5 Strategies for Preventing Hip Fractures in Older Adults

Older person in pain on the ground from falling

Did you know?

  • According to the Centers for Disease Control and Prevention (CDC), 95 percent of all hip fractures result from falls.1
  • After a hip fracture in an older adult, the mortality rate within one year is between 18 and 31 percent.2
  • After a fall with a hip fracture, only half of older adults were able to return to their prior level of function.3

Physical therapists and occupational therapists can help patients prevent falls from happening by keeping their environment, home, and activities safe to support independence and a higher quality of life. The best practice in hip fracture prevention is a multi-system approach.

How PTs and OTs Can Help Prevent Hip Fractures Due to Falls

1. Train Balance

Improving the body’s response to a potential fall will reduce the risk of injury. This includes what we all know as standard balance retraining, but it also means training your patient on what to do if they DO experience a fall.3

Help them down to the floor and teach them the best way to recover. This should include a self-assessment of potential injury, as bleeding risk increases with age and polypharmacy, which can make recovery less safe.

If your patient has already experienced a fall, investigate WHY that fall happened and address the cause. Do they need more light or better glasses? Can obstacles be removed from walkways? Does the patient need better shoes, or do they have ankle weakness?

Finally, have your patient talk with their doctor or pharmacist regarding the side effects of their medications. Increased risk of falls is a common side effect of several medications found in the profiles of older adults.

2. Home Safety

Work with your patient in their home to make their environment as safe as possible. Simple interventions such as strategically placed grab bars, offset door hinges, and brightly colored tape can keep older adults living longer and safer in their own homes.

Consider discussing in-home safety alert systems to prevent your patients from lying on the floor for an extended period after a fall. Assess caregiver support to perform daily check-ins, either by phone or in person.

Finally, practice safe techniques for falling. Fear of falling increases risk of falling. Practicing helps give your patient confidence and reduces their fear.

3. Incontinence Training

Falls often happen when we are rushing—such as might occur in the middle of the night when rushing to the bathroom.

Teaching strategies to reduce episodes of incontinence and improve bladder control can reduce the need to rush and facilitates safer mobility for reduced falls. This training can also reduce urinary tract infections, another common reason for falling in older adults.

Simple dietary changes like increasing water intake and reducing caffeine can also make a big difference. Have your patients check with their doctor or pharmacist to review medications here as well, since many that are commonly used by older adults can lead to bladder irritation or sensitivity.

4. Exercise

Weighted and resistance exercises should be used to strengthen muscles and bones, but older adults are often seen as too fragile to lift heavy weight. Don’t underestimate older adults! They often lift grandchildren who weigh thirty or more pounds and can safely perform strengthening exercises with your guidance.

Increase the weight lifted to functional levels using weighted bars to simulate grocery bags or laundry baskets. Use free weights to simulate lifting a grandchild. Utilize overload principles and high-intensity training to make optimal strength gains.3

Note: If bone health is questionable, avoid weighted activities at end-range spinal flexion.

5. Nutrition

In conjunction with our partners in dietetics, therapists should be counseling patients on caloric intake to facilitate an active lifestyle, especially under the conditions of chronic diseases such as diabetes, which change intake requirements.

Like any patient, older adults need to have adequate, quality caloric intake to support a rehabilitation program, especially one focused on overload principles. Increased protein is required to build muscle mass, but between 30 and 40 percent of older adults don’t meet the minimum protein intake requirements for basic function.4

Older adults need 1.2 to 2.0 g/kg/day of protein, but often only get 0.8 g/kg/day. And if your patient is also healing from an injury or surgery, they will need even more than that. Older adults also need phosphorus and calcium to build stronger bones.

Several new tools have been introduced to help guide the rehabilitation of patients with hip fractures, including two new clinical practice guidelines. The first is a physician-led effort with the input of two physical therapists, which can be viewed here. The second is a physical therapist-led production that uses the International Classification of Functioning, Disability and Health (ICF) model to guide screening, assessment, and intervention.

Use the best tools, provide the best care, and prevent hip fractures.

  1. Parkkari J, Kannus P, Palvanen M, Natri A, Vainio J, Aho H, Vuori I, Järvinen M. Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int, 1999;65:183–7.
  2. Min, K., Beom, J., Kim, B. R., Lee, S. Y., Lee, G. J., Lee, J. H., Lee, S. Y., Won, S. J., Ahn, S., Bang, H. J., Cha, Y., Chang, M. C., Choi, J. Y., Do, J. G., Do, K. H., Han, J. Y., Jang, I. Y., Jin, Y., Kim, D. H., Kim, D. H., … Lim, J. Y. (2021). Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures. Annals of rehabilitation medicine45(3), 225–259. https://doi.org/10.5535/arm.21110Nikitovic 
  3. McDonough, C. M., Harris-Hayes, M., Kristensen, M. T., Overgaard, J. A., Herring, T. B., Kenny, A. M., & Mangione, K. K. (2021). Physical therapy management of older adults with hip fracture: clinical practice guidelines linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy and the Academy of Geriatric Physical Therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy51(2), CPG1-CPG81.
  4. Baum, J. I., Kim, I. Y., & Wolfe, R. R. (2016). Protein Consumption and the Elderly: What Is the Optimal Level of Intake?. Nutrients8(6), 359. https://doi.org/10.3390/nu8060359
  5. M., Wodchis, W. P., Krahn, M. D., & Cadarette, S. M. (2013). Direct health-care costs attributed to hip fractures among seniors: a matched cohort study. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA24(2), 659–669. https://doi.org/10.1007/s00198-012-2034-6