Explore care seeking behavior of older adults with hip fracture in Odisha, India

Hip fractures commonly occur in adults over 50 years mostly due to simple falls. Rough estimates suggest 600,000 adults suffer hip fracture injury annually in India. It is expected to rise in coming years as the population in India would become older and increase in life expectancy. The best practices for management of older  people  with hip fractures are  early admission and surgery at a specialist treatment center, orthogeriatric care, early mobilization, appropriate care at home after discharge including preventing future falls and treatment for osteoporosis. There is a general lack of awareness of these best practices and delays to  reach care increases the risk of complications  and mortality from hip fractures in older people.

There is no information available on cause of delays in seeking treatment after a hip fracture in older adults. The research is aimed to understand the processes in decision making; when, why and how they choose a treatment facility and the delays during decision making. The proposed study will be conducted in Odisha, an eastern state in India with the population of 43 million and more than 9% over 60 years of age. Facility for Orthopaedic surgery is not available at all government district hospitals. Majority of patients requiring surgery access private hospitals in urban areas and those unable to afford seek care in  government hospitals, which are overcrowded and at a great distance from home.

A total of 30 interviews with hip fracture patients and their carers will be conducted in Khordha and Cuttack districts of Odisha. These patients will be over 50 years of age and admitted to one of the selected government or private hospital or traditional care center. The data collected from the interviews will be analysed to explore the cause of the hip fracture and inform the following:

  • Patient’s experience following hip fracture and awareness of the consequences of the injury
  • Factors influencing delay in treatment: carer involvement in decision making, household finance in care seeking decisions, availability and access to treatment, transport, and availability of surgical care in local hospital
  • Socio-cultural factors: Belief in a particular discipline of treatment, preference for the treatment and patient satisfaction

The results of the study cannot be generalised as the study will be conducted in two purposively selected district in Odisha . As health care delivery system and socio economic condition are not uniform throughout the country, the result cannot be generalized.

It is hoped that the findings of this study will provide an understanding of the care seeking behaviors of older adults with hip fracture, and inform on contextually appropriate interventions  to reduce delay in availing appropriate care.



Care seeking pathways of older adults with hip fracture in India: exploratory study protocol.
Tewari A, Sahu KS, Yadav L, Pati S, Nallala S, Webster P, Norton R, Rath S.
Int J Equity Health. 2015 Nov 14


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