Alcohol Use and Psychological Distress After Hip Fracture in Older Adults: NHS Quality Improvement Project From Silver Trauma.
Abstract
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.
Comments
Future work
Thank you for your work. Any future larger plans for the research and strategy to improve compliance with screening? Thank you.
Future work
Hi Liam, thank you for reading our abstract and for your question, and sorry for the late reply.
We haven’t confirmed the following steps yet, but we designed the project as a first scoping PDSA cycle, and we recommend a prospective next phase. That would mean a baseline period, then a short pilot on hip-fracture bays, followed by a larger prospective cohort. A larger sample would allow adjustment for frailty, pain and cognition, and would help test how well AUDIT-C and brief mood tools (GDS-15/HADS) work in very old post-operative patients.
On compliance, one of our clearest lessons was how inconsistently mood and alcohol are recorded: only 9 of 141 screened patients met our inclusion criteria. The strategy we proposed builds screening within existing workflows rather than adding to them:
Over the longer term, we think there is a case for adding in the mood and alcohol fields to the National Hip Fracture Database so that it becomes a nationally visible parameter.
Happy to discuss further :)
Tatchana