Published online May 19, 2026. doi: 10.5498/wjp.v16.i5.114590
Revised: December 1, 2025
Accepted: February 2, 2026
Published online: May 19, 2026
Processing time: 183 Days and 0.4 Hours
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 pro
To investigate the psychological stress responses and intervention strategies for elderly patients with hip fractures during the prehospital emergency period.
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 inter
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).
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.
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.
- Citation: Shen L, Su XM, Pan ZY, Long L, Xie H, Yang MS, Dai JN, Chen CM. Psychological stress response and intervention strategies for elderly patients with hip fractures during the prehospital emergency period. World J Psychiatry 2026; 16(5): 114590
- URL: https://www.wjgnet.com/2220-3206/full/v16/i5/114590.htm
- DOI: https://dx.doi.org/10.5498/wjp.v16.i5.114590
According to epidemiological data[1], hip fractures are among the most common types of fractures among the elderly, with an incidence rate of 10.0 per 100000, and are higher among males (11.2 per 100000) than among females (8.8 per 100000). Among individuals who experienced hip fractures, the 71-80 years age group had the highest incidence, accounting for 37.39%, followed by the 81-90 years age group (28.79%) and the 61-70 years age group (20.64%), with the proportion of females (67.02%) exceeding that of males (32.98%)[2]. The primary mechanisms of hip fracture injury include falls, falls from a height, and motor vehicle accidents, with falls accounting for 64.88% of cases[3]. Hip fractures not only threaten the physical health of older adults but also tend to have a negative impact on mental health. Faced with sudden limitations in mobility and a decline in the ability to care for themselves, many elderly individuals experience anxiety and depression[4]. Research indicates that approximately 30% of patients exhibit depressive symptoms after sustaining a fracture[5]. This change in psychological state not only reduces quality of life but may also delay the rehabilitation process.
Psychological stress reactions are common among elderly patients with hip fractures, with an intensity comparable to that of cancer patients, and may even lead to stress ulcers and mental disorders. 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 about the treatment outcomes they face during this stage, which may further exacerbate psychological stress reactions[6-9]. However, current research investigating psychological stress responses during the prehospital emergency phase in elderly patients with hip fractures is relatively scarce, and some studies lack sufficient validation. Therefore, the present study aimed to investigate psychological stress responses and the effects of intervention strategies during the prehospital emergency phase among a group of elderly individuals who sustained hip fractures, as well as long-term outcomes, including fracture healing, functional recovery, and psychological status over a 12-month follow-up period.
This prospective study enrolled 80 elderly patients with hip fractures admitted to our hospital between September 2023 and September 2024. Patients were randomly divided into two groups using a random number table: Control [received conventional prehospital emergency care interventions (n = 40)] and observation [received standardized psychological interventions in addition to the interventions used in the control group (n = 40)] groups. Statistical comparison of the general characteristics of the two groups revealed no significant differences (P > 0.05) (Table 1). This study was approved by the Ethics Committee of our hospital.
| Baseline indicators | Control group | Observation group | t/χ2 | P value |
| Group | 40 | 40 | ||
| Age (years) | 73.10 ± 3.15 | 72.92 ± 4.21 | 0.217 | 0.830 |
| BMI (kg/m2) | 23.76 ± 2.25 | 23.69 ± 2.22 | 0.140 | 0.889 |
| Gender (n) | 0.450 | 0.502 | ||
| Male | 21 | 18 | ||
| Female | 19 | 22 | ||
| Affected side | 1.805 | 0.179 | ||
| Left side | 22 | 16 | ||
| Right side | 18 | 24 | ||
| History of anxiety and depression | 10 | 9 | 0.069 | 0.793 |
| Educational background | 0.222 | 0.895 | ||
| Junior high school or below | 25 | 23 | ||
| High school | 10 | 11 | ||
| College or above | 5 | 6 | ||
| Monthly income (1000 CNY) | 5.29 ± 0.98 | 5.33 ± 0.86 | 0.194 | 0.847 |
The inclusion criteria were as follows: (1) Age ≥ 65 years; (2) Diagnosed with hip fractures (intertrochanteric fractures of the femur, femoral neck fractures) by radiological examination, and pathological fractures were excluded; (3) Conscious during emergency treatment, able to communicate normally with medical staff, and cooperated with the assessment; (4) Time of injury was within 24 hours and occurred during prehospital emergency treatment; and (5) Patients or their legal guardians provided informed consent for this study and signed the informed consent form. Additionally, all patients included had to be willing to complete the 12-month follow-up and provide relevant assessment data. The exclusion criteria were as follows: (1) Severe cardiovascular disease and inability to tolerate surgical treatment; (2) History of mental illness or cognitive impairment, such as dementia; (3) Severe drug or alcohol dependence; (4) Multiple injuries that may affect the assessment of psychological stress response(s); (5) Severe hearing or language impairments that would prevent effective communication with medical staff; (6) Expected survival time < 12 months; and (7) Inability to complete follow-up due to geographical or family factors.
The control group received conventional prehospital emergency care interventions.
Examination and assessment: Patients underwent a comprehensive physical examination, with particular attention devoted to potential concomitant injuries to the cranium, thoracic and abdominal organs, and pelvis. Life-threatening injuries are prioritized, and patients are assisted in maintaining a good position.
Hemostasis and wound management: Nursing staff quickly assessed bleeding status and implemented appropriate targeted hemostatic measures. For general wounds: Apply sterile gauze pads for local pressure hemostasis. For active bleeding from major vessels: A tourniquet was used for hemostasis, and the tourniquet application time was recorded. For bleeding lasting > 1 hour: Release the tourniquet for 1-2 minutes every 0.5-1 hour while applying pressure hemostasis at the wound site to prevent limb necrosis.
Fracture site immobilization: The fracture site is temporarily immobilized to align the bones and prevent wound infection, while minimizing damage to blood vessels and nerves.
Establishment of intravenous access and fluid resuscitation: Rapid establishment of intravenous access and administration of fluid resuscitation to restore blood volume.
Transportation: Prompt transportation of patients and monitoring of their overall condition to ensure safety and comfort during transportation. The observation group received a standardized psychological intervention based on the control group. To ensure the consistency of intervention implementation across different medical staff, the following uniformity guarantee measures were implemented before study initiation: (1) Unified training: All implementers (emergency nurses and psychologists) participated in an 8-hour standardized training program, including theoretical learning [core principles of geriatric psychological intervention, correct use of Hamilton Anxiety and Depression Scale (HAM-A and HAM-D, respectively) scales] and practical operation (simulation of emergency scene communication and standardized guidance of relaxation techniques). After training, a two-part assessment (theoretical written test ≥ 85 points, situational simulation operation pass rate 100%) was conducted; only those who passed were allowed to participate in the intervention; (2) Standardized operation manual: A “Prehospital Emergency Psychological Intervention Manual for Elderly Hip Fracture Patients” was formulated, which clearly defines the wording of comforting remarks (e.g., fixed templates such as “you are now in a safe environment, and we will closely monitor your condition”), the step-by-step guidance process of relaxation techniques (e.g., “inhale slowly through the nose for 3 seconds until the abdomen expands, then exhale slowly through the mouth for 5 seconds until the abdomen contracts”), and the recording requirements of psychological state changes; and (3) Quality control during implementation: A special supervision team was established to conduct random checks on 10% of the intervention process recordings (audio recordings with patient consent) and intervention records every week, and group discussions were organized to correct deviations in the operation (e.g., non-standard guidance of relaxation exercises) in a timely manner.
Psychological assessment: In an emergency scene, medical staff can use the HAM-A and HAM-D to quickly assess patients’ levels of anxiety, fear, and other negative emotions through brief questioning. This enables an initial psychological assessment to be completed alongside an initial physical examination, with another assessment conducted during transport to promptly identify any changes in emotional state. Immediate psychological support: Nursing staff should comfort patients with a gentle yet firm tone, such as “you are safe now, and we are doing everything we can to help you”, and explain emergency measures in simple, easy-to-understand language. Additionally, the staff could provide comfort through nonverbal cues such as gently patting the patient’s shoulder while taking care not to affect the injured area. Throughout the emergency process, comfort and explanations were repeated every 5-10 minutes to ensure emotional stability.
Relaxation technique guidance: When the patient’s emotional state is stable, and their physical condition permits, guide them through deep breathing exercises: Inhale while the abdomen expands and exhale while the abdomen contracts, with a 3-5-second interval between each breath, repeated 5-10 times. Muscle relaxation exercises: The muscles were gradually relaxed starting from the head, holding each relaxation for 10-15 seconds, and repeated 3-5 times.
Family communication and support: This clearly and concisely explains the patient’s condition, emergency measures, and risks to family members. Guide family members on how to provide psychological support to the patient, such as holding the patient’s hand, offering verbal encouragement, and soothing their emotions to avoid excessive anxiety that may affect the patient. If family members were absent, they were promptly informed about the situation via phone or other means. Family members should be encouraged to accompany patients during emergencies and participate in psychological support. Detailed documentation of changes in the patient’s psychological state and psychological intervention measures will provide a reference for subsequent treatment.
During the study, potential confounding factors, such as surgical timing and postoperative antibiotic use, were rigorously controlled to ensure the accuracy and reliability of the results. The treatment measures and prognosis of complications were as follows: (1) For patients with poor wound healing, regular dressing changes and debridement were performed based on wound conditions, with secondary suturing when necessary; (2) Delayed-healing patients required enhanced nutritional support, including calcium supplements, vitamin D, and other fracture-healing medications, combined with physical therapies such as infrared irradiation; and (3) For patients developing tract infections, sensitive antibiotics were selected based on bacterial culture and drug sensitivity test results. The patients were encouraged to drink more water to increase urine output and flush the urethra.
All patients were followed up for 12 months after discharge. The follow-up methods included outpatient visits, telephone interviews, and WeChat video consultations. The specific postoperative follow-up times were 3 months, 6 months, and 12 months.
Fracture healing assessment: Radiographic examinations were performed at each follow-up visit to evaluate fracture callus formation and bone union. Healing time was defined as the time from surgery to the confirmation of complete bone union on radiography and clinical examination (no tenderness or abnormal movement at the fracture site).
Functional recovery assessment: The Harris Hip Score (HHS) was used to evaluate hip joint function. The scale includes pain (44 points), function (47 points), range of motion (5 points), and deformity (4 points), with a total score of 100 points. Scores ≥ 90 points indicate excellent function, 80-89 points indicate good function, 70-79 points indicate fair function, and < 70 points indicate poor function.
Long-term psychological state assessment: The HAM-A and HAM-D scales were used again at each follow-up time point to assess patients’ anxiety and depression levels.
Long-term complication assessment: The incidence of long-term complications such as pressure ulcers, deep vein thrombosis (DVT), and osteomyelitis was recorded. The diagnosis of DVT was confirmed using color Doppler ultrasonography, and osteomyelitis was diagnosed based on clinical symptoms, laboratory examinations (elevated white blood cell count, erythrocyte sedimentation rate, and C-reactive protein), and imaging findings.
Comparison of emergency-related indicators between the 2 groups: Observed and recorded resuscitation, related examinations, emergency transfer to surgery, and emergency ward time.
Comparison of HAM-A, HAM-D, and adherence scores between the two groups: HAM-A: This 14-item scale (including anxiety, mood, and cognitive function, etc.), with a total score range of 0-56 points, with higher scores indicating greater anxiety levels[10]. HAM-D: This scale consists of 17 items (including depressive mood and insight), with a total score ranging from 0 points to 52 points; the score is positively correlated with the patient’s depressive severity[11]. The assessment utilized our hospital’s self-developed patient compliance survey (Cronbach’s α coefficient: 0.792, content validity index: 0.891). This 5-item scale uses a 0-4 point scale (total score: 0-20), with higher scores indicating better patient compliance. Specific items included adherence to healthcare providers’ instructions for breathing and muscle relaxation exercises, active cooperation with emergency measures, emotional stability maintenance, understanding and acceptance of medical condition explanations, and willingness to participate in subsequent treatment decisions.
Comparison of systolic and diastolic blood pressures, and heart rate: Diastolic blood pressure, systolic blood pressure, and heart rate were measured and recorded before and after the intervention.
The incidence of complications was compared between the two groups: Complication incidence rate = poor wound healing rate + delayed healing rate + urinary tract infection rate: (1) Criteria for poor wound healing: The wound exhibits redness, swelling, exudation, and pus formation, or shows a healing time significantly exceeding the normal range, with irregular edges or necrotic tissue; (2) Criteria for delayed healing: Failure to achieve expected healing progress within the normal timeframe, such as the absence of noticeable callus formation at fracture sites or incomplete wound closure within standard periods; (3) Severity grading of tract infections: Mild urinary tract infections (UTIs) present with mild symptoms such as frequent urination, urgency, and dysuria, with minimal white blood cell count on urinalysis; moderate UTIs involve aggravated symptoms, including fever and back pain, accompanied by significantly elevated white blood cells and occasional red blood cells; and severe UTIs manifest with high fever, chills, systemic toxic symptoms, marked white blood cell and red blood cell increases in urinalysis, possible pyuria, and potential renal impairment.
Comparison of satisfaction with the intervention: The Nurse Work Satisfaction Survey Scale[12] was used to assess patient satisfaction with nursing care after the intervention. The questionnaire consisted of 25 items rated on a four-point rating scale, with a total score of 100 points. Scores of 25-59 indicate dissatisfaction, 60-79 indicate average satisfaction, 80-89 indicate satisfaction, and 90-100 indicate high satisfaction. Overall satisfaction = (number of very satisfied cases + number of satisfied cases)/total number of cases × 100.
Long-term outcome indicators: Fracture healing time (days) and healing rate at 3 months, 6 months, and 12 months postoperatively. HHS at 3 months, 6 months, and 12 months postoperatively. HAM-A and HAM-D scores at 3 months, 6 months, and 12 months. Incidence of long-term complications (pressure ulcers, DVT, and osteomyelitis) within 12 months after surgery.
Data analysis was performed using SPSS software (version 24.0; IBM Corporation, Armonk, NY, United States). Quantitative data are expressed as mean ± SD and compared using t-tests, whereas qualitative data are expressed as n (%) and were compared using the χ2 test. Intergroup comparisons were performed using t-tests, and intragroup comparisons were performed using paired t-tests. Differences with P < 0.05 were considered to be statistically significant. Considering that educational background, economic status, and history of anxiety and depression may affect the intervention effect, we further conducted covariate adjustment analysis to control for confounding factors using multiple linear regression analysis for continuous outcome indicators such as HAM-A/HAM-D scores, compliance scores, first-aid-related indicators, and physiological indicators. Educational background (categorical variable: Junior high school or below, senior high school, junior college or above), monthly income (continuous variable, representing economic status), and history of anxiety and depression (dichotomous variable: Yes/no) were included as covariates to compare the differences in intervention effects between groups after adjustment. For the outcome indicator of complication rate (dichotomous variable: Yes/no), multivariate logistic regression analysis was used, and the above covariates were included to evaluate the association between standardized psychological intervention and complication rate after controlling for confounding factors. A P-value < 0.05 was considered statistically significant.
For long-term outcome indicators, repeated measures analysis of variance was used to compare the changes in HHS, HAM-A, and HAM-D scores between the two groups at different follow-up time points. The t-test was used to compare the fracture healing times between the two groups. The χ2 test was used to compare the healing rate and long-term complication incidence between the two groups. P < 0.05 was considered statistically significant.
Compared with the control group, the observation group experienced shorter times to resuscitation, related examinations, emergency transfer to surgery, and emergency transfer to the ward (P < 0.05) (Table 2).
| Group | n | Rescue time | Time spent on related examinations | Time spent on emergency transfer to surgery | Time spent from the emergency to the ward |
| Control group | 40 | 36.12 ± 4.23 | 18.25 ± 2.25 | 14.23 ± 3.23 | 63.56 ± 5.56 |
| Observation group | 40 | 21.15 ± 2.22 | 12.48 ± 1.28 | 8.56 ± 2.18 | 46.89 ± 4.34 |
| t | 19.819 | 14.097 | 9.202 | 14.948 | |
| P value | < 0.01 | < 0.01 | < 0.01 | < 0.01 |
After the intervention, the observation group had lower HAM-A and HAM-D scores and higher compliance scores than the control group (P < 0.05) (Table 3).
| Group | n | HAM-A | HAM-D | Compliance | |||
| Before intervention | After intervention | Before intervention | After intervention | Before intervention | After intervention | ||
| Control group | 40 | 23.34 ± 3.12 | 13.56 ± 2.89a | 17.65 ± 2.23 | 11.12 ± 2.49a | 9.13 ± 1.44 | 13.97 ± 1.48a |
| Observation group | 40 | 23.56 ± 3.08 | 11.23 ± 1.45a | 17.45 ± 2.18 | 8.01 ± 1.21a | 8.99 ± 1.51 | 15.06 ± 1.36a |
| t | 0.317 | 4.558 | 0.406 | 7.105 | 0.424 | 3.430 | |
| P value | 0.752 | < 0.01 | 0.686 | < 0.01 | 0.673 | < 0.01 | |
Both groups exhibited significant decreases in systolic blood pressure, diastolic blood pressure, and heart rate after the intervention (P < 0.05). However, compared with the control group, the observation group exhibited lower systolic and diastolic blood pressure and heart rate levels, which were also closer to the normal range (P < 0.05) (Table 4).
| Group | n | Systolic blood pressure (mmHg) | Diastolic blood pressure (mmHg) | Heart rate (beats/minutes) | |||
| Before intervention | After intervention | Before intervention | After intervention | Before intervention | After intervention | ||
| Control group | 40 | 125.23 ± 5.12 | 121.56 ± 4.34a | 92.12 ± 4.23 | 90.56 ± 3.18a | 88.56 ± 5.89 | 84.12 ± 3.65a |
| Observation group | 40 | 125.56 ± 5.08 | 118.89 ± 2.67a | 92.34 ± 4.18 | 85.87 ± 2.56a | 88.78 ± 5.92 | 80.45 ± 2.21a |
| t | 0.289 | 3.314 | 0.234 | 7.266 | 0.167 | 5.440 | |
| P value | 0.773 | < 0.01 | 0.816 | < 0.01 | 0.868 | < 0.01 | |
The incidence of complications was lower in the observation group than in the control group (P < 0.05) (Table 5).
| Group | n | Poor wound healing | Delayed healing | Urinary tract infection | Overall incidence rate |
| Control group | 40 | 3 (7.50) | 4 (10.00) | 4 (10.00) | 11 (27.50) |
| Observation group | 40 | 1 (2.50) | 1 (2.50) | 0 (0.00) | 2 (5.00) |
| Fisher | 0.013 |
Compared with the control group, the observation group exhibited higher levels of satisfaction with the intervention (P < 0.05) (Table 6).
| Group | n | Group | Satisfied | Average | Dissatisfied | Overall satisfaction |
| Control group | 40 | 15 (37.50) | 12 (30.00) | 6 (15.00) | 7 (17.50) | 27 (67.50) |
| Observation group | 40 | 23 (57.50) | 13 (32.50) | 3 (7.50) | 1 (2.50) | 36 (90.00) |
| χ2 | 6.050 | |||||
| P value | 0.014 |
Fracture healing status: The fracture healing time of the observation group was 128.56 ± 15.32 days, which was significantly shorter than that of the control group 156.78 ± 18.45 days (t = 7.892, P < 0.01). At 3 months postoperatively, the healing rate of the observation group was 65.00% (26/40), which was higher than that of the control group, 42.50% (17/40) (χ2 = 5.333, P = 0.021). At 6 months postoperatively, the healing rate of the observation group reached 95.00% (38/40), which was significantly higher than that of the control group, 77.50% (31/40) (χ2 = 5.165, P = 0.023). Twelve months postoperatively, all patients in both groups achieved complete fracture healing (Table 7).
| Group | n | Fracture healing time (mean ± SD, days) | Healing rate at 3 months | Healing rate at 6 months | Healing rate at 12 months |
| Control group | 40 | 156.78 ± 18.45 | 42.50 (17/40) | 77.50 (31/40) | 100.00 (40/40) |
| Observation group | 40 | 128.56 ± 15.32 | 65.00 (26/40) | 95.00 (38/40) | 100.00 (40/40) |
| t/χ2 | - | 7.892 | 5.333 | 5.165 | - |
| P value | - | < 0.01 | 0.021 | 0.023 | - |
Functional recovery (HHS): At each follow-up time point, the HHS of the observation group was significantly higher than that of the control group (P < 0.05). The scores of both groups increased gradually with the extension of the follow-up period; however, the observation group showed a more significant upward trend. At 12 months postoperatively, the excellent and good rate of hip function in the observation group was 87.50% (35/40), which was significantly higher than that of the control group, 65.00% (26/40) (χ2 = 6.410, P = 0.011) (Table 8).
| Group | n | 3 months postoperatively | 6 months postoperatively | 12 months postoperatively | Excellent and good rate at 12 months (%) |
| Control group | 40 | 65.32 ± 5.45 | 75.68 ± 6.12 | 82.15 ± 5.89 | 65.00 (26/40) |
| Observation group | 40 | 72.45 ± 5.89 | 83.21 ± 5.78 | 89.67 ± 5.34 | 87.50 (35/40) |
| t/χ2 | - | 5.987 | 6.345 | 6.789 | 6.410 |
| P value | - | < 0.01 | < 0.01 | < 0.01 | 0.011 |
Long-term psychological state: At 3 months, 6 months, and 12 months postoperatively, the HAM-A and HAM-D scores of the observation group were significantly lower than those of the control group (P < 0.05). The scores of both groups showed a downward trend with the extension of follow-up time, and the observation group maintained lower levels of anxiety and depression throughout the follow-up period (Table 9).
| Group | n | HAM-A (3 months) | HAM-A (6 months) | HAM-A (12 months) | HAM-D (3 months) | HAM-D (6 months) | HAM-D (12 months) |
| Control group | 40 | 10.23 ± 2.15 | 8.56 ± 1.89 | 7.12 ± 1.56 | 7.89 ± 1.78 | 6.45 ± 1.45 | 5.32 ± 1.23 |
| Observation group | 40 | 8.15 ± 1.78 | 6.32 ± 1.56 | 5.08 ± 1.34 | 6.12 ± 1.56 | 4.89 ± 1.23 | 3.78 ± 1.05 |
| t | - | 4.892 | 5.345 | 5.789 | 4.678 | 5.123 | 5.456 |
| P value | - | < 0.01 | < 0.01 | < 0.01 | < 0.01 | < 0.01 | < 0.01 |
Long-term complication incidence: Within 12 months postoperatively, the incidence of long-term complications in the observation group was 7.50% (3/40), including 1 case of pressure ulcer and 2 cases of DVT. The incidence of long-term complications in the control group was 25.00% (10/40), including three cases of pressure ulcers, five of DVT, and two of osteomyelitis. The incidence of long-term complications in the observation group was significantly lower than that in the control group (χ2 = 4.507, P = 0.034) (Table 10).
| Group | n | Pressure ulcer | Deep vein thrombosis | Osteomyelitis | Total incidence rate (%) |
| Control group | 40 | 3 (7.50) | 5 (12.50) | 2 (5.00) | 25.00 (10/40) |
| Observation group | 40 | 1 (2.50) | 2 (5.00) | 0 (0.00) | 7.50 (3/40) |
| χ2 | - | - | - | - | 4.507 |
| P value | - | - | - | - | 0.034 |
Hip fractures are among the most common types of fractures among the elderly and are often caused by osteoporosis and other factors. Patients require prompt prehospital emergency care after sustaining an injury[13]. Psychological stress responses refer to psychological and physiological reactions experienced by an individual who encounters sudden stressors. Elderly patients who experience hip fractures are prone to anxiety, fear, and other psychological stress responses during prehospital emergency care, and the incidence of these psychological issues is relatively high. These issues not only increase patient suffering but may also impair emergency care outcomes and subsequent rehabilitation progress, potentially leading to prolonged psychological burdens on the patient[14-17]. Therefore, assessing and ad
From a physiological perspective, negative emotions such as anxiety and fear activate the body’s stress response system, triggering sympathetic nervous system excitation that leads to physiological changes like elevated blood pressure and increased heart rate. This physiological stress response not only exacerbates patients' discomfort but may also interfere with emergency procedures. For instance, during operations like venipuncture or fracture fixation, patients’ muscle tension and vasoconstriction caused by anxiety can increase the difficulty and risk of these procedures[18-22]. In this study, after intervention, the observation group showed lower HAM-A and HAM-D scores compared to the control group. Additionally, their systolic and diastolic blood pressure levels, as well as heart rate, were lower and more normalized. This indicates that the intervention effectively alleviated patients’ anxiety and depressive emotions, reduced excessive sympathetic nervous system excitation, and stabilized blood pressure and heart rate. Specifically, reducing anxiety helps decrease patients’ resistance to emergency procedures, making them more cooperative during treatment. Muscle relaxation facilitates smooth operation and reduces delays caused by repeated procedures. Meanwhile, stable blood pressure and heart rate provide more favorable physiological conditions for emergency care, lowering the risk of complications triggered by excessive physiological stress responses[23-25].
From a psychological perspective, psychological intervention provides patients with comprehensive emotional support, enhancing their sense of care and attention. This increased satisfaction strengthens patients’ confidence and trust in treatment, while improving treatment adherence[26,27]. Our study reveals that compared to the control group, the observation group demonstrated better compliance and shorter emergency response times, including reduced durations for resuscitation, diagnostic tests, emergency-to-surgery transfers, and ward admissions. Patients in positive psychological states are more willing to actively cooperate with medical staff and participate in emergency procedures, significantly minimizing delays caused by non-compliance. For instance, during examinations, patients maintain proper positions as required, ensuring swift and accurate testing. Similarly, during emergency-to-surgery or ward transfers, patients prepare promptly, preventing delays due to inadequate preparation.
From a societal perspective, psychological interventions can foster a more harmonious healthcare environment by improving communication and interaction between patients, medical staff, and family members. A robust social support network helps patients better cope with disease-related stress and promotes their recovery. Studies indicate that patients in the observation group reported higher satisfaction with interventions compared to the control group. The implementation of psychological interventions allows patients to experience greater care and respect from healthcare providers, strengthening the trust between patients and medical staff. Meanwhile, family members gain deeper insights into patients’ needs and psychological states through participation in these interventions, enabling them to offer more effective support and encouragement[28,29].
In terms of complication development, psychological stress responses increase the risk of complications by affecting the patient’s immune system and endocrine system. The specific mechanism involves: Psychological stress activates the hypothalamic-pituitary-adrenal axis, leading to increased secretion of stress hormones like cortisol. Persistent elevation of cortisol suppresses normal immune function, reduces immune cell activity and quantity, and weakens the body’s defense against pathogens. Standardized psychological interventions, through relaxation training and counseling, alleviate patients’ psychological stress, regulate hypothalamic-pituitary-adrenal axis function, and reduce cortisol secretion, thereby improving immune function and lowering infection risks[30]. Additionally, a positive mental state enhances patients’ cooperation with treatment and nursing care, encouraging adherence to medical instructions for rehabilitation exercises, which indirectly reduces complication risks. For instance, patients who receive psychological intervention may participate more actively in rehabilitation exercises, promoting fracture healing and reducing complications such as pulmonary infections and DVT caused by prolonged bed rest[31].
The long-term follow-up results of this study further confirm the positive effects of standardized psychological interventions. Firstly, in terms of fracture healing, the observation group had a significantly shorter healing time and higher healing rate at 3 months and 6 months postoperatively. This may be related to the fact that psychological intervention reduces stress hormone levels, which are known to inhibit bone formation and delay fracture healing[32]. By alleviating anxiety and depression, the intervention creates a favorable physiological environment for bone repair, promoting callus formation and bone union. Secondly, regarding functional recovery, the observation group maintained higher HHS throughout the follow-up period, indicating better hip joint function. This is likely because patients with improved psychological status are more willing to adhere to postoperative rehabilitation training, which is crucial for restoring hip joint mobility and muscle strength[33]. In contrast, patients with persistent anxiety and depression may be reluctant to participate in rehabilitation exercises, leading to poor functional outcomes. Thirdly, the long-term psychological state assessment showed that the observation group continued to have lower anxiety and depression levels, suggesting that the positive effects of prehospital psychological intervention are sustainable. This may be due to the fact that the intervention helps patients establish positive coping styles, enabling them to better adapt to the physical and psychological changes caused by hip fractures and maintain emotional stability during the long recovery period[34]. Finally, the observation group had a lower incidence of long-term complications such as pressure ulcers and DVT. This is attributed to improved patient compliance with nursing care and rehabilitation guidance, as well as the regulatory effect of psychological intervention on the immune system, which reduces the risk of infection and thrombosis[35].
However, the current study has a limited sample size and is confined to a single healthcare institution, which may affect the generalizability of the findings. Future research should therefore expand the sample size and incorporate multi-center data, while strengthening cross-regional and multi-tier hospital collaboration. This will enhance the reliability and generalizability of the results, providing a more scientific basis for optimizing intervention strategies. Additionally, future studies could further explore the optimal duration and frequency of psychological interventions, as well as the long-term effects on quality of life and mortality, to provide more comprehensive evidence for clinical practice.
In summary, standardized psychological interventions can improve the psychological stress response of elderly patients with hip fractures during the prehospital emergency period to a certain extent, reduce their anxiety and depression levels, shorten emergency response time, improve patient cooperation, stabilize physiological indicators, and increase patient satisfaction with the intervention while reducing the incidence of complications. However, the limited sample size and single-center design of this study may have affected the generalizability of the results. Therefore, future studies should expand the sample size and include multicenter data to enhance the reliability and generalizability of the findings to provide a scientific basis for optimizing intervention strategies. Furthermore, the 12-month follow-up results show that this intervention can significantly promote fracture healing, enhance long-term functional recovery, maintain stable psychological status, and reduce the incidence of long-term complications.
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