Caregivers’ misperception of the severity of hip fractures

Abstract

Sara Elli,1 Diego Contro,1 Silvana Castaldi,2,3 Marco Fornili,4 Ilaria Ardoino,4 Antonello V Caserta,5 Lorenzo Panella5 1Post Graduate School of Physical and Rehabilitation Medicine, Department of Health Sciences, University of Milan, Milan, Italy; 2Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; 3Health Management Department, Fondazione IRCCS Ca’ Granda OMP, Milan, Italy; 4Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; 5Rehabilitation Department, UOC Physical and Rehabilitation Medicine, Traumatology Orthopaedic Specialist Center, Gaetano Pini – CTO, Milan, Italy Purpose: The aim of our study was to evaluate how the caregiver of a hip fracture patient perceives the patient’s health status and autonomy in the period immediately preceding the acute event and whether these judgments are actually in line with the prognosis predicted by the medical team caring for the patient in the rehabilitation structure.Patients and methods: We enrolled 147 patients of both sexes, aged ≥65 years, who were referred to our center following surgical treatment of hip fractures of various nature. At the beginning of the rehabilitation program, each patient’s caregiver was asked to complete the Blaylock Risk Assessment Screening Score (BRASS) questionnaire. The same questionnaire was compiled contemporaneously by the doctor taking care of the patient.Results: Analysis of the data shows that the caregivers tend to assign lower scores than the doctor, with a mean difference in agreement with the Bland–Altman plot of -2.43, 95% CI=-2.93 to -1.93, t-test P<0.001. Furthermore, differences in objectivity emerge in the evaluation of the clinical problems of the patient in a borderline clinical condition.Conclusion: This study revealed that caregivers systematically misperceive the clinical situation of hip fracture patients prior to the acute event. Altered perception of such an important factor can lead to a general lack of satisfaction with the outcome achieved by the patient at the end of the rehabilitation process. We therefore believe that an adequate, effective communication between the people making up the health care team and the patient’s social and family network is the foundation of the rehabilitation process. It is precisely on this foundation that the individual’s care and assistance need to be assembled. Keywords: hip fracture, disease perception, caregiver expectations, effective communication

Keywords

• hip fracture
• disease perception
• caregiver expectations
• effective communication.