concerns about falling and activity restriction among older adults after hip fracture. We identified several contributing factors related to the individual, formal care, environment, and social structure. We observed immutable factors that seem to worsen concerns and activity restriction, as well as modifiable factors that seem to help overcome fears and increase activity. Management of concerns about falling and associated activity restriction after hip fracture needs a comprehensive approach that considers the various individual and external factors impacting fears and activity restriction in the community. To investigate factors contributing to concerns about falling and activity restriction in the community among older adults who had a hip fracture. A mixed method systematic review with a convergent segregated approach. We searched Medline, Embase, PsycInfo, PEDRo, CINAHL and the Cochrane library. Results were synthesised narratively considering physical, psychological, environmental, care, and social factors and presented in tables. Critical appraisal was completed in duplicate. We included 19 studies (9 qualitative, 9 observational, 1 mixed methods) representing 1480 individuals and 23 factors related to concerns about falling and activity restriction. Physical factors included falls history, comorbidities, balance, strength, mobility and functionality. Psychological factors included anxiety and neuroticism scores, perceived confidence in/control over rehabilitation and abilities, and negative/positive affect about the orthopaedic trauma, pre-fracture abilities and future needs. Environmental factors included accessibility in the home, outdoors and with transport. Social and care factors related to the presence or absence of formal and informal networks, which reduced concerns and promoted activity by providing feedback, advice, encouragement, and practical support. These findings highlight that to improve concerns about falling and activity restriction after hip fracture, it is important to: improve physical and functional abilities; boost self-confidence; promote positive affect; involve relatives and carers; increase access to clinicians, and; enhance accessibility of the home, outdoors and transport. Most factors were reported on by a small number of studies of varying quality and require replication in future research.