Psychological stress response and intervention strategies for elderly patients with hip fractures during the prehospital emergency period

Abstract

BACKGROUND

Hip fractures are among the most common types of fractures among the elderly, especially those aged 71-80 years, with females outnumbering males. During the prehospital emergency phase, psychological stress reactions are particularly pronounced among elderly individuals who sustain hip fractures, primarily because of intense pain, mobility limitations, and uncertainty regarding treatment outcomes.

AIM

To investigate the psychological stress responses and intervention strategies for elderly patients with hip fractures during the prehospital emergency period.

METHODS

This prospective study included 80 elderly patients with hip fractures who were treated between September 2023 and September 2024. Patients were randomly divided into two groups: Control [routine prehospital emergency nursing interventions (n = 40)] and observation [standardized psychological interventions in addition to routine care (n = 40)]. The Hamilton Anxiety and Depression Scale (HAM-A and HAM-D, respectively) scores, patient compliance, blood pressure, heart rate before and after the intervention, emergency-related indicators, and the incidence of complications were compared between the groups. Additionally, a 12-month follow-up included indicators, including fracture healing status (healing time and radiographic evaluation), functional recovery (Harris Hip Score), long-term psychological state (HAM-A and HAM-D re-evaluation at 3 months, 6 months, and 12 months postoperatively), and incidence of long-term complications (pressure ulcers, deep vein thrombosis, and osteomyelitis) were also evaluated.

RESULTS

The observation group experienced significantly shorter times to resuscitation, relevant examinations, transfer from the emergency department to surgery, and time from the emergency department to the ward than the control group (P < 0.05). After the intervention, HAM-A and HAM-D scores were significantly lower in the observation group than in the control group (P < 0.05). Both groups exhibited significant decreases in systolic and diastolic blood pressures and heart rate after the intervention (P < 0.05), with the observation group having lower levels closer to the normal range than the control group (P < 0.05). The observation group also exhibited better compliance (P < 0.05), a lower incidence of complications (P < 0.05), and higher satisfaction with the intervention (P < 0.05) than the control group. Furthermore, during the 12-month follow-up period, the observation group showed significantly shorter fracture healing time, higher Harris Hip scores, lower HAM-A and HAM-D scores, and a lower incidence of long-term complications compared to the control group (all P < 0.05).

CONCLUSION

Standardized psychological intervention during the prehospital emergency period for elderly patients with hip fractures reduces psychological stress and the incidence of complications and improves physiological indicators, warranting widespread clinical implementation.

Keywords: Intervention strategies; Psychological stress response; Prehospital emergency period; Elderly patients; Hip fracture

Core Tip: This study investigated psychological stress responses in 80 elderly hip fracture patients during prehospital emergency care. Patients were randomized to receive either routine care (control group) or routine care plus standardized psychological interventions (observation group). Results demonstrated that the observation group had significantly shorter key emergency time points, lower post-intervention Hamilton Anxiety and Depression Scale scores, and improved physiological indicators (blood pressure, heart rate) compared to the control group (P < 0.05). The observation group also exhibited better compliance and a lower incidence of complications. The study concludes that standardized psychological intervention effectively reduces psychological stress and improves outcomes, warranting clinical implementation.