Abstract
Hip fractures in the elderly are frequently associated with complications and unfavorable outcomes. Managing postoperative delirium, pain, sleep disturbances, and overall quality of life presents significant challenges in clinical care. This study aimed to explore the effectiveness of refined nursing interventions in improving postoperative recovery and patient satisfaction among elderly patients undergoing hip fracture surgery. A retrospective analysis was conducted on 252 elderly patients with surgically treated hip fractures admitted to Zhejiang Provincial People’s Hospital and Tongxiang First People’s Hospital between January 2021 and June 2024. To minimize selection bias, participants were allocated into 2 groups using propensity score matching, ensuring comparable baseline characteristics between the groups. The observation group (n = 126) received refined nursing care tailored to individual needs, while the control group (n = 126) received standard nursing care. Key outcomes assessed included the incidence and duration of postoperative delirium, hospital length of stay, pain intensity (visual analog scale), sleep quality (Pittsburgh Sleep Quality Index), quality of life (SF-36), recovery quality (the quality of recovery-40), and satisfaction with nursing care. Compared to the control group, patients in the observation group showed a marked reduction in both the incidence and duration of postoperative delirium. They also experienced shorter hospital stays and reported lower pain scores by the third postoperative day. Sleep quality was notably better on the first and third days following surgery. Moreover, assessments at 1 and 2 months postoperatively revealed significantly higher scores in both quality of life and recovery. Nursing satisfaction was also significantly enhanced in the refined care group (P < .05 for all comparisons). Refined nursing interventions, with a focus on personalized, comprehensive care strategies, significantly improve postoperative outcomes in elderly patients with hip fractures. These measures not only mitigate delirium and pain but also promote better sleep, faster recovery, improved life quality, and greater patient satisfaction, demonstrating meaningful clinical application.
Keywords: delirium, elderly, hip fractures, nursing care, pain management, postoperative care, sleep disorders
1. Introduction
Hip fractures in the elderly are a common and serious health issue, with their incidence rising significantly due to an aging population.[1,2] These fractures not only lead to a substantial decline in patients’ quality of life but also significantly increase the risk of postoperative complications and mortality, making them a leading cause of disability among the elderly.[3,4] Data shows that the 5-year survival rate for hip fracture patients is considerably lower than that of their age-matched peers, and postoperative functional recovery is often incomplete. This imposes a heavy economic burden on patients and their families, while also causing significant psychological stress.[5] As such, optimizing postoperative care for elderly hip fracture patients to promote full rehabilitation has become a critical focus of clinical research.
Postoperative delirium is one of the most common and severe complications in the recovery of elderly hip fracture patients, profoundly affecting rehabilitation outcomes.[6] Delirium not only extends hospital stays and raises medical costs but also increases nursing workloads, negatively impacting patients’ quality of life, and long-term functional recovery.[7–9] Furthermore, managing postoperative pain, improving sleep quality, and enhancing life quality remain critical unresolved issues.[10,11] Effective pain management encourages early mobilization and shortens recovery times; quality sleep supports physical healing and boosts immune function; while improved life quality reflects overall health and well-being. However, traditional nursing care models often lack the specificity and systematic approach required to address these complex needs, making them less effective for the comprehensive rehabilitation of elderly hip fracture patients.
In recent years, refined nursing care has emerged as a personalized and holistic approach, gaining traction in clinical practice.[12,13] This model involves a thorough assessment of patients’ physiological, psychological, and social needs, leading to the development of individualized care plans that aim to enhance nursing quality, reduce complications, and promote functional recovery and life quality.[14] Research has shown that refined nursing care significantly improves pain management and sleep quality. However, studies on the application of refined nursing specifically for elderly hip fracture patients are still limited, necessitating further investigation into its clinical benefits and effectiveness.
The objective of this research is to evaluate the effect of improved nursing care on postsurgical delirium and recovery in older people with hip fractures, by means of a retrospective cohort analysis.
2. Materials and methods
2.1. General information
This study was approved by the Ethics Committee of Zhejiang Provincial People’s Hospital (Approval No. ZJPH2021-012). This retrospective cohort study included 252 elderly hip fracture patients who underwent surgery at Zhejiang Provincial People’s Hospital and Tongxiang First People’s Hospital between January 2021 and June 2024. Patients were grouped into the observation group (n = 126) and the control group (n = 126) using propensity score matching to control for potential confounding factors and reduce selection bias. The propensity scores were calculated based on variables such as age, gender, BMI, comorbidities, and ASA classification to ensure comparable baseline characteristics between the 2 groups. The observation group received refined nursing interventions, including preoperative care, intraoperative care, postoperative care, dietary interventions, blood circulation monitoring, bed rest management, and rehabilitation interventions. The control group received standard care. All data were extracted from the electronic medical records of the hospitals to ensure accuracy and completeness. Since this was a retrospective study, informed consent forms for the patients were archived in the hospital database, and no additional informed consent was required for this study.
2.2. Inclusion and exclusion criteria
2.2.1. Inclusion criteria
Elderly patients diagnosed with hip fractures confirmed by X-ray, CT, or MRI; aged ≥ 65 years; underwent hip fracture surgery after admission; postoperative hospitalization time ≥ 7 days; and both the patient and family members consented to participate in the study and could understand and cooperate with the nursing interventions.
2.2.2. Exclusion criteria
Patients with severe cognitive dysfunction, psychiatric disorders, or aphasia who could not communicate effectively; those with severe multiple organ failure or other life-threatening diseases; patients with limb dysfunction caused by non-fracture reasons, such as severe neurological diseases; those with contraindications to the nursing interventions used in this study; and patients with incomplete medical records or missing follow-up data.
2.3. Nursing interventions
To ensure the consistency and quality of the nursing interventions, all nursing staff involved in the study followed a standardized nursing process operation manual. This manual outlined specific guidelines and procedures for preoperative, intraoperative, and postoperative care, ensuring that all interventions were evidence-based and consistent across patients.
Before the implementation of the study, all nursing staff participated in standardized training sessions, which included detailed instructions on delirium prevention, pain management, sleep quality improvement, and individualized dietary interventions. Additionally, regular quality checks were conducted by the nursing supervisor team to monitor adherence to the manual and ensure the interventions were implemented correctly and consistently. This training and monitoring system helped to maintain uniformity in the application of nursing care throughout the study.
2.3.1. Control group
Patients received routine nursing interventions, which included fasting and restricting water intake for 4 hours before surgery and 6 hours after surgery. Regular rounds were performed to observe local pressure and peripheral blood circulation. Patients were regularly assisted in changing positions to prevent pressure ulcers and circulation impairment. Once the patient’s condition improved, functional training of the affected limb, including passive and active movements, was assisted to promote limb recovery.
2.3.2. Observation group
The observation group received refined nursing care, which involved the following steps:
A nursing intervention team, consisting of the head nurse, deputy head nurse, and charge nurse, was established to design, train, and ensure the quality of the nursing plan, ensuring that the measures were evidence-based and standardized.
Nursing staff received training on delirium prevention, pain management, sleep quality improvement, and personalized diet. A nursing quality supervision team was formed to regularly review nursing records and resolve issues (e.g., insufficient staff or inconsistent measures), ensuring smooth implementation of nursing interventions.
Preoperatively, a comprehensive assessment was conducted, and a personalized nursing plan was developed. The surgery process, precautions, and prognosis were explained to the patient and their family, with psychological counseling provided to reduce anxiety. Intraoperatively, strict sterile techniques were followed, and laminar flow operating rooms were used to ensure clean instruments and environment. The anesthesia team monitored vital signs and maintained the patient’s body temperature. Postoperatively, the patient’s position was monitored, regular repositioning was performed, and chest physiotherapy was provided to promote sputum expulsion. Wound healing was observed, and a personalized dietary recovery plan was implemented to prevent complications. Peripheral blood circulation was monitored, rehabilitation training was initiated, cognitive function was assessed regularly, and appropriate interventions were taken to ensure patient comfort and safety.
Standardized training and execution, along with issue resolution, ensured efficient implementation of the nursing interventions, improving nursing quality and the study’s reproducibility.
2.4. Outcome measures
2.4.1. Primary outcome measures
Delirium incidence: The confusion assessment method was applied to evaluate the effect of delirium after surgery. The amount and percentage of patients with delirium were recorded and compared.
Delirium duration: Days from onset to resolution of delirium were recorded and compared.
Hospital stay: The total length of hospitalization during the perioperative period was recorded, and differences between the 2 groups were compared to assess the impact of nursing interventions on hospitalization time.
2.4.2. Secondary outcome measures
Visual analog scale (VAS) pain scores: Pain levels were assessed on the first, second, and third postoperative days using the VAS. Mean pain scores were recorded and compared in both groups.
Pittsburgh Sleep Quality Index (PSQI) Sleep Quality Scores: Sleep quality was assessed on the first, second, and third postoperative days using the PSQI. The mean results of all time points were recorded and compared.
SF-36 Quality of Life Scores: The SF-36 Health Survey Questionnaire was used to evaluate the QOL for 2, 1, and 2 months after operation. The mean results of all time points were recorded and compared.
The quality of recovery-40 (QOR-40) recovery quality scores: The QOR-40 was assessed after surgery, which covered areas like well-being, emotion, self care, mental support, and pain control. The scores of both groups were recorded and compared.
Nursing satisfaction: Patient satisfaction with nursing services was evaluated using a self-designed questionnaire, which included questions on nursing quality, communication, and the effectiveness of nursing interventions. Rates of satisfaction, satisfaction and dissatisfaction among both groups were recorded and compared.
2.5. Data collection
Data collection was carried out using both electronic medical records and patient follow-up questionnaires. Researchers extracted basic information such as age, sex, BMI, education level, type of surgery, ASA grade, and comorbidities from the patients’ hospital records. Main outcome measures were obtained through clinical examinations, regular assessments, and patient questionnaires. Nursing satisfaction was assessed using a self-designed questionnaire completed by the patient after the intervention, covering nursing quality, communication, and the effectiveness of interventions. All data were collected and recorded by research team members according to standardized procedures. The research team received training to ensure data accuracy and consistency.
2.6. Statistical analysis
The data were analyzed with SPSS 22.0 statistic software. The consecutive data was given as the average ± SD (±s), and the independent sample t test was used to compare the 2 groups. The classification data was reported in terms of frequency and percent, and the Chi-Square Test (χ²) was used to compare between groups. A significance level of P < .05 was set for all statistical tests. For continuous variables (e.g., delirium duration, hospital stay, VAS pain scores, PSQI sleep quality scores, SF-36 quality of life scores, QOR-40 recovery quality scores), independent-sample t tests were used to compare the differences between the observation and control groups. For categorical variables (e.g., delirium incidence, nursing satisfaction), chi-square tests were used for intergroup comparisons. Data were analyzed at different time points before and after the intervention to assess the impact of different nursing models on patients. To handle missing data (which was <6%), multiple imputation was employed to ensure the completeness of the dataset and to minimize potential bias due to missing information. Bonferroni correction was applied for multiple comparisons to reduce type I errors.
3. Results
3.1. Baseline characteristics
This study included 252 elderly patients with hip fractures. As shown in Table 1, there were no significant differences between the 2 groups in terms of age, gender, BMI, education level, surgical type, ASA classification, or comorbidities (hypertension, diabetes, heart disease) (all P > .05). The baseline characteristics were comparable between the groups, ensuring a solid foundation for the subsequent outcome comparisons.
Table 1.
Baseline data [mean ± SD, n (%)].
| Control group (n = 126) | Observation group (n = 126) | t/χ2 | P | |
|---|---|---|---|---|
| Age(year) | 76.24 ± 6.83 | 75.91 ± 7.14 | t = 0.414 | .812 |
| Gender | χ² = 0.685 | .754 | ||
| Male | 61 (48.41) | 58 (46.03) | ||
| Female | 65 (51.59) | 68 (53.97) | ||
| BMI (kg/m²) | 21.34 ± 3.45 | 22.54 ± 4.32 | t = 0.935 | .536 |
| Education level | χ² = 0.419 | .654 | ||
| Middle school or below | 43 (34.13) | 41 (32.54) | ||
| High school or above | 83 (65.87) | 85 (67.46) | ||
| Type of surgery | χ² = 0.487 | .745 | ||
| Hip arthroplasty | 76 (60.32) | 75 (59.52) | ||
| PFNA | 50 (39.68) | 51 (40.48) | ||
| ASA classification | χ² = 0.351 | .856 | ||
| I | 17 (13.49) | 22 (17.46) | ||
| II | 65 (51.59) | 55 (43.65) | ||
| III | 44 (34.92) | 49 (38.89) | ||
| Comorbidities | χ² = 0.465 | .759 | ||
| Hypertension | 41 (32.54) | 46 (36.51) | ||
| Diabetes | 21 (16.67) | 20 (15.87) | ||
| Heart disease | 21 (16.67) | 25 (19.84) |
ASA = American society of anesthesiologists, PFNA = proximal femoral nail antirotation.
3.2. Primary outcomes
Regarding clinical outcomes, the observation group had significantly lower delirium incidence, duration, and hospital stay compared to the control group. The delirium incidence was 17.46% in the observation group versus 30.95% in the control group; the delirium duration was 3.36 ± 0.56 days in the observation group compared to 4.25 ± 1.03 days in the control group; and the hospital stay was 13.76 ± 3.82 days in the observation group versus 15.24 ± 4.51 days in the control group, with all differences statistically significant (P < .05) (Table 2). These results indicate that refined nursing interventions can significantly reduce postoperative delirium incidence and duration, and shorten hospital stay.
Table 2.
Comparison of delirium incidence, duration, and length of hospital stay between the 2 groups [mean ± SD, n (%)].
| Control group (n = 126) | Observation group (n = 126) | t/χ2 | P | |
|---|---|---|---|---|
| Delirium incidence | 39 (30.95) | 22 (17.46) | χ² = 4.563 | .033 |
| Delirium duration (days) | 4.25 ± 1.03 | 3.36 ± 0.56 | t = 5.675 | <.001 |
| Length of hospital stay (days) | 15.24 ± 4.51 | 13.76 ± 3.82 | t = 3.505 | .001 |
3.3. VAS scores
Regarding the VAS pain scores, the observation group reported scores of 5.10 ± 1.00 and 4.90 ± 1.10 on postoperative days 1 and 2, respectively, which were lower than those of the control group (5.40 ± 1.20 and 5.23 ± 1.30). However, the differences were not statistically significant (P = .135 and P = .427). On postoperative day 3, the observation group’s VAS score was significantly lower than that of the control group (4.50 ± 1.12 vs 5.00 ± 1.40, P < .05) (Table 3, Fig. 1). These results suggest that refined nursing interventions can effectively reduce postoperative pain, particularly on the third day after surgery.
Table 3.
Comparison of pain scores on postoperative days 1, 2 and 3 between the 2 groups (mean ± SD).
| Control group (n = 126) | Observation group (n = 126) | t | P | |
|---|---|---|---|---|
| Postoperative 1 day | 5.40 ± 1.20 | 5.10 ± 1.00 | 1.500 | .135 |
| Postoperative 2 day | 5.23 ± 1.30 | 4.90 ± 1.10 | 0.800 | .427 |
| Postoperative 3 day | 5.00 ± 1.40 | 4.50 ± 1.12 | 2.950 | .002 |
Figure 1.
Comparison of pain scores on postoperative days 1, 2 and 3.
3.4. Sleep quality
In terms of postoperative sleep quality, the observation group had PSQI scores of 15.00 ± 3.50 and 8.24 ± 2.10 on postoperative days 1 and 3, respectively, which were significantly lower than the control group’s scores of 15.50 ± 4.00 and 12.00 ± 2.30 (P = .035 and P = .001). On postoperative day 2, the observation group’s PSQI score was 13.00 ± 4.50, lower than the control group’s 13.35 ± 5.30, with a difference approaching statistical significance (P = .054) (Table 4, Fig. 2). These results indicate that refined nursing interventions can significantly improve postoperative sleep quality, particularly on the first and third days after surgery.
Table 4.
Comparison of postoperative sleep quality between the 2 groups (mean ± SD).
| Control group (n = 126) | Observation group (n = 126) | t | P | |
|---|---|---|---|---|
| Postoperative 1 day | 15.50 ± 4.00 | 15.00 ± 3.50 | 1.486 | .035 |
| Postoperative 2 day | 13.35 ± 5.30 | 13.00 ± 4.50 | 1.923 | .054 |
| Postoperative 3 day | 12.00 ± 2.30 | 8.24 ± 2.10 | 4.864 | .001 |
Figure 2.
Comparison of postoperative sleep quality.
3.5. Quality of life
This study assessed the quality of life (SF-36) scores in both groups at 2 weeks, 1 month, and 2 months post-surgery. At 2 weeks, no significant difference was found between the groups (control: 67.60 ± 8.20, observation: 72.00 ± 5.60, t = −1.145, P = .234). However, at 1 month and 2 months post-surgery, the observation group had significantly higher SF-36 scores than the control group (1 month: 75.50 ± 6.50 vs 71.00 ± 8.70, t = −2.567, P = .010; 2 months: 79.60 ± 9.70 vs 75.10 ± 5.10, t = −8.467, P = .001) (Table 5). These findings indicate that refined nursing interventions can notably enhance patients’ long-term quality of life.
Table 5.
Comparison of postoperative quality of life between the 2 groups (mean ± SD).
| Control group (n = 126) | Observation group (n = 126) | t | P | |
|---|---|---|---|---|
| Postoperative 2 weeks | 67.60 ± 8.20 | 72.00 ± 5.60 | ‐1.145 | .234 |
| Postoperative 1 month | 71.00 ± 8.70 | 75.50 ± 6.50 | ‐2.567 | .010 |
| Postoperative 2 months | 75.10 ± 5.10 | 79.60 ± 9.70 | ‐8.467 | .001 |
3.6. Postoperative recovery quality
The observation group showed significantly better postoperative recovery quality compared to the control group in various aspects: physical comfort, emotional state, self-care ability, psychological support, pain management, and overall score. Specifically, the observation group’s physical comfort score was 34.50 ± 2.80, higher than the control group’s 28.42 ± 3.20 (t = 6.805, P < .001). The emotional state score for the observation group was 32.01 ± 3.50, compared to 25.13 ± 4.10 in the control group (t = 7.105, P < .001). For self-care ability, the observation group scored 38.73 ± 3.94, while the control group scored 30.25 ± 4.80 (t = 5.995, P < .001). The observation group also had a higher psychological support score (35.34 ± 3.00 vs 27.50 ± 3.51, t = 7.495, P < .001), better pain management (25.04 ± 2.21 vs 19.36 ± 2.45, t = 6.495, P < .001), and an overall score of 160.20 ± 12.70, compared to 140.50 ± 15.27 in the control group (t = 7.245, P < .001) (Table 6). These findings indicate that refined nursing interventions significantly enhanced the patients’ overall recovery quality.
Table 6.
Comparison of postoperative recovery quality between the 2 groups (mean ± SD).
| Control group (n = 126) | Observation group (n = 126) | t | P | |
|---|---|---|---|---|
| Physical comfort | 28.42 ± 3.20 | 34.50 ± 2.80 | 6.805 | <.001 |
| Emotional state | 25.13 ± 4.10 | 32.01 ± 3.50 | 7.105 | <.001 |
| Self-care ability | 30.25 ± 4.80 | 38.73 ± 3.94 | 5.995 | <.001 |
| Psychological support | 27.50 ± 3.51 | 35.34 ± 3.00 | 7.495 | <.001 |
| Pain | 19.36 ± 2.45 | 25.04 ± 2.21 | 6.495 | <.001 |
| Total score | 140.50 ± 15.27 | 160.20 ± 12.70 | 7.245 | <.001 |
3.7. Nursing satisfaction
In terms of nursing satisfaction, the observation group had a significantly lower dissatisfaction rate than the control group (3.97% vs 11.11%), with higher rates of “satisfied” and “very satisfied” at 33.33% and 62.70%, respectively, compared to 34.13% and 54.76% in the control group (χ²=8.678, P = .015) (Table 7). These findings suggest that refined nursing interventions significantly improved patient satisfaction with care.
Table 7.
Comparison of nursing satisfaction between the 2 groups (n/%).
| Not satisfied | Satisfied | Very satisfied | Total satisfaction | |
|---|---|---|---|---|
| Control group (n = 126) | 14 (24.14) | 43 (34.13) | 69 (54.76) | 112 (88.89) |
| Observation group (n = 126) | 5 (3.97) | 42 (33.33) | 79 (62.70) | 121 (95.24) |
| χ 2 | 8.678 | |||
| P value | .015 |
4. Discussion
This study shows that refined nursing interventions significantly reduce the incidence and duration of postoperative delirium in elderly hip fracture patients, while improving pain management, sleep quality, recovery, and overall life quality. Additionally, it enhances nursing satisfaction and shortens hospitalization time compared to the control group. These findings emphasize the clinical value of refined nursing in promoting postoperative recovery in elderly hip fracture patients.
Although no previous studies have specifically examined refined nursing for delirium in this patient group, this study confirms its effectiveness in reducing delirium. Most current research on refined nursing focuses on conditions like traumatic sepsis and severe acne in adolescents.[15,16] This study expands the focus beyond delirium prevention by assessing pain management, sleep, and quality of life, providing a broader evaluation of nursing intervention outcomes. These results align with Wang et al who found that refined nursing positively affects multidimensional postoperative recovery.[17] Furthermore, the use of personalized dietary plans and dynamic blood circulation monitoring extends the application of refined nursing, enhancing its systemic and targeted impact.
Refined nursing interventions, addressing both physiological and psychological needs, help reduce delirium incidence. Preoperative psychological counseling reduces anxiety and stress, improves confidence in surgery, and mitigates stress responses during and after surgery.[18] Strict intraoperative temperature control and vital signs monitoring help maintain stability, reducing the risk of complications like infections and thrombosis. Personalized pain management and dietary interventions improve patient comfort and accelerate recovery, thus enhancing overall quality of life.
This study introduces innovative practices, including thorough psychological counseling and strict temperature control, which are less commonly addressed in previous research. These methods effectively reduce preoperative anxiety and minimize complications by stabilizing temperature and vital signs during surgery. Regular incision monitoring and sterile techniques further ensure patient safety and recovery. These strategies yielded significant improvements in recovery quality.
However, this study has some limitations. Although it is a retrospective cohort design, the research quality is high due to the use of propensity score matching and standardized nursing interventions. However, it is still susceptible to selection and information biases, which could potentially affect the accuracy of the results. The small sample size and single-center setting may also limit the generalizability of the findings. To enhance the reliability and external validity of the results, future research should consider conducting larger, multicenter, prospective randomized controlled trials. Additionally, while standardized training protocols were implemented for nursing staff, variations in staff experience may still impact the consistency of the interventions. A prospective multicenter study with standardized intervention protocols and larger sample sizes would provide more robust evidence to further verify these findings.
Future studies should explore the mechanisms behind refined nursing and incorporate additional interventions, such as technology-assisted care and remote monitoring, to improve recovery outcomes. Using emerging technologies like smart nursing systems and remote monitoring could further optimize care and enhance patient recovery. By continually improving nursing practices, refined interventions can provide more effective postoperative rehabilitation, ultimately enhancing the quality of life for elderly hip fracture patients.
5. Conclusion
This study highlights the effectiveness of refined nursing interventions in the postoperative care of elderly hip fracture patients. These interventions significantly reduce delirium incidence, enhance pain management, sleep quality, and overall life quality, while improving nursing satisfaction. By implementing personalized care and multifaceted approaches, refined nursing fosters comprehensive recovery. Despite limitations such as a retrospective design and small sample size, the findings suggest that refined nursing should be integrated into clinical practice. Future studies should use larger, prospective randomized controlled trials and explore new technologies to further validate and optimize the approach.
Author contributions
Conceptualization: Lingyan Qu, Yulian Li, Dongyue Hong.
Data curation: Lingyan Qu, Yulian Li, Dongyue Hong.
Formal analysis: Lingyan Qu, Yulian Li.
Investigation: Lingyan Qu.
Methodology: Lingyan Qu.
Visualization: Yulian Li, Dongyue Hong.
Writing – original draft: Lingyan Qu, Yulian Li, Dongyue Hong.
Writing – review & editing: Yulian Li, Dongyue Hong.
Abbreviations:
- PSQI
- Pittsburgh Sleep Quality Index
- QOR-40
- the quality of recovery-40
- VAS
- visual analog scale
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Qu L, Li Y, Hong D. Effectiveness of refined nursing on postoperative recovery in elderly hip fracture patients: A retrospective study. Medicine 2025;104:35(e43870).
Contributor Information
Lingyan Qu, Email: 75400884@qq.com.
Yulian Li, Email: 214694967@qq.com.
References
- [1].Sing CW, Lin TC, Bartholomew S, et al. Global epidemiology of hip fractures: secular trends in incidence rate, post-fracture treatment, and all-cause mortality. J Bone Miner Res. 2023;38:1064–75. [DOI] [PubMed] [Google Scholar]
- [2].Gandossi CM, Zambon A, Ferrara MC, et al. Frailty and post-operative delirium influence on functional status in patients with hip fracture: the GIOG 2.0 study. Aging Clin Exp Res. 2023;35:2499–506. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [3].Maggi S, Siviero P, Wetle T, et al. A multicenter survey on profile of care for hip fracture: predictors of mortality and disability. Osteoporos Int. 2010;21:223–31. [DOI] [PubMed] [Google Scholar]
- [4].Bellelli G, Mazzola P, Corsi M, et al. The combined effect of ADL impairment and delay in time from fracture to surgery on 12-month mortality: an observational study in orthogeriatric patients. J Am Med Dir Assoc. 2012;13:664.e9–14. [DOI] [PubMed] [Google Scholar]
- [5].Langsetmo L, Shikany JM, Cawthon PM, et al. The association between protein intake by source and osteoporotic fracture in older men: a prospective cohort study. J Bone Miner Res. 2017;32:592–600. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [6].Bruce AJ, Ritchie CW, Blizard R, Lai R, Raven P. The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int Psychogeriatr. 2007;19:197–214. [DOI] [PubMed] [Google Scholar]
- [7].Fenta E, Teshome D, Kibret S, et al. Incidence and risk factors of postoperative delirium in elderly surgical patients. Sci Rep. 2025;15:1400. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [8].Assefa S, Sahile WA. Assessment of magnitude and associated factors of emergence delirium in the post-anesthesia care unit at Tikur Anbesa Specialized Hospital, Ethiopia. Ethiop J Health Sci. 2019;29:597–604. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [9].Gleason LJ, Schmitt EM, Kosar CM, et al. Effect of delirium and other major complications on outcomes after elective surgery in older adults. JAMA Surg. 2015;150:1134–40. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [10].Robinson TN, Raeburn CD, Tran ZV, Angles EM, Brenner LA, Moss M. Postoperative delirium in the elderly: risk factors and outcomes. Ann Surg. 2009;249:173–8. [DOI] [PubMed] [Google Scholar]
- [11].Yildizeli B, Ozyurtkan MO, Batirel HF, Kuşcu K, Bekiroğlu N, Yüksel M. Factors associated with postoperative delirium after thoracic surgery. Ann Thorac Surg. 2005;79:1004–9. [DOI] [PubMed] [Google Scholar]
- [12].Dai DD, Jia CY, Wang YN, Ma J, Bi XY. Meticulous nursing care for coronary CT angiography: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltim). 2024;103:e39551. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [13].Hao W, Ma T, Feng C. Application effect of meticulous nursing on community elderly patients with coronary heart disease under the background of medical treatment partnerships. J Healthc Eng. 2021;2021:3511985. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [14].Ai H. A randomised controlled trial: effect of the meticulous nursing model on the treatment compliance and quality of life of patients with upper gastrointestinal bleeding. Ann Palliat Med. 2021;10:8737–45. [DOI] [PubMed] [Google Scholar]
- [15].Yuan Z, Yang S, Zhang C, et al. Retrospective analysis of the clinical efficacy of early goal-directed therapy combined with meticulous nursing intervention in patients with posttraumatic sepsis. J Healthc Eng. 2021;2021:6706464. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [16].Ren R, Bao S, Qian W, Zhao H. Topical ALA-photodynamic therapy combined with acne debridement and meticulous nursing for the treatment of moderate-severe acne in adolescent patients. Clin Cosmet Investig Dermatol. 2021;14:1303–10. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [17].Wang Y, Wang Y, Han J. The role of refined nursing combined with targeted nursing in patients with digestive tract hemorrhages complicated by liver cirrhosis. Am J Transl Res. 2021;13:5336–42. [PMC free article] [PubMed] [Google Scholar]
- [18].Wu G, Shi F, Fu G. Effect of high-quality nursing care combined with psychological intervention on stress response in surgery and postoperative negative emotions of patients undergoing general anesthesia. Altern Ther Health Med. 2025;31:176–81. [PubMed] [Google Scholar]