title: Hip fracture patients' cognitive state affects family members' experiences - a diary study of the hip fracture recovery.
abstract: BACKGROUND
  Many patients with hip fractures suffer from dementia disease, which has shown to affect the outcome of recovery strongly, as well as care and treatment. As most hip fracture patients are discharged home early after surgery, caregiving often falls on family members - spouses, daughters, sons, or even neighbours become informal carers.
  
  
  OBJECTIVE
  To explore how hip fracture patients' cognitive state affect family members' experiences during the recovery period.
  
  
  METHODS
  Eleven diaries written by family members' of hip fracture patients were analysed by means of qualitative content analysis.
  
  
  RESULTS
  The analysis generated two main categories with four categories. The first main category was; 'Being a family member of a cognitively impaired patient' with the categories 'Dissatisfaction with lack of support' and 'Emotional distress due to the patient's suffering'. The second main category was 'Being a family member of a cognitively intact patient' with the categories 'Satisfaction with a relative's successful recovery' and 'Strain due to their caring responsibilities'. Being a family member of a patient with cognitive impairment and a hip fracture meant being solely responsible for protecting the interests of the patient; in regard to care, rehabilitation and resources. The family members were also burdened with feelings of powerlessness and sadness due to the patients' suffering. On the contrary, family members of cognitively intact hip fracture patients had positive experiences. The family members expressed pleasure from seeing their close ones make progress. However, when the healing process was delayed this led to strain on the family members.
  
  
  CONCLUSIONS
  The findings suggest the hip fracture patient's cognitive state is more decisive than the hip fracture itself for the family members' experiences.
authors.affiliation: Division of Nursing, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden. ann-marie.hedman@rkh.se
authors.forename: Ann-Marie Rydholm
authors.initials: AM
authors.lastname: Hedman
authors.forename: Lars
authors.initials: L
authors.lastname: Strömberg
authors.forename: Margareta
authors.initials: M
authors.lastname: Grafström
authors.forename: Kristiina
authors.initials: K
authors.lastname: Heikkilä
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D005190:Family / Q000523:psychology*; D006620:Hip Fractures / Q000523:psychology*; D006801:Humans; D013548:Sweden