Exploring older adults’ experiences of daily mobility over the first 6 months after hip fracture: a qualitative interview study

Abstract

Objective

In this qualitative study, we explored older adults’ experiences of daily mobility after hip fracture, both early and again 6 months postsurgery.

Design

Individual semistructured interviews exploring the participants’ experiences at two timepoints: shortly after hospital discharge and 6 months postsurgery. The analyses were performed using systematic text condensation involving the following steps: obtaining an overall impression/identifying themes, identifying meaning units, condensation and synthesising into descriptions and concepts.

Setting

Recruitment at a university hospital in Norway. 21 interviews were conducted in participants’ homes and 7 at a rehabilitation institution, between September 2022 and December 2023.

Participants

We included community-dwelling individuals aged 65 and older who had suffered a hip fracture from a larger longitudinal study (Mobilise-D Clinical Validation Study). We used a purposive sampling strategy and recruited six men and nine women aged 74–94 years.

Results

Shortly after surgery, participants experienced mobility limitations and faced new feelings that challenged their everyday lives, such as fear of falling and a sense of loss of freedom, both contributing to uncertainty about the future. Optimism and coping strategies, along with social support, were perceived as motivational factors underlying mobility recovery. After 6 months, participants experienced varied mobility recovery and adaptation to a new everyday life. Some participants were satisfied and accepted some mobility limitations, while others voiced disappointment and continued to struggle with mobility restrictions and ongoing challenging feelings.

Conclusion

A hip fracture can profoundly disrupt the everyday lives of older adults, leading to loss of mobility and challenging feelings. Coping strategies and social support play a crucial role in mobility recovery. 6 months postsurgery, participants reported varied recovery experiences, from resuming valued activities and adapting to limitations to continued struggles with daily mobility and challenging feelings. Rehabilitation programmes should address both physical and psychosocial aspects to support mobility recovery in the initial 6 months and, for some individuals, beyond.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• A major strength lies in the analysis of interviews conducted at two different timepoints both early and 6 months postsurgery, enabling the exploration of experiences with daily mobility over time while minimising the risk of recall bias.

• We ensured sample variation in background characteristics, such as age, gender, housing conditions, living alone or co-living and prefracture function.

• Limiting the study to home-dwelling participants and those with normal to mildly impaired cognitive function restricts the findings’ applicability to individuals living in nursing homes or those with more severe cognitive impairment.

Introduction

Hip fracture is one of the most severe fall-related injuries among older adults resulting in sudden changes to their daily mobility. The consequences for individuals can be serious, with one-fourths dying within the first year.¹ Less than half of the survivors regain their prefracture level of mobility, and one in five who previously lived independently is unable to return home.^{2 3} Physical mobility, defined as the ability to walk and move around freely to carry out the activities of daily living,⁴ is essential for social and emotional well-being.⁵ An earlier qualitative interview study found that patients view stable mobility for desired activities, such as personal care and activities of daily living, as one of the most important aspects of recovery after a hip fracture.⁶

Given the emphasis of individuals’ place on being mobile, knowledge about mobility recovery after a hip fracture is crucial. Typically, the extent to which older adults return to their prefracture level of mobility has been evaluated through quantitative studies. According to Dyer et al, changes in daily mobility following a hip fracture are usually assessed using patient- or proxy-reported outcomes, comparing pre- and postfracture levels of functioning.² These assessments often include the activities of daily living, walking ability and the use of walking aids, showing that many older adults are unable to regain their prefracture level of mobility.² Finally, digital mobility outcomes obtained from sensor-based activity monitoring have been used to reliably capture mobility in both clinical settings and patients’ own environments.⁷ However, quantitative studies fail to capture patients’ lived experiences of daily mobility and factors impacting everyday life after a hip fracture.

Understanding patients’ experiences of daily mobility and recovery after a hip fracture is important for developing effective and patient-centred rehabilitation programmes.⁸ In a previous interview study, older adults described the hip fracture as a life-breaking event,⁹ with reduced daily mobility being one of the consequences. This limitation made them cautious and uncertain regarding their ability and confidence to move. Several studies exploring patients’ experiences with rehabilitation and recovery after hip fracture have found that patients highlight daily mobility as a key aspect of recovery.610,16 For instance, one interview study that examined patients’ perspectives on recovery during participation in a randomised controlled trial found that regaining mobility was one of the most commonly reported goals during late-phase rehabilitation.¹⁶ Despite these insights, we need a deeper understanding of how older adults experience daily mobility throughout the recovery process, and how it influences their everyday lives.

Therefore, we conducted interviews at two timepoints with the same participants, with the aim of exploring older adults’ experiences of daily mobility after hip fracture, both early and again 6 months postsurgery. The first interview was conducted shortly after hospital discharge, at an early stage of recovery, and the second interview 6 months postsurgery, when most rehabilitation programmes typically have ended. This study was a secondary data collection linked to the Mobilise-D Clinical Validation Study (CVS), a European observational cohort study aimed at developing and validating digital mobility outcomes using wearable sensors in clinical populations where mobility loss is a major challenge.¹⁷

Methods

Study design

We conducted individual semistructured interviews with older adults suffering from a low-energy hip fracture at two timepoints, shortly after discharge from hospital and again 6 months after surgery. The qualitative design of the study was guided by hermeneutic phenomenology, focused on exploring participants’ experiences and perspectives.

Recruitment

Sample from a clinical study

We recruited participants from the Mobilise-D CVS, and the protocol is described elsewhere.¹⁷ The hip fracture cohort was enrolled between May 2021 and July 2023 and included individuals aged 45 years or older undergoing acute low-energy hip fracture surgery, who were home dwelling before the hip fracture, able to consent to study procedures and could walk 4 m independently with or without walking aids after the surgery. Detailed exclusion criteria are presented in the study protocol.¹⁷ The participants in the current interview study were selected from individuals who had provided written informed consent to participate in the Mobilise-D CVS at the participating hospital in Trondheim, Norway.

Participants

A purposive sample was included during hospital stay, consisting of participants 65 years and older with various background characteristics, such as age, gender, housing conditions, living alone/co-living, fracture type and surgical procedure, prefracture reliance on walking aids, prefracture Activities of Daily Living (ADL) function, assessed by the Nottingham Extended ADL Scale,¹⁸ and normal to mildly impaired cognitive function, as assessed by a geriatrician. All 15 invited participants, 9 women and 6 men aged 74–94 years, accepted the invitation and were included. Eight participants lived in multilevel houses or flats, five in one-level flats and two in sheltered housing. Six shared their home with a partner, while the others lived alone. Eight participants were not reliant on walking aids indoors or outdoors before the hip fracture. At the time of the second interview 6 months after the surgery, 13 participants remained in the study. Of these, three were no longer reliant on walking aids, either indoors or outdoors. Two of the participants were lost to follow-up for the second interview: one passed away, while the other had worsening cognitive impairment. All 15 participants received rehabilitation. Participants discharged directly to their homes were offered community-based rehabilitation, either as home physiotherapy or at a physiotherapy clinic, individually or in groups. Those with lower functional levels were first discharged to inpatient rehabilitation before being offered community-based services. Characteristics of each participant can be found in table 1.

Table 1. Participant characteristics.

Participant	Age range	Sex	Housing conditions and living alone/co-living
P1	85–89	Female	Living alone in one-level flat
P2	75–79	Male	Living with partner in multilevel house
P3	75–79	Male	Living with partner in multilevel house
P4	85–89	Female	Living with partner in multilevel house
P5	75–79	Female	Living alone in one-level flat
P6	90–94	Female	Living with partner in multilevel house
P7	85–89	Male	Living alone in multilevel house
P8	85–89	Female	Living alone in one-level flat
P9	80–84	Female	Living alone in sheltered housing
P10	80–84	Female	Living with partner in one-level flat
P11	85–89	Female	Living alone in multilevel flat
P12	90–94	Male	Living alone in multilevel house
P13	70–74	Female	Living alone in multilevel flat
P14	75–79	Male	Living with partner in one-level flat
P15	85–89	Male	Living alone in sheltered housing

Data collection

The face-to-face interviews were conducted between September 2022 and December 2023. The first round of interviews was carried out 1–4 weeks after discharge from the hospital (2–5 weeks postsurgery) at the participants’ current residence. Six participants were still in a short-term rehabilitation institution, one was readmitted to the hospital due to a cardiac examination and eight were discharged to their homes. At the time of the second interview 6 months after surgery (referred to as ‘after 6 months’ in the following), all 13 still participating in the study resided in their own homes where the interviews were performed.

All interviews lasted between 25 and 50 min and were audio recorded. We used semistructured interview guides with open-ended questions. The interview guides had an open approach, allowing the participants to talk broadly about daily mobility experiences. The guide for the first interview focused on the participants’ daily mobility before the hip fracture, the changes they experienced after the surgery and their outlook for mobility recovery. In the second interview, participants were asked about their experiences with regaining mobility and rehabilitation, as well as their outlook for future mobility. Both interview guides are provided in an online supplemental file.

The interviewer listened through the participant’s first interview before conducting the second one to ensure the best possible foundation for asking follow-up questions. To assist interpretation of the interview data, notes on impressions and contextual details were taken after each interview.

The sample size was guided by the concept of information power.¹⁹ Participants with the same experience of hip fracture were purposively selected with variation in baseline characteristics to reflect the target population. The interviewer’s clinical experience and the context of conducting interviews in participants’ current residences contributed to richness, depth and quality of the data. Thus, information obtained from 28 interviews with 15 participants was considered sufficient to ensure thorough exploration of the data to answer the research question of the study.

Data analysis

Interviews were transcribed using Nettskjema’s (web-based survey tool developed by the University of Oslo) transcription tool, checked and revised manually by the first author (ME). Transcripts were anonymised and uploaded into NVivo 14 (QSR International, 2024), for data management and coding. Both interviews from each participant were treated as one dataset, with timing of the interview considered during analysis.

Data were analysed using Malterud’s four-step method of systematic text condensation, inspired by Giorgi’s phenomenological approach.²⁰ Interpretation of the data was a cyclical process between the following four steps. First, two authors (ME and RG), repeatedly read and listened to the interviews and the notes to gain an overall impression and identify preliminary themes inductively, meaning that the analysis process was not guided by a particular theoretical perspective. These were discussed and refined with a third author (KT) into initial code groups. Second, ME coded meaning units related to the study aim, which were then organised under the code groups and revised by RG and KT. This iterative process established a new code group, which was later merged with an existing one after further review by the full author team. This process resulted in three groups of similar meaning units, with the first two code groups containing meaning units from both interviews, while the third code group contained meaning units from the last round of interviews. Third, the content of each code group was condensed into subthemes. ME created condensates, artificial quotations maintaining participants’ original terminology, which were reviewed and discussed with the coauthors to reach consensus. Finally, these condensates were used to summarise findings in the interpretative syntheses. Subthemes reflecting descriptions and concepts of the participants’ experiences of daily mobility after hip fracture were merged into overarching themes with informative labels. ME drafted the findings in close collaboration with the other authors. Quotes were selected by ME and validated by RG and KT to illustrate the connection between themes and lived experiences. BV, who is trilingual, checked the English translation of the quotes.

The Results section outlines the three main themes, each containing subthemes.

Research team and reflexivity

The research group consisted of four physiotherapists (JLH, KT, RG and ME), and an experimental psychologist/movement scientist (BV). ME has several years of clinical experience in an orthopaedic department at a hospital, including the treatment of hip fracture patients, and the other research group members have comprehensive experience from hip fracture research.

ME was responsible for participant recruitment and conducted the semistructured interviews. None of the researchers were involved in the management of patient care. The participants were not informed about the interviewer’s profession or personal goals for doing the research. The interview guides were developed collaboratively by the researchers without being directed by any specific theory.

At the time of the interviews, ME’s preconceptions were shaped by her clinical background, the assumptions that daily mobility is important for patients after hip fracture, and the benefits of exercises in rehabilitation to regain mobility. Being aware of these preconceptions, she asked open-ended follow-up questions to gain a deeper understanding of the informants’ perspectives and wrote reflexive notes after each interview. The other researchers had less clinical experience with this patient group, which enabled them to take a more distanced perspective.

Patient and public involvement

Prior to the design of the Mobilise-D CVS, patients were involved in the planning of the study and in the review of patient-facing documents to ensure readability and understanding.¹⁷ Prior to the data collection in the present study, we conducted pilot interviews with two patients and made minor adjustments to the interview guides informed by their experiences and feedback.

Results

We identified three main themes: (1) facing new challenging feelings; (2) motivational factors underlie mobility recovery and (3) adaptation to a new everyday life. The themes and subthemes are shown in figure 1.

Figure 1. Older adults’ experiences of daily mobility after hip fracture, both early and again 6 months postsurgery—a thematic presentation of main themes and subthemes.

Facing new challenging feelings

After the hip fracture, our participants experienced a sudden change in mobility affecting their everyday lives. Shortly after hospital discharge, they explained having less energy to perform daily activities, and they spent more time sitting and being less active than before. They described symptoms of weakness, stiffness, fatigue and that they now walked slower over shorter distances and were dependent on walking aids. One participant described that her hip felt like ‘a brake pad’ (P9). In addition to experiencing limitations in moving around, the participants faced new feelings that challenged their everyday lives. They described that they had become afraid of falling, a new feeling that affected their confidence in moving around. Many participants realised they had previously taken their mobility for granted, not having experienced any limitations. As they now experienced that their ability to move was restricted, they felt that some of their freedom was lost. The limitations in daily mobility, fear of falling and sense of loss of freedom all contributed to what many participants described as a feeling of uncertainty about the future. To varying degrees, they experienced gradual improvements in daily mobility after 6 months. However, some continued to struggle with the challenging feelings.

Fear of falling

The participants experienced that they became afraid of falling again after the hip fracture. They described the fear of falling as a new, terrifying feeling of insecurity that followed them in their daily activities. One participant who suffered a hip fracture in her home after a sudden fall for no known reason described her fear of falling like this: ‘I’m terrified that I’ll fall again. It kind of sticks with you. It’s hard to shake off the feeling that I could fall again’. (P9, first interview, 80–84-year-old woman living alone in sheltered housing).

Many participants reported that fear of falling made them more cautious, especially in activities they found demanding, such as climbing stairs. Some avoided activities or environments they now deemed risky. One participant who lived alone described that she did not go outdoors even for the few metres to her mailbox: ‘I couldn't have gone out to the mailbox all by myself, I wouldn't have dared. I would have managed it, yes. But I wouldn't have dared’. (P5, first interview, 75–79-year-old woman living alone in one-level flat). She believed she was physically able to walk to the mailbox, but her fear of falling held her back.

Some participants experienced a gradual decrease in their fear of falling during rehabilitation, at the same time describing mobility improvements that allowed them to gradually reduce the use of walking aids. After 6 months, most participants still relied on a walking aid outdoors. One participant expressed her persistent fear of falling and reliance on a rollator 6 months after the hip fracture in this way: ‘I don’t let it (the rollator) out of my sight. (…) It’s just as much because I’m afraid. I don’t dare let go of the rollator’. (P1, second interview, 85–89-year-old woman living alone in one-level flat).

Sense of loss of freedom

Many participants experienced that their changed mobility and the fear of falling had a greater impact on their lives than just moving from one place to another. They mentioned how mobility restrictions after the hip fracture affected their sense of freedom, something they had never experienced before. One participant expressed how the fear of falling now restricted her freedom: ‘That (the fear of falling) limits me in the sense that I no longer feel free. (…) Because, I’ve never had to think about that before’. (P9, first interview, 80–84-year-old woman living alone in sheltered housing).

Some participants expressed that they were more restricted to their homes after the hip fracture. After 6 months, they had given up on some activities important to them, such as meeting friends at a café or going for a walk in the forest, because they could no longer do these activities independently. Becoming dependent on help from others or a walking aid to move around was seen as a limitation that affected their sense of freedom. One participant, who had become dependent on a rollator and lost her driving licence after the hip fracture, expressed her situation this way: ‘Going out and driving my car during the day, and meeting friends at a café…I have stopped doing that. (…) I’m more isolated, not as free as I was before. Because I used to be very active, you know, and I’m not anymore’. (P5, second interview, 75–79-year-old woman living alone in one-level flat).

Uncertainty about the future

Facing challenging new feelings, such as fear of falling and a sense of loss of freedom, some participants felt uncertain about the future. Reduced independence experienced in the early phase after the hip fracture particularly contributed to this uncertainty. They expressed doubts about their ability to do what was needed to regain their previous level of mobility. One participant shared her experience during rehabilitation shortly after surgery: ‘That uncertainty that pops up now and then. Maybe especially when you’re feeling a bit down about other things (…) Then you kind of give up a little bit’. (P1, first interview, 85–89-year-old woman living alone in one-level flat).

A male participant, who experienced complications and readmission to the hospital due to heart failure, said that he had viewed life so bleakly after returning home from rehabilitation, he did not feel he had any future: ‘At that point, I saw things very darkly. (…) I also told my children that, in a way, I’m done with my life’. (P15, first interview, 85–89-year-old man living alone in sheltered housing).

After 6 months, some participants expressed that they had become more anxious about moving around after the hip fracture. They hoped that, in time, they would feel confident enough to move around as they once did. However, they were uncertain how long it would take or whether things would ever return to normal. Participant 9 (woman living alone in sheltered housing) expressed this uncertainty about the future, saying: ‘I’m in my ‘mid 80 s’ and I have been in good health. (…) Maybe it’s not like that anymore, maybe it won’t be like that again either…’.

Motivational factors underlie mobility recovery

The participants experienced varying degrees of mobility improvement the first 6 months postsurgery. Optimism and belief in one’s ability to handle the new situation, along with support from healthcare professionals and family members, were perceived as motivational factors that helped them on their journey to mobility recovery.

Optimism and coping

Shortly after hospital discharge, many participants expressed an optimism about regaining their mobility. One participant viewed early mobilisation and walking in the hospital corridors shortly after the surgery as a crucial confirmation that he would regain his walking ability, which boosted his optimism about the recovery process. The participants who reported themselves to be optimistic typically expected to regain mobility and resume their previous activities within a few months. As one participant said: ‘I expect to do everything again. That, after some time, I don’t see this stopping me from doing what I did before. (…) So, it hasn't even crossed my mind, that it (mobility) won’t be pretty much the way it was before’. (P3, first interview, 75–79-year-old man living with partner in multilevel house). The same participant had also experienced that his parents regained mobility when they had hip fractures at the same age as himself, which gave him confidence that he would handle it just as successfully.

Some participants considered exercises essential for regaining mobility. They believed it was their responsibility to engage in a rehabilitation programme and expressed that they had faith in their ability to carry out the exercises. One participant said: ‘I have to be good at exercising… because I’ve decided that I will do everything I can to get good again’. (P10, first interview, 80–84-year-old woman living with partner in one-level flat). While others did not focus on exercising but believed that determination and confidence in their ability to do the same as before helped them cope with regaining mobility. One participant explained that her past experiences of good health, combined with an inherently positive attitude and the conviction that things usually turn out well, had helped her regain her daily mobility, by the time of the second interview: ‘I’m not the type to worry too much. I assume things will go well enough. I don’t know what else it could be. (…) I think a lot of it comes down to who I am as a person. (…) I think I just must continue to do what I’ve been doing’. (P4, second interview, 85–89-year-old woman living with partner in multilevel house).

Support from others

Most participants emphasised support, both from healthcare professionals and from family and friends, as motivational factors in their recovery of mobility. Many reported that participating in rehabilitation programmes contributed to improved mobility. One participant noted gradual improvements in muscle strength and balance, ultimately feeling safer moving around after engaging in exercise for a while. Another participant highlighted the impact of encouragement from her physiotherapist on her motivation to continue exercising: ‘I have been encouraged throughout, because he says: ‘You couldn’t do this last time’ (…) That has meant I’ve been motivated to keep up with my training’. (P10, second interview, 80–84-year-old woman living with partner in one-level flat). Some participants also pointed out that it was not just the exercises with the physiotherapist that helped but also the opportunity to connect with others in similar situations, which was important to maintain motivation.

Some of those who had a partner to come home to described this as essential to feeling safe. One participant highlighted the emotional importance of having a caring partner, noting that facing the challenges after her hip fracture would have been much harder if she had been alone. She explained: ‘There is, of course, one thing that is absolutely crucial, and that is that we are two. Coming home alone after this would have been a completely different experience. (…) If I had been alone in this, I think that it (regaining mobility) would have been much slower as well. I would probably have been more cautious, more afraid (…)’ (P4, first interview, 85–89-year-old woman living with partner in multilevel house). After 6 months, she emphasised the importance of relational support, saying: ‘Being two provides a sense of security and stability in life’.

Participants without a partner at home highlighted the support they received from their children and grandchildren. This included practical assistance, but encouragement from family members was also viewed as vital for maintaining motivation: ‘It’s that I have support from those closest to me and being encouraged in what I’m doing’. (P8, first interview, 85–89-year-old woman living alone in one-level flat).

Adaptation to a new everyday life

After 6 months, most participants continued to experience mobility impairments that affected their everyday lives to varying degrees and led to different reactions. Some felt satisfied, believing that they had nearly fully regained their daily mobility. Others found that they were not as mobile as prior to the hip fracture, but they did not perceive this change as prominent in their everyday lives. A few participants felt that they were far from regaining their previous mobility and expressed disappointment, though some also expressed cautious hope. A common factor among participants who were less mobile than before was that they had to adapt to a new everyday life. They mentioned adaptations, such as using walking aids, taking short walks instead of a long walk and using the car more often.

Acceptance

Participants who were satisfied with their daily mobility found that it no longer limited the activities they valued. They were able to do what was important to them in life, even if their mobility was not fully regained. One participant, who had accepted that he could not walk as far as before, was pleased that he could walk to the bus stop and had resumed other important activities in his daily life. He expressed it this way: ‘I wouldn’t claim that I’m completely 100% as mobile as I was before. But I’m not far off, though there is a bit less, that’s true. But there is not less of…what really matters. That (mobility) doesn’t stop me from doing what I want to do’. (P3, second interview, 75–79-year-old man living with partner in multilevel house).

Others reflected that they had noticed changes in their mobility even before the hip fracture, such as worsening balance and having to stop certain activities. One participant expressed that he had been through a process of beginning to accept that mobility changes with age: ‘I have gone through a process where I have accepted that things are starting to change as a result of ageing’. (P14, second interview, 75–79-year-old man living with partner in one-level flat).

Many participants became dependent on a rollator, especially when walking outdoors, and the security this provided made them accept that it had become a part of their everyday lives after the hip fracture. As stated by P13 (second interview, 70–74-year-old woman living alone in multilevel flat): ‘When I go to town, I also use the rollator. I think it’s a cheap insurance to use that rollator’. Another participant, still dependent on a rollator, did not see it as a permanent solution but could accept using a cane eventually.

Disappointment

Participants who experienced that they were far from regaining daily mobility expressed no longer being optimistic like they had been shortly after hospital discharge. They largely continued to struggle with challenging feelings, such as fear of falling and a sense of loss of freedom. Some had assumed at an early stage that they could rely on time to heal, but now they felt that they were making little progress and expressed discouragement about their new situation. One participant who previously moved around without any walking aid expressed that her life was markedly changed, and she implied that this affected her self-image: ‘Well, you have a completely different life now. Because previously I was active, (…) going up in the woods here, and I don't do that anymore. So now it’s the rollator, going to the store or getting in a car and coming along to the shopping centre. Yes, that’s what life consists of now. (…) But there’s not much walking with that thing there (points to her rollator). That’s just something I’ve come to terms with … it’s not really me, though…’ (P5, second interview, 75–79-year-old woman living alone in one-level flat).

Another participant said she had lost her courage and expressed her disappointment with the lack of progress like this: ‘Dissatisfied with it (my walking ability). (…) That I can’t manage it. That I don’t feel any progress. Like a feeling of resignation…’ (P1, second interview, 85–89-year-old woman living alone in one-level flat).

Although these participants felt that their limited progress in regaining mobility had diminished their optimism, some of them still held a cautious hope for improvement. P10 (second interview, 80–84-year-old woman living with partner in one-level flat), who before the hip fracture used to go for a 4 km daily walk without any walking aid and now could only manage short walks with a rollator, still expressed hope for regaining her mobility: ‘I was actually quite optimistic, but I feel that progress has been a bit slow. I should be better at walking now that it has been over half a year. So, I am not as optimistic today, but I still hope, that I can walk well again, like I did before’.

Discussion

In this study, we explored older adults’ lived experiences of daily mobility over the first 6 months after hip fracture. Our findings revealed that a hip fracture along with the sudden and dramatic change in daily mobility introduced new feelings that challenged their everyday lives. Fear of falling was a common experience among our participants, along with a sense of loss of freedom, that both contributed to a feeling of uncertainty about the future. A main finding was that optimism and finding coping strategies along with support from healthcare professionals and family was experienced as crucial in regaining mobility. 6 months after surgery, the participants experienced varying degrees of mobility recovery. They had adapted to a new everyday life, with some feeling that mobility was no longer a limitation for participating in valued activities, while others accepted certain mobility restrictions. Meanwhile, a few others were disappointed and described limited progress in regaining mobility. They continued to struggle with challenging feelings such as fear of falling, a sense of loss of freedom, and uncertainty about the future, all of which disrupted their everyday lives.

Our findings illustrate that changes in daily mobility following a hip fracture are experienced not only as physical limitations, but also as disruptions that affect many aspects of older adults’ everyday lives. Participants described how these mobility changes disrupted their lives and brought forth new and challenging feelings. A similiar perception of disruption from normal life was also reported 4 months after hip fracture surgery in a qualitative study by Bruun-Olsen et al.²¹ This disruption can be understood in light of how mobility encompasses more than just physical movement from one point to another, as it also impacts mental, social and emotional well-being.⁵ A qualitative synthesis reported that patients view mobility after a hip fracture as vital for enabling daily activities and participation, rather than as a goal in itself.¹⁵ This may explain why our participants seem to be more concerned with the consequences of changed mobility rather than the daily mobility itself.

The experience of hip fracture represented more than a physical injury; it marked a disruption that challenged some of the participants’ sense of continuity in daily life. This can be seen through the lens of Bury’s theory of ‘Biographical Disruption’,²² later modified by Williams,²³ which describes how chronic illness or significant injury can profoundly disrupt an individual’s life and self-identity and how they adapt. In our study, the hip fracture and resulting mobility loss did not only affect their physical functioning but also introduced fear of falling and challenged their perception of independence and freedom, both contributing to uncertainty about the future. Despite these challenges, most participants were optimistic early in the recovery process, believing that they would regain their previous level of mobility and their life as it was before. This optimism may have counterbalanced the challenging feelings, enabling them to avoid reconstructing their self-understanding and perceiving this as a disruption to their life at that stage. This interpretation aligns with findings from Southwell et al in the early postoperative phase,²⁴ who reported that while hip fracture was not alone experienced as a biographical disruption, it was recognised as a potential tipping point in the older adults’ gradual loss of independence.

We followed up the same participants 6 months postsurgery, and during this period, a significant change had occurred. After 6 months, some participants perceived the loss of mobility following hip fracture as a part of the ageing process rather than as a disruptive event. Others adapted to the new situation in a positive way and did not perceive the event as something that disrupted their lives, which is in line with Williams’ modification of the theory.²³ In contrast, a few participants experienced that they still struggled with mobility restrictions and challenging feelings, such as fear of falling, and they felt they were making little progress. These participants experienced a limitation to their previously active lifestyle, which forced them to adjust their everyday activities. They also experienced a shift in their relationships with family and friends, transitioning from an equal role to becoming dependent on others for help. Altogether, this led them to begin redefining their identity, and this indicates that the hip fracture may have caused a biographical disruption. Our finding of biographical disruption provides additional qualitative evidence to a systematic review by Taylor et al,²⁵ which concluded that hip fractures have profound psychosocial impacts, and underscores the importance of addressing both physical and psychosocial aspects in rehabilitation.

A dominant view among several participants was that optimism and belief in their ability to handle the new situation, along with support from others, played a significant role in their recovery of daily mobility. This conception of mobility recovery can be associated with self-efficacy, which is a person’s belief in one’s ability to succeed in a particular situation or to accomplish a task.²⁶ Our data showed traces of earlier personal and others’ experiences of success, social encouragement and support, and optimistic confidence in their ability to recover mobility, indicating that these participants had higher levels of self-efficacy. Similar findings have been reported earlier, where some participants’ conceptions of recovery could be associated with psychological aspects, such as self-efficacy.^{21 27} Support from healthcare professionals and family members, especially having a partner, played a crucial role in enhancing self-efficacy by providing encouragement and safety. The importance of support from family and friends to overcome challenges during recovery after hip fracture aligns with research by Langford et al²⁸ and Karlsson et al.²⁹ 

The participants who showed signs of biographical disruption expressed disappointment with their mobility progress after 6 months. They had lost their initial optimism, felt discouraged by their new situation and had hoped to recover simply by giving it time, raising the question of whether they had lower self-efficacy. This may indicate that rehabilitation programmes do not sufficiently support patients’ self-efficacy and may end too early. Findings from an intervention study by O’Halloran et al³⁰ showed that motivational interviewing, given after standard rehabilitation, improved both self-efficacy and physical activity. These results support that rehabilitation programmes should include building self-efficacy and empowering patients to take an active role throughout their recovery journey.

Strengths and weaknesses of the study

The qualitative design of this study implies that it should be assessed by the means of trustworthiness, which includes credibility, transferability, confirmability and dependability.³¹ A major strength of this study is conducting analyses of interviews at two different timepoints, allowing for the exploration of daily mobility over time and reducing the risk of recall bias. Patients had different lengths of hospital stay. To be able to include participants shortly after hospital discharge, the first interviews were conducted between weeks 2 and 5 postsurgery. The majority of the interviews were conducted in the participants’ own homes, providing a safe environment for open conversation. This setting offered the interviewer additional insights into the participants’ daily mobility, enhancing the opportunity to ask relevant follow-up questions and further enabling credibility. To enable a truthful interpretation of participants’ views, we provided quotes from participants to illustrate the authenticity of the original data and their perspectives. We added age range, gender and housing conditions, including living alone or co-living to each quote to provide context. Three of the researchers did the analysis described in detail in the Methods section, increasing both credibility and confirmability. We consider it a strength that we ensured sample variation in terms of age, gender, housing conditions, living alone or co-living and prefracture ADL (Activities of Daily Living) function and reliance on walking aids. However, limiting the study to home-dwelling participants and only those with normal or mildly impaired cognitive function restricts the findings’ applicability to individuals living in nursing homes or those with more severe cognitive impairment. We have described the research process and clarified our preconceptions in the Methods sections in adherence with the Standards for Reporting Qualitative Research checklist to ensure transparency.³² The first author’s preunderstanding as a physiotherapist with clinical experience from this patient group may have influenced the findings. However, the other researchers had less clinical experience, allowing them to maintain a more distanced position. This combination of close and distant perspectives in the analysis and reporting along with thorough discussions contributed to a more nuanced interpretation of the data.³³

Conclusion

A hip fracture causes a break in mobility that can profoundly disrupt the everyday lives of older adults. Our qualitative investigation revealed how a hip fracture along with the sudden loss of mobility introduces challenging feelings, such as fear of falling and a sense of loss of freedom, that contribute to uncertainty about the future. By following participants over time, we found that coping strategies and social support played a crucial role in regaining mobility and adaptation to a new everyday life. After 6 months, participants reported varied experiences of daily mobility recovery: some had accepted certain limitations and resumed valued activities, while others voiced disappointment and continued to struggle with mobility restrictions and challenging feelings, though some still held a cautious hope for improvement. These findings indicate that recovery of daily mobility after a hip fracture depends not only on physical exercise but also on coping strategies and social support. This highlights the need for rehabilitation that goes beyond physical exercise, aiming to enhance self-efficacy to support mobility recovery and facilitate adaptation to a new everyday life. For some individuals, this process may extend beyond 6 months postsurgery.

Healthcare professionals should recognise that the changes in daily mobility after a hip fracture are not only physical. The hip fracture and subsequent mobility changes can also disrupt an individual’s everyday life and sense of identity, which highlights the importance of being more curious about exploring the lived experiences of patients beyond their physical injury. Healthcare professionals should educate patients about the emotional consequences of their injury and include fall prevention exercises to address the fear of falling.³⁴ Further, rehabilitation programmes should be tailored to meet individual needs and support self-efficacy, especially in the absence of social support, throughout the entire recovery process, which may extend beyond 6 months after surgery for some individuals.

Data availability statement

Data are available on reasonable request.