The impact of hip fracture on resilience in health-related quality of life: a cohort study

PURPOSE: Hip fractures significantly impact health-related quality of life (HRQoL) in older adults. This study aimed to investigate and quantify changes in different domains of HRQoL following a hip fracture and to identify factors associated with maintaining HRQoL (resilience). METHODS: The study included a cohort of 2,529 individuals aged 65 + who experienced their first hip fracture between 2016 and 2020. HRQoL was assessed using the EQ5D-5L tool both prior to and 4 months after the fracture. Resilience was defined as maintaining or improving pre-fracture EQ5D levels at follow-up. Associations between sociodemographic characteristics, acute conditions, medical factors, and resilience in specific EQ5D domains-Mobility, Usual Activities, Self-Care, Pain/Discomfort, and Anxiety/Depression-were analyzed using regression models. RESULTS: Sixty-nine percent were women and the mean age was 82.6 years. A decline was observed across all EQ5D domains and in the global EQ5D index following a hip fracture. The proportion of patients exhibiting resilience varied by domain, ranging from 36 to 77%, with Mobility being the most adversely affected and Anxiety/Depression the least affected. Factors associated with resilience differed by domain. Mobility, Usual Activities, and Self-Care followed a similar pattern, while Pain/Discomfort and Anxiety/Depression showed distinct patterns. Notably, the absence of fall-risk-increasing medications was the only factor consistently associated with resilience across all domains. CONCLUSIONS: While hip fractures generally lead to declines in HRQoL, a significant proportion of patients demonstrate resilience within 4 months post-fracture. Patterns of resilience vary across EQ5D domains, with physical functions being most impacted and mental health the least.