Alcohol Use and Psychological Distress After Hip Fracture in Older Adults: NHS Quality Improvement Project From Silver Trauma.

Introduction

Older adults with hip fractures have high mortality, loss of independence and a substantial burden of depression and anxiety, yet mood and alcohol use are rarely screened systematically in trauma pathways. We examined whether alcohol risk was associated with post-fracture psychological distress and hospital length of stay (LOS) in a Silver Trauma service, to inform an integrated screening pathway.

Methods

We undertook a retrospective cross-sectional review of adults aged ≥50 years admitted with hip fracture to the Bristol Royal Infirmary between January and April 2023, using existing data from the National Hip Fracture Database, hip-fracture proformas and general practice records. Variables were Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) score at admission, post-fracture depression and/or anxiety documented in primary care, and index admission LOS. Given the small sample and data that showed skewed, non-normal distributions of variables, we used Fisher’s Exact test, Mann-Whitney U test and Spearman’s correlation.

Results

Nine of 141 screened patients met the inclusion criteria (mean age 68.9 years, SD 13.2). The mean AUDIT-C score was 6.78; two patients were classified as high-risk drinkers. Two patients had depression recorded, and three had anxiety after the fracture. The mean LOS was 24.6 days (SD 25.1; range 3–72). High alcohol risk was not significantly associated with depression or anxiety (both p=1.00); alcohol scores did not differ by psychological distress status (all p>0.89). Alcohol risk showed a moderate but non-significant correlation with LOS (ρ=0.48, p=0.20).

Conclusions

Alcohol misuse was not a strong independent predictor of psychological morbidity or LOS, but low recorded prevalence and reliance on routine documentation suggest under-detection. The findings support universal mood and alcohol screening at admission and pre-discharge, multidisciplinary review of positive screens and structured primary care follow-up. Embedding this pathway within Plan–Do–Study–Act cycles may improve holistic recovery after hip fracture.