Discussion
hip fracture, cognitive impairment, fracture, traumatic, weakness
Previous studies have provided important insights into the experiences of patients and caregivers following hip fracture, which we have further explored to better understand this challenge.This study identified that discharge processes after hip fracture do not currently fully prepare informal caregivers for their roles. As such, key learning points for health professionals are suggested to improve collaboration and support in the transition from hospital to home. These include: a greater explanation on ‘normal’ recovery processes; engaging for (dyad) joint decision-making; and promote the provision of additional (community) services for support. This is supported by previous findings that have also highlighted several key recommendations for translational care which emphasise dyad engagement, education and well-being.Joint decision-making based on setting realistic and tailored goals, is another practical strategy health professionals may employ to support the transition of people with hip fracture and their informal caregiver from hospital to home. This agrees with previous authors such as Angeli A key finding of this study was the powerlessness which caregivers felt they had in supporting and advocating for the person with hip fracture. As a result of their inability to advocate for the person with hip fracture, participants frequently reported feelings of either over anticipation (negative) contrasted with unrealistic (positive) opinions on what could be offered and provided to the person who they were supported. This is a common theme that resonates within previous literature.This study offers insights into an informal caregiver population which may differ to most previously reported. Previous literature has emphasised the caregiver experience of caring for people with long-term conditions which is unlikely to be transferable to the acute, traumatic and rapid nature of caregiving for people with hip fracture.This study presents strengths and limitations. A notable strength was its ability to capture experiences during a novel time in healthcare history, where hospitals were making rapid, visitor policy changes in response to the COVID-19 pandemic. Due to the timing of the study, the participants shared a distinctive experience and its effect on rehabilitation and on the caregiver experience. However, one may also interpret this as weakness as it is not a typical reflection of care for this population. Interviews took place within 4 months post-hip fracture, despite previous literature suggesting physical recovery may take up to 12 months,It is likely that group allocation (ie, receiving the HIP HELPER intervention) may have impacted people’s experiences. For example, the HIP HELPER workbook was designed to support goal-setting, thus such guidance may have influenced the way in-which recovering from, or caring for someone with a hip fracture may be perceived by participants. We acknowledge findings may not be fully generalisable because of the small sample size and England-based focus. Participants presented with limited socioeconomic, cultural or ethic perspectives, despite our best endeavours and there was also a lack of perspectives of those caring for a person with cognitive impairment.