Study Links Home-based Hip Fracture Recovery Success to Neighborhood Conditions

University of Maryland School of Medicine researchers found an association between the neighborhood socioeconomic status of older Medicare beneficiaries and the number of days they spend at home after they suffer a fall-related hip fracture.

Published on JAMA Network Open on Dec. 23, the cohort study, “Neighborhood Deprivation and Days Spent at Home After Fall-Related Hip Fracture,” analyzed a random sample of Medicare claims and assessment data from 2010 to 2019 of 52,012 older adults who suffered fall-related hip fractures, underwent arthroplasty or internal fixation, and were discharged to their homes. The mean age of the Medicare beneficiaries, 73.8% of whom were female, was 82.2 years.

The study's senior author, Jason Falvey, DPT, PhD, believes that neighborhood conditions can impact whether older hip fracture repair patients can successfully recover at home. | Photo: University of Maryland School of Medicine

The study then incorporated the Area Deprivation Index (ADI), a national metric that captures factors such as income, education, employment and housing quality, to determine that higher neighborhood socioeconomic deprivation was negatively associated with days spent at home after hip fracture over 12 months. Specifically, it found that patients in the most deprived neighborhoods spent 22.8 fewer days at home over the following year than those in the least disadvantaged areas.

The results suggest that many older adults in economically deprived neighborhoods lack the resources to support recovery from a hip fracture at home. The researchers’ action item for facilities in the wake of the study is to use the findings to guide development of more community-tailored interventions.

'Harder to regain independence'

“Neighborhood context is a critical determinant of health, but it’s often overlooked in hip fracture research,” said the study’s senior author, Jason R. Falvey, DPT, PhD, associate professor of physical therapy and rehabilitation science at the University of Maryland School of Medicine and director of the school’s Center for Disability Justice, in an article on the university’s website headlined “New Study Finds Where You Live Affects Recovery After a Hip Fracture.” “Older adults in neighborhoods like West Baltimore face compounded challenges — limited ability to get to rehabilitation services, fewer supports for caregivers, and neighborhood factors like broken sidewalks that impede mobility. These realities make it harder to regain independence after a hip fracture,” he said.

Dr. Falvey told the website that the findings reflect an urgent need to break the barriers that prevent many in this cohort of patients from safely recovering at home. He advocated community-tailored care models and recovery programs, as well as policy interventions including investment in community-level resources, caregiver supports, transportation services and safe neighborhood infrastructure, to help older adults independently recover from hip fractures and age in place “no matter where they live,” rather than in skilled nursing facilities or long-term care settings.

He said clinicians should consider neighborhood and social factors when planning patients’ recoveries from hip fractures, which could involve earlier referrals to community resources, better coordination of postoperative care and tailored rehabilitation plans.