What post-operative care and rehabilitation strategies should be implemented for older adults following hip fracture surgery?

Post-operative care and rehabilitation strategies for older adults following hip fracture surgery should include:

• Early mobilisation: Offer physiotherapy assessment and mobilisation on the day after surgery unless contraindicated, with mobilisation at least once daily and regular physiotherapy review to promote recovery of mobility and independence ¹.
• Multidisciplinary management: Implement a formal Hip Fracture Programme from admission that includes orthogeriatric assessment, rapid optimisation for surgery, early goal setting for rehabilitation, coordinated multidisciplinary review, and integration with related services such as mental health, falls prevention, bone health, primary care, and social services ¹.
• Delirium prevention and cognitive assessment: Actively screen for cognitive impairment and delirium, providing individualised care to minimise delirium risk and maximise independence ¹.
• Rehabilitation planning: Develop a tailored, personalised rehabilitation plan with the patient and carers, detailing short- and long-term goals, therapies, delivery methods, follow-up arrangements, and key contacts, regularly updated to reflect progress and changing needs ²,³.
• Early supported discharge: Consider early supported discharge if the patient is medically stable, mentally able to participate, can transfer and mobilise short distances, and has not reached full rehabilitation potential, with ongoing multidisciplinary team involvement ¹.
• Intermediate care: Use intermediate care settings only if included in the Hip Fracture Programme and under its clinical and managerial leadership to ensure continuity and quality of rehabilitation ¹.
• Patient and carer information: Provide verbal and written information about diagnosis, surgery, analgesia, possible complications, postoperative care, rehabilitation, long-term outcomes, and involved healthcare professionals ¹.
• Referral to specialist services: Refer to orthogeriatricians, physiotherapists, occupational therapists, falls services, psychological therapy, dietitians, and other relevant specialists as needed based on rehabilitation progress and individual needs ²,³.
• Support for bone health and prevention of future fractures: Encourage tailored exercise to improve muscle strength and balance, smoking cessation, alcohol moderation, and nutritional support to reduce risk of further fragility fractures ⁵.