Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, 6396University of Oxford, Oxford, UK.
Major Trauma Centre, 6396Oxford UniversityHospitals NHS Foundation Trust, Oxford, UK.
Qual Health Res. 2023 Mar;33(4):308-320. doi: 10.1177/10497323231153605. Epub 2023 Feb 6.
Ankle fracture is a common injury, and depending on injury severity, treatment may be a support boot, cast or surgery. Older people, particularly those with severe injuries who are asked to restrict weight bearing, struggle with early recovery. To elicit older peoples' experience of recovery 6 months after injury, we drew on a phenomenological approach using interviews. Findings revealed that getting on with life was a way of accepting what it feels like to 'be vulnerable', needing to 'be safe' while determinedly working hard to 'be myself'. Being vulnerable identified endurance of inactivity, loneliness and dependency in the non-weight bearing period of recovery, followed by a struggle to weight bear while lacking confidence and being fearful of falling and causing further damage. Being safe conveyed fragility where sensations, pain and stiffness acted as bodily reminders of injury. Lack of function and awareness of danger led to carefulness where planning or curtailing of activities ensured their safety. Being myself showed a determination to push away from a disrupted self-identify of being older or disabled while being challenged by the continuous process of learning to be more mobile. A lack of readiness for old age created a drive to age well. Despite loss of ability, participants hoped to regain their pre-injury way of living. This study challenges practice that disregards the hard work required to recover from ankle fracture. As comorbidity increases with age, failure to consider this aspect may contribute to frailty in this group of older people.
踝关节骨折是一种常见的损伤,根据损伤的严重程度,治疗方法可能是支撑靴、石膏或手术。老年人,特别是那些因严重受伤而被要求限制负重的老年人,在早期康复方面存在困难。为了了解老年人受伤后 6 个月的康复体验,我们采用了现象学方法,通过访谈进行研究。研究结果表明,“继续生活”是一种接受“脆弱”感觉的方式,需要“安全”,同时坚定地努力“做自己”。脆弱性表现为在康复的非负重期活动耐力下降、孤独和依赖,然后在缺乏信心和害怕跌倒并造成进一步损伤的情况下努力负重。安全性传达了脆弱性,感觉、疼痛和僵硬会让人想起受伤的身体。缺乏功能和对危险的意识导致人们小心谨慎,规划或限制活动以确保其安全。做自己表现出一种决心,远离因受伤而被打乱的自我认同,即年老或残疾的自我认同,同时也面临着不断学习变得更加灵活的挑战。对老年的准备不足会促使人们健康地老去。尽管丧失了能力,参与者仍希望恢复受伤前的生活方式。这项研究挑战了忽视踝关节骨折康复所需的艰苦努力的实践。随着年龄的增长,合并症的增加,如果不考虑这一方面,可能会导致这组老年人的脆弱性增加。