Care gaps in hospital discharge planning for older adults with fall-related fractures: a mixed-methods study

Abstract

Objective

To analyze discharge planning for older adults hospitalized due to fractures resulting from same-level falls, combining the investigation of associations between sociodemographic and clinical variables with a qualitative exploration of the processes and perceptions involved.

Method

A mixed-methods study conducted in a public hospital in the interior of Bahia and in home settings. A total of 142 medical records of older adults hospitalized for fractures (September 2022 to August 2023) were analyzed, and interviews were conducted with 16 participants after discharge. Quantitative data were analyzed using descriptive statistics and Pearson's chi-square test (p < 0.05), while qualitative data were analyzed through content analysis.

Results

Only 17 medical records included discharge instructions, which were generic and restricted to clinical aspects. Interviews revealed a predominance of lack of guidance on fall prevention and reports of ptophobia after discharge, leading to activity restriction and social isolation. An association was found between lower limb fractures and female sex, as well as the presence of two to three comorbidities; individuals aged 60 to 79 years showed a higher occurrence of upper limb fractures.

Conclusion

The findings point to the urgent need for structured, individualized, and multidisciplinary long-term planning. Nurse-led protocols that include guidance on fall prevention and psychosocial support are essential to prevent ptophobia and activity restriction, ensuring safe hospital-to-home transitions for older adults who have sustained fractures resulting from same-level falls.