Barriers and facilitators to transitional care in older adults following hip fracture: A mixed-methods systematic review.
Abstract
Background
Hip fracture is a leading cause of disability and mortality in older adults, affecting an estimated 2.6 million people annually worldwide. Transitional care, the coordinated management of the shift from hospital to community, is central to functional recovery yet remains poorly systematised across health systems.
Aim
To identify the barriers and facilitators to hospital-to-community transitional care in older adults (≥65 years) following hip fracture surgery.
Methods
A mixed-methods systematic review following the Joanna Briggs Institute (JBI) convergent integrated approach. Four databases (MEDLINE, CINAHL, Cochrane Library, Scopus) were searched on 18th September 2025 for studies published between September 2020 and September 2025. Study quality was appraised with JBI design-specific checklists. Data were synthesised narratively and thematically. This review was prospectively registered on PROSPERO.
Results
Thirty-six primary studies (n = 36; 2020-2025), spanning 17 countries, were included. Five thematic categories of barriers and facilitators were identified: (1) rehabilitation, (2) patient and caregiver education and information, (3) mental health and psychosocial dimensions, (4) discharge planning and care continuity, and (5) caregiver involvement and social support. Methodological quality was predominantly high across all study designs. Key facilitators included multidisciplinary rehabilitation pathways, structured discharge planning, digital health tools, psychosocial self-efficacy interventions, and active caregiver engagement. Main barriers were discontinuity of post-discharge care, limited digital literacy, fear of falling, and inadequate caregiver preparation.
Conclusions
Effective transitional care after hip fracture requires integrated, person-centred and family-centred interventions across five interdependent domains. Orthopaedic and trauma nurses are strategically placed to lead and coordinate safe, effective, and humanised care transitions.