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To identify the latent frailty trajectory and explore corresponding predictors among older adults living with frailty who experience hip fracture surgery within 3 months after discharge.
From December 2022 to November 2024, 178 individuals were consecutively enrolled in a longitudinal observational study conducted at a tertiary hospital in Zhejiang Province, China.
The Reported Edmonton Frail Scale measured the frailty level at 5 points, which included baseline (pre-fracture), at discharge, 2 weeks, 1 and 3 months after discharge. Latent class growth models were set up for the frailty trajectory. Multinomial logistic regression was performed to explore the predictors of frailty trajectory classes.
One hundred fifty-three participants completed the full follow-up. Latent class growth models identified 3 frailty trajectories. Class 1: moderate frailty transformed to severe frailty (n = 27; 17.65%); Class 2: mild frailty transformed to moderate frailty (n = 86; 56.20%); Class 3: pre-frailty transformed to mild frailty (n = 40; 26.15%). A higher-level D-Dimer at admission and the five-item version of the Geriatric Depression Scale increased the incidence of Class 2 compared to Class 3. The higher scores of the Abbreviated Mental Test decreased the incidence of Class 2 compared to Class 3. Longer surgical waiting time, a higher-level five-item version of the Geriatric Depression Scale and the Age-Adjusted Charlson Comorbidity Index increased the incidence of Class 1 compared to Class 3. The higher scores of the Abbreviated Mental Test and Mini Nutritional Assessment Short Form decreased the incidence of Class 1 compared to Class 3.
Three frailty trajectory classes were identified among older adults living with frailty who experience hip fracture surgery after discharge within 3 months. D-Dimer at admission, surgical waiting time, depressive symptoms, cognitive status, comorbidity index and nutritional status are associated with these fluctuating frailty trajectories.
Modifiable factors such as improving nutrition and cognitive status and managing depression, comorbidities and preoperative evaluations provide methods for future interventions to prevent or mitigate frailty among this population.
What problem did the study address? Frailty is an inherent dynamic among older adults living with frailty who experience hip fracture surgery after discharge within 3 months. Some factors affect the mitigated frailty process in this population. What were the main findings? Three frailty trajectory classes were identified in this study. And the level of their frailty worsens 3 months after surgery compared to pre-fracture. D-Dimer at admission, surgical waiting time, depressive symptoms, cognitive status, comorbidity index and nutritional status are associated with these fluctuating frailty trajectories. Where and on whom will the research have an impact? The findings of this study provide screening, intervention and discharge plan evidence for healthcare workers in orthopaedics and geriatrics Departments. Helping community healthcare workers and primary caregivers set the theoretical basis for home-based intervention programs.
We have adhered to relevant EQUATOR guidelines using the STROBE reporting method.
No patient or public contribution.
To clarify the concept of life space in community-dwelling older adults to provide a clear and standardised conceptual basis for further research.
Rogers' evolutionary approach was used to identify surrogate terms, related terms, attributes, antecedents and consequences.
Literature from 1936 to 2025 was searched from PubMed, CINAHL, ProQuest, Cochrane databases, Scopus, Web of Science and CNKI.
A total of 46 articles were included for further analysis and synthesis. The attributes of life space in community-dwelling older adults were dynamic variability, multidimensionality and interaction between intrinsic abilities and external environmental demands. Antecedents were classified into four categories, namely, individual, physical, psychological and social factors. Life space can bring positive consequences, promoting walking, assessing the risk of falling, predicting cognitive decline, facilitating rehabilitation and improving quality of life, as well as negative consequences, causing diminished subjective well-being, heightened loneliness, increased risks of hospital readmission and mortality.
Life space, as a spatial indicator of a person's range of mobility, reflects older adults' physical range of motion, the frequency of activity, their need for assistance and the level of social participation. Older adults with adequate life space in the community are more likely to engage in outdoor activities. In contrast, restricted life space can lead to adverse outcomes.
Surrogate terms, related terms, attributes, antecedents and consequences identified by the concept analysis approach will contribute to a greater understanding of life space. These analytical findings establish an essential conceptual framework for future research while offering evidence-based theoretical guidance to improve life space in community-dwelling older adults, ultimately enhancing health outcomes and quality of life.
No patient or public contribution.
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