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Patients experience a need for informal care after a fragility fracture

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Abstract

Summary

In this qualitative secondary analysis, patients with a fragility fracture described needing informal care post-fracture. A significant proportion reported receiving no care or not enough care, often devising strategies to care for themselves. Requesting help from multiple individuals allowed patients to minimize the burden to family and friends.

Introduction

In individuals with fragility fractures, our objectives were to examine (1) the experience of receiving informal care post-fracture; and (2) how these care experiences influenced post-fracture recovery and subsequent management of bone health.

Methods

A secondary analysis of six primary qualitative studies was conducted. Individuals in the primary studies were English-speaking women and men, 45 years and older, who were living in the community and had sustained a recent fragility fracture or reported a history of previous fragility fractures. Participants who reported at least one instance of needing informal care were categorized as receiving “enough care”, “insufficient care”, or “no care”.

Results

Of 145 participants in the primary studies, 109 (75%) described needing informal care after their fracture. Of those needing care, 62 (57%) were categorized as receiving enough care while 47 (43%) were categorized as receiving insufficient or no care. The care needed affected the management of participants’ fracture and bone health, including access to health care services. Participants who received insufficient or no care, especially those living alone, devised strategies to care for themselves and often requested help from multiple individuals to minimize the burden to family and friends. Compared with men, women appeared to report needing help with personal daily activities, such as bathing, and transportation to appointments related to bone health.

Conclusion

Informal care needs are an additional burden of fragility fractures. Post-fracture interventions should consider the broader context of patients’ lives and potentially support the care needs of patients as part of their services.

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Data availability

The manuscript is based on qualitative interviews that contain personal information about participants. Participants did not consent to having their data made available; however, we would be able to provide data to support the manuscript based on reasonable requests, such as that for a meta-ethnography. For data requests, authors should contact Sharon Freitag, Senior Director of Research Ethics at Unity Health Toronto.

Code availability

Not applicable.

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Funding

The primary studies were funded by the Dean’s Fund, Faculty of Medicine, University of Toronto and the following grants from the Canadian Institutes of Health Research: CGA-86802; IMH-102813; CBO-109629; MOP-119522; and MOP-136934. Joanna Sale held a Canadian Institutes of Health Research New Investigator Salary Award at the time the research was conducted (Funding Reference Number COB-136622). Joanna Sale was in part funded by the Ontario Ministry of Health and Long-Term Care, Osteoporosis Strategy. Views expressed are those of the researchers and not the Ministry. The authors acknowledge with thanks support from the Brookfield Partners Foundation through the Brookfield Chair in Fracture Prevention.

Author information

Authors and Affiliations

  1. Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada

    Joanna E. M. Sale, Lucy Frankel, Winnie Yu, Julia Paiva, Jessica Saini & Sean Hui

  2. Institute of Health Policy, Management & Evaluation, University of Toronto, 4th Floor – 155 College Street, Toronto, ON, M5T 3M6, Canada

    Joanna E. M. Sale

  3. Department of Surgery, Faculty of Medicine, University of Toronto, 5th Floor - 149 College Street, Toronto, ON, M5T 1P5, Canada

    Joanna E. M. Sale

  4. Department of Surgery, University of Toronto, St. Michael’s Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada

    Earl Bogoch

  5. Department of Community Health Sciences, 3D10 - 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada

    Lynn Meadows

Authors
  1. Joanna E. M. Sale
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  2. Lucy Frankel
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  3. Winnie Yu
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  4. Julia Paiva
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  5. Jessica Saini
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  7. Earl Bogoch
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  8. Lynn Meadows
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Corresponding author

Correspondence to Joanna E. M. Sale.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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All authors have provided consent for publication of this manuscript.

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The authors declare no competing interests.

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Learning objectives:

On completion of this article, you should be able to:

1) Understand the experience of informal care needs after a fragility fracture.

2) Appreciate how informal care needs affect fracture recovery and bone health management.

3) Consider the broader context of patients’ lives and support the care needs of patients as part of a Fracture Liaison Service

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Sale, J.E.M., Frankel, L., Yu, W. et al. Patients experience a need for informal care after a fragility fracture. Osteoporos Int 33, 1027–1035 (2022). https://doi.org/10.1007/s00198-021-06273-y

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