Self-perceived frailty in older adults with hip fracture: a qualitative study

Abstract Objective This study aimed to explore self-perceptions and embodied experiences of different dimensions of frailty among older adults with hip fracture, to complement objective frailty assessment and inform the development of patient-centered perioperative nursing interventions. Design A qualitative descriptive study using semi-structured interviews and thematic analysis. Setting and participants The orthopedic trauma ward of a tertiary teaching hospital in Shanghai, China. A purposive sample of older adults aged ≥ 60 years with hip fracture admitted for surgery, who were able to communicate and provide informed consent. Methods A qualitative study was conducted. From September to November 2025, older adults with hip fracture were purposively recruited from the orthopedic ward of a tertiary hospital and participated in face-to-face semi-structured interviews until sufficient information power was obtained. Guided by the Comprehensive Geriatric Assessment (CGA) framework, data were analyzed using Braun and Clarke’s six-phase thematic analysis approach. Results A total of 14 patients were interviewed. Four overarching themes were identified: Perceived surgical threat and uncertainty, Loss of control and feeling like a burden, Pain disturbing rest and nourishment, Role disruption and the buffering effect of support. Conclusions By foregrounding the subjective perspectives of older adults with hip fracture, this study reveals that multidimensional frailty is experienced as an integrated state characterized by life threat, loss of control, pain interference and disruption of social roles, rather than as a mere accumulation of clinical indicators. The findings suggest that clinical frailty assessment should incorporate patient-reported subjective perceptions alongside objective measures, providing a foundation for developing patient-reported multidimensional frailty assessment tools and designing targeted perioperative interventions.