Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly PhD, RN, FAAN, Chairperson; Ruth A. Bush PhD, MPH, FAMIA, Member; Caroline Etland PhD, RN, Member


Frailty, Hip fracture, pathway



Background/ Purpose: The majority of adult hip fracture patients never return to their pre-fracture functional level and have a poor quality of life (Kistler, Nicholas, Kates, & Friedman, 2015; Pioli et al., 2016; Sheehan et al., 2018). The prevalence of frailty in adult hip fracture patients is estimated at 51%. Frail patients with hip fractures are twice as likely to have a complication (Kistler et al., 2015). Extant studies have examined frailty and hip fractures independently, nonetheless, a gap in the literature exists with few investigations of the connection between frailty and post-operative outcomes after hip fracture. The purpose of this study is to examine the relationship between frailty and post-operative outcomes in adult patients with a hip fracture.

Conceptual Basis: Donabedian (2003) writes of a triad of components that contribute to quality in healthcare in the Model of Healthcare Quality: structure, process, and outcome. By linking outcomes to the structure and process quality interventions can be designed.

Method: A retrospective, descriptive, comparative design with a convenience sample (N = 302) of hip fracture patients, aged 50 years and older, receiving inpatient services at a large urban community Magnet designated Southern California hospital between February 2018 and July 2019 was used for this study. Data were extracted from the electronic health record. Descriptive and bivariate analyses were conducted.

Results: Eighteen percent of hip fracture patients were discharged back to the home environment. Age had a significant relationship with discharge destination, 46% of cases aged 50-69 discharged home compared to 15% of those age 70-89, and 5% over the age of 89 (χ2 = 35.6, p2=4.81, p2=19.0, p2=9.68, p=.002), cardiac disease (χ2=7.01, p=.008), and COPD (χ2=8.50, p=.004). Frailty had significant relationships with discharge disposition (χ2= 28.35, p2= 6.36, p2=7.45, p=.006). A frailty-based pathway was implemented and compared to a group of cases without a pathway. A significant result from the pathway was an improvement in functional ability with the mean distance walked in the pre-pathway group was 19.07 feet (SD 58.86) and the post-pathway group had a mean walking distance of 72.27 feet (SD 168.45; t= -3.71, p<.001).

Conclusions and Implications: Frailty has a significant relationship with post-operative outcomes of the older adult hip fracture patient. Healthcare providers should assess for and consider frailty when developing a plan of care in order to ensure appropriate interventions and resources are used to benefit the frail older adult with a hip fracture.

Document Type

Dissertation: Open Access