Author: Katharina Denk
Denk, Katharina, 2025 Frailty in acute hip fracture patients: prevalence and clinical implications, Flinders University, College of Medicine and Public Health
Terms of Use: This electronic version is (or will be) made publicly available by Flinders University in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. You may use this material for uses permitted under the Copyright Act 1968. If you are the owner of any included third party copyright material and/or you believe that any material has been made available without permission of the copyright owner please contact copyright@flinders.edu.au with the details.
Hip fractures and frailty are major global public health concerns. Geriatric low-impact hip fracture incidence continues to rise, and despite medical advances, they are major life events with high risks of negative health outcomes.
While there is no consensus regarding the definition, diagnosis, and management of frailty, it can be described as an expression of aging poorly. Vulnerability to stressors is increased in all body systems, increasing the risk of poor recovery.
Several risk factors for sustaining a hip fracture have been described in the literature. Many of these factors are also part of the wider appearance of frailty.
The exploration of the clinical utility of frailty tools in hip fracture patients was thus deemed valuable.
A systematic review conducted for the research presented in this thesis demonstrated a high prevalence of frailty, measured by hand grip strength, in hip fracture patients. Hand grip strength has been part of a test battery for diagnosing sarcopenia for two decades and has been suggested to be a sole indicator of frailty. Hand grip strength in hip fracture patients was found to be decreased beyond age and gender-stratified values.
An observational study was conducted to investigate the association of frailty with various primary outcome variables in older adults with hip fractures. The main aim was to assess the prevalence of frailty in acute hip fracture patients and to explore the clinical utility of frailty measures in this population. The study found that frailty, measured by both hand grip strength and the reported Edmonton frailty score, was associated with longer hospital stays, poorer mobility status at discharge, and specific discharge destinations. Frailty was also associated with higher mortality rates at 3 months and 12 months. The study provided adjusted and unadjusted analyses; odds ratios varied widely in size and had to be interpreted for their clinical relevance. Clinical applications of frailty in discharge planning and management of hip fracture patients could be recommended.
Further research was suggested to explore hand grip strength beyond cut-off values and to assess healthcare providers' knowledge about frailty qualitatively.
Keywords: hip fracture, frailty, hand grip strength, Edmonton frailty score, ageing
Subject: Medicine thesis
Thesis type: Doctor of Philosophy
Completed: 2025
School: College of Medicine and Public Health
Supervisor: Prof. Ruurd Jaarsma