The Psychological Health of Patients and Their Caregivers

  • Paolo FalaschiEmail author
  • Stefano Eleuteri
Part of the Practical Issues in Geriatrics book series (PIG)


Hip-fracture (HF) patients are among the most vulnerable of hospitalised patients. The associated caregiving rehabilitation task often falls to the lot of a member of the patient’s family. Informal caregivers are an important resource for elderly patients suffering from hip fracture because they play a key role during their recovery. A mutual relationship seems to exist between the patient’s psychological well-being and the caregiver’s burden, so that improvements in the state of health of the one boosts that of the other, and vice versa. This datum confirms the importance of using a bio-psycho-social approach when dealing with both patients and caregivers and evaluating the HF patient’s and caregiver’s psychological status. In this chapter we will illustrate why the psychological status of patients and their caregivers is important in the management and outcome of hip fracture, how it should be assessed and how it could be positively influenced by the orthogeriatric team.


Family Caregiver Informal Caregiver Caregiver Burden Confusion Assessment Method Poor Functional Recovery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Bueckling B, Struewer J, Waldermann A, Horstmann K, Schubert N, Balzer-Geldsetzer M et al (2014) What determines health-related quality of life in hip fracture patients at the end of acute care? A prospective observational study. Osteoporos Int 25:475–484CrossRefGoogle Scholar
  2. 2.
    Kao S, Lai KL, Lin HC, Lee HS, Wen HC (2005) WHOQOL-BREF as predictors of mortality: a two-year follow-up study at veteran homes. Qual Life Res 14:1443–1454CrossRefPubMedGoogle Scholar
  3. 3.
    Fenton FR, Cole MG, Engelsmann F, Mansouri I (1997) Depression in older medical inpatients. Int J Geriatr Psychiatry 12:389–394CrossRefPubMedGoogle Scholar
  4. 4.
    Holmes JD, House AO (2000) Psychiatric illness predicts poor outcome after surgery for hip fracture: a prospective cohort study. Psychol Med 30:921–929CrossRefPubMedGoogle Scholar
  5. 5.
    Miller EA, Weissert WG (2000) Predicting elderly people’s risk for nursing home placement, hospitalization, functional impairment, and mortality: a synthesis. Med Care Res Rev 57:259–297CrossRefPubMedGoogle Scholar
  6. 6.
    Krogseth M, Wyller TB, Engedal K, Juliebø V (2014) Delirium is a risk factor for institutionalization and functional decline in older hip fracture patients. J Psychosom Res 76:68–74CrossRefPubMedGoogle Scholar
  7. 7.
    Marcantonio ER, Flacker JM, Michaels M, Resnick NM (2000) Delirium is independently associated with poor functional recovery after hip fracture. J Am Geriatr Assoc 48:618–624CrossRefGoogle Scholar
  8. 8.
    Saczynski JS, Marcantonio ER, Quach L, Fong TG, Gross A, Inouye SK et al (2012) Cognitive trajectories after postoperative delirium. N Engl J Med 367:30–39CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Pompei P, Foreman M, Rudberg MA, Inouye K, Braund V, Cassel CK (1994) Delirium in hospitalized older patients: outcomes and predictors. J Am Geriatr Soc 42:809–815CrossRefPubMedGoogle Scholar
  10. 10.
    Mossey JM, Knott K, Craik R (1990) The effects of persistent depressive symptoms on hip fracture recovery. J Gerontol 45:M163–M168CrossRefPubMedGoogle Scholar
  11. 11.
    Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M et al (1982) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17:37–49CrossRefPubMedGoogle Scholar
  12. 12.
    Alarcón T, González-Montalvo JI, Gotor P, Madero R, Otero A (2011) Activities of daily living after hip fracture: profile and rate of recovery during 2 years of followup. Osteoporos Int 22:1609–1613CrossRefPubMedGoogle Scholar
  13. 13.
    Fredman L, Hawkes WG, Black S, Bertrand RM, Magaziner J (2006) Elderly patients with hip fracture with positive affect have better functional recovery over 2 years. J Am Geriatr Soc 54:1074–1081CrossRefPubMedGoogle Scholar
  14. 14.
    Langer JK, Weisman JS, Rodebaugh TL, Binder EF, Lenze EJ (2015) Short term affective recovery from hip fracture prospectively predicts depression and physical functioning. Health Psychol 34:30–39CrossRefPubMedGoogle Scholar
  15. 15.
    Visschedijk J, Achterberg W, Van Balen R, Hertogh C (2010) Fear of falling after hip fracture: a systematic review of measurement instruments, prevalence, interventions, and related factors. J Am Geriatr Soc 58:1739–1748CrossRefPubMedGoogle Scholar
  16. 16.
    National Alliance for Caregiving (NAC), American Association of Retired Persons (AARP) (2009) Caregiving in the U.S. NAC\AARP, Bethesda\Washington, DCGoogle Scholar
  17. 17.
    Neugaard B, Andresen E, McKune SL, Jamoom EW (2008) Health-related quality of life in a national sample of caregivers: Findings from the behavioral risk factor surveillance system. J Happiness Stud 9:559–575CrossRefGoogle Scholar
  18. 18.
    Deimling GT, Poulshock SW (1985) The transition from family in-home care to institutional care focus on health and attitudinal issues as predisposing factors. Res Aging 7:563–576CrossRefPubMedGoogle Scholar
  19. 19.
    Liu HY, Yang CT, Cheng HS, Wu CC, Chen CY, Shyu YI (2015) Family caregivers’ mental health is associated with postoperative recovery of elderly patients with hip fracture: A sample in Taiwan. J Psychosom Res 78:452–458CrossRefPubMedGoogle Scholar
  20. 20.
    Carretero S, Garcés J, Ródenas F, Sanjosé V (2009) The informal caregiver’s burden of dependent people: theory and empirical review. Arch Gerontol Geriatr 49:74–79CrossRefPubMedGoogle Scholar
  21. 21.
    Shyu YIL, Chen MC, Liang J, Tseng MY (2012) Trends in health outcomes for family caregivers of hip-fractured elders during the first 12 months after discharge. J Adv Nurs 68:658–666CrossRefPubMedGoogle Scholar
  22. 22.
    Lin PC, Lu CM (2005) Hip fracture: family caregivers’ burden and related factors for older people in Taiwan. J Clin Nurs 14:719–726CrossRefPubMedGoogle Scholar
  23. 23.
    Lin PC, Lu CM (2007) Psychosocial factors affecting hip fracture elder’s burden of care in Taiwan. Orthop Nurs 26:155–161CrossRefPubMedGoogle Scholar
  24. 24.
    Falaschi P, Eleuteri S, Mitroi C, Farulla C, Martocchia A (2015) Hip fracture: relation between patient’s and caregiver’s psychological wellbeing. In: Abstracts of the 4th Fragility Fracture Network Congress, Rotterdam, 3–5 Sept, pp 75–76Google Scholar
  25. 25.
    Eleuteri S, Bellanti G, Falaschi P Hip fracture: preliminary results supporting significative correlations between the psychological wellbeing of patients and their relative caregivers. J Gerontol Geriatr, submitted. in pressGoogle Scholar
  26. 26.
    Testa MA, Simonson DC (1996) Assessment of quality-of-life outcomes. N Engl J Med 334:835–840CrossRefPubMedGoogle Scholar
  27. 27.
    World Health Organization (1948) WHO constitution. World Health Organization, GenevaGoogle Scholar
  28. 28.
    Roth T, Kammerlander C, Gosch M, Luger TJ, Blauth M (2010) Outcome in geriatric fracture patients and how it can be improved. Osteoporos Int 21:S615–S619CrossRefPubMedGoogle Scholar
  29. 29.
    Randell AG, Nguyen TV, Bhalerao N, Silverman SL, Sambrook PN, Eisman JA (2000) Deterioration in quality of life following hip fracture: a prospective study. Osteoporos Int 11:460–466CrossRefPubMedGoogle Scholar
  30. 30.
    Bertram M, Norman R, Kemp L, Vos T (2011) Review of the long-term disability associated with hip fractures. Inj Prev 17:365–370CrossRefPubMedGoogle Scholar
  31. 31.
    Rasmussen B, Uhrenfeldt L (2014) Lived experiences of self-efficacy and wellbeing in the first year after hip fracture: a systematic review protocol of qualitative evidence. JBI Database Syst Rev Implement Rep 12:73–84CrossRefGoogle Scholar
  32. 32.
    Garratt A, Schmidt L, Mackintosh A, Fitzpatrick R (2002) Quality of life measurement: bibliographic study of patient assessed health outcome measures. BMJ 324:1417–1421CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Xenodemetropoulos T, Devison S, Ioannidis G, Adachi JD (2004) The impact of fragility fracture on health-related quality of life. The importance of antifracture therapy. Drugs Aging 21:711–730CrossRefPubMedGoogle Scholar
  34. 34.
    Hutchings L, Fox R, Chesser T (2011) Proximal femoral fractures in the elderly: how are we measuring outcome? Injury 42:1205–1213CrossRefPubMedGoogle Scholar
  35. 35.
    Liem IS, Kammerlander C, Suhmb N, Blauth M, Roth T, Gosch M et al (2013) Identifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures. Int J Care Inj 44:1403–1412CrossRefGoogle Scholar
  36. 36.
    Bandura A (2010) Self-efficacy. In: Weiner EB, Craighead EW (eds) The corsini encyclopedia of psychology, 4th edn. Wiley, HobokenGoogle Scholar
  37. 37.
    Jellesmark A, Herling SF, Egerod I, Beyer N (2012) Fear of falling and changed functional ability following hip fracture among community-dwelling elderly people: an explanatory sequential mixed method study. Disabil Rehabil 34:2124–2131CrossRefPubMedGoogle Scholar
  38. 38.
    McMillan L, Booth J, Currie K, Howe T (2013) ‘Balancing risk’ after fall-induced hip fracture: the older person’s need for information. Int J Older People Nurs 9:249–257CrossRefPubMedGoogle Scholar
  39. 39.
    Pesonen A, Kauppila T, Tarkkila P, Sutela A, Niinisto L, Rosenberg PH (2009) Evaluation of easily applicable pain measurement tools for the assessment of pain in demented patients. Acta Anaesthesiol Scand 53:657–664CrossRefPubMedGoogle Scholar
  40. 40.
    Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919CrossRefPubMedGoogle Scholar
  41. 41.
    Siddiqi N, Stockdale R, Britton AM, Holmes J (2007) Interventions for preventing delirium in hospitalized patients. Cochrane Database Syst Rev 2:CD005563.Google Scholar
  42. 42.
    de Castro SMM, Ünlü Ç, Tuynman JB, Honig A, van Wagensveld BA, Steller EP et al (2014) Incidence and risk factors of delirium in the elderly general surgical patient. Am J Surg 208:26–32CrossRefPubMedGoogle Scholar
  43. 43.
    Murray AM, Levkoff SE, Wetle TT, Beckett L, Cleary PD, Lipsitz LA et al (1993) Acute delirium and functional decline in the hospitalised elderly patient. J Gerontol Med Sci 48:M181–M186CrossRefGoogle Scholar
  44. 44.
    Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R et al (2001) Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med 29:1370–1379CrossRefPubMedGoogle Scholar
  45. 45.
    Nightingale S, Holmes J, Mason J, House A (2001) Psychiatric illness and mortality after hip fracture. Lancet 357:1264–1265CrossRefPubMedGoogle Scholar
  46. 46.
    Bostrom G, Condradsson M, Rosendahl E, Nordstrom P, Gustafson Y, Littbrand H (2014) Functional capacity and dependency in transfer and dressing are associated with depressive symptoms in older people. Clin Interv Aging 9:249–257CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Djernes JK (2006) Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatr Scand 113:372–387CrossRefPubMedGoogle Scholar
  48. 48.
    Atay İM, Aslan A, Burç H, Demirci D, Atay T (2016) Is depression associated with functional recovery after hip fracture in the elderly? J Orthop 13:115–118CrossRefPubMedGoogle Scholar
  49. 49.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198CrossRefPubMedGoogle Scholar
  50. 50.
    Fianco A, Sartori RD, Negri L, Lorini S, Valle G, Delle Fave A (2015) The relationship between burden and well-being among caregivers of Italian people diagnosed with severe neuromotor and cognitive disorders. Res Dev Disabil 39:43–54CrossRefPubMedGoogle Scholar
  51. 51.
    Keyes CLM (2002) The mental health continuum: from languishing to flourishing in life. J Health Soc Behav 43:207–222CrossRefPubMedGoogle Scholar
  52. 52.
    Dupuy HJ (1984) The Psychological General Well-Being (PGWB) index. In: Wenger N (ed) Assessment of quality of life in clinical trials of cardiovascular therapies. Le Jacq, New YorkGoogle Scholar
  53. 53.
    Novak M, Guest C (1989) Application of a multidimensional caregiver burden inventory. Gerontologist 29:798–803CrossRefPubMedGoogle Scholar
  54. 54.
    Pearlin LI, Mullan JT, Semple SJ, Skaff MM (1990) Caregiving and the stress process: an overview of concepts and their measures. Gerontologist 30:583–594CrossRefPubMedGoogle Scholar
  55. 55.
    McCullagh E, Brigstocke G, Donaldson N, Kalra L (2005) Determinants of caregiving burden and quality of life in caregivers of stroke patients. Stroke 36:2181–2186CrossRefPubMedGoogle Scholar
  56. 56.
    Kashner TM, Magaziner J, Pruitt S (1990) Family size and caregiving of aged patients with hip fractures. In: Biegel DE, Bulm A (eds) Aging and caregiving: theory, research and policy. Sage, Beverly HillsGoogle Scholar
  57. 57.
    Gambatesa M, D’Ambrosio A, D’Antini D, Mirabella L, De Capraris A, Iuso S et al (2013) Counseling, quality of life, and acute postoperative pain in elderly patients with hip fracture. J Multidiscip Healthc 6:335–346PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Sapienza University of RomeRomeItaly

Personalised recommendations