The hidden cost of hip fractures: a patient-caregiver perspective

Older adults with hip fracture experience a profound change in health status which can be altered beyond the postoperative healing period resulting in increased care requirements post discharge from hospital. Few studies to date have described the severity of burden faced by caregivers in this cohort.

The aim of this study is to characterize the degree of caregiver burden associated with hip fracture in Ireland and identify the factors potentially associated with it.

A prospective pilot cohort study was conducted at a Major Trauma Centre in the Republic of Ireland (ROI). Patients aged 60 and over with an isolated hip fracture who underwent surgical fixation between April 7, 2025, and August 1, 2025 were invited to participate in the study with their primary caregiver. The main outcome of interest was caregiver burden at 3 months post discharge, measured using the Caregiver Strain Index (CSI) and the Zarit Burden Interview (ZBI).

16 patient-caregiver pairs participated in the present study. 11 out of 16 (69%) caregivers were the children of the hip fracture patients. 56% of caregivers were female, while 44% of caregivers were male. The median caregiver age was 60 years (IQR_25-75 51-70.5; range 25-83 years). 63% of caregivers were in employment while 37% were unemployed. The median CSI score at 3 months was 3.5 (IQR_25-75 2-7.75; range 0-11). The median ZBI score at 3 months was 14.5 (IQR_25-75 1-48; range 0-58). Five caregivers (31%) had a CSI score ≥ 7, and five caregivers reported ZBI scores 41-60. Frailty was shown to be associated with ZBI scores (p = 0.019), but not CSI scores (p = 0.366).

While majority of caregivers reported minimal caregiver burden, 5 out of 16 caregivers reported moderate to severe burden. The primary caregiver was most commonly the daughter of the hip fracture patient. Frailty was associated with increased caregiver burden (ZBI). Future research is needed to clarify the extent of caregiver burden in this cohort and determine how multidisciplinary-based intervention can mitigate burden in at-risk patient-caregiver pairs.