Hip fracture recovery in older adults: a guide for families

After a hip fracture, the biggest dangers for an older person come from lying in bed: chest infections, blood clots, pressure sores, confusion, constipation and rapid loss of muscle. Each day in bed costs strength that takes much longer to rebuild.

That is why hospitals aim to have patients sitting out of bed and standing within a day or two of surgery. Most hip fracture operations, whether the bone is fixed with a nail or plate or the ball of the joint is replaced, are designed so the person can put weight on the leg straight away. Ask the surgeon if there are any limits.

Many older adults do not get back to the level of walking they had before the fracture. The ones who do best are those who start moving early, keep exercising for months, and have family support at home.

Expect the physiotherapist to sit your parent on the edge of the bed, stand them with a walker and take a few steps within 1 to 2 days. It can look too soon, but it is the right thing to do.

Confusion (delirium) is common after a hip fracture, especially at night. Familiar faces, glasses, hearing aids, a clock and daylight help. Tell the team if your parent seems more confused than usual.

Before discharge, ask: Can they put full weight on the leg? Are there movements to avoid? Which blood thinner and for how long? When is the follow-up X-ray? Has anyone checked them for osteoporosis?

The first days at home are when families feel most unsure. Focus on safe transfers: bed to chair, chair to toilet, and short walks with the walker. Someone should stay close for every walk at first.

Set up the home: a commode or raised toilet seat, a firm chair with arms, a clear path, night lights and no loose rugs. Keep the walker within reach of the bed.

Exercises at this stage are simple and done several times a day: ankle pumps, heel slides, buttock squeezes, and sit to stand from a firm chair with help. Short walks every 1 to 2 hours during the day are better than one long walk.

Walking distance should increase steadily, and the number of sit to stands your parent can do without using their hands is a good sign of progress. Add bridges in bed, seated knee straightening, and standing exercises holding the kitchen counter.

Fear of falling is very common and can hold recovery back as much as weakness. Practising getting up from the floor with a physiotherapist, and knowing what to do after a fall, builds confidence.

Watch for warning signs: new or worsening pain in the hip or groin, the leg looking shorter or turned out, calf swelling or pain, breathlessness, fever or a red, oozing wound. Contact the surgeon or hospital straight away.

Many people move from a walker to a stick in this period, though some need the walker longer and that is fine. A physiotherapist should decide when it is safe to change.

Balance training becomes the focus: standing with feet together, then one foot in front of the other, then on one leg holding the counter. This is what lowers the risk of the next fall.

Going outdoors, managing a few steps and returning to temple visits or short outings are realistic goals in this period for many older adults.

Recovery continues for up to a year. Keep doing strength and balance exercises at least 3 times a week, as stopping lets the gains slip away quickly.

A hip fracture from a simple fall usually means the bones are weak. Ask the doctor about an osteoporosis assessment and treatment, vitamin D and calcium, and review any medicines that cause dizziness or drowsiness. An eye check and a home safety review are worth doing too.

People who have had one hip fracture are at higher risk of another. Strength and balance training is one of the best proven ways to lower the risk of falls in older adults.

Many families manage a parent's recovery from another city or country. Online physiotherapy lets a physiotherapist see your parent at home on video, guide the exercises with whoever is present, check the home for hazards, and keep you updated. Some parents need a home visit physiotherapist in the first weeks, followed by online sessions once they are safer on their feet.