A study on the trajectory of change and influencing factors of care dependence in elderly patients during hospitalization after total hip arthroplasty

BACKGROUND: Elderly hip fracture patients (patients aged ≥ 60 years) require prolonged rehabilitation after surgery and are care-dependent. Patients’ care dependence was strongly associated with the recovery of health-related quality of life. This study aimed to explore the trajectory and influencing factors of care dependence among elderly patients 14 days after total hip arthroplasty (THA) during their hospital stay. METHODS: Using the convenience sampling methodology, 210 elderly patients who underwent THA in three tertiary comprehensive hospitals in Jingzhou City and Yichang City from February to August 2023 were selected and recruited as the research subjects. The demographic and disease data questionnaire and the Orthopedic Social Support Scale were used to collect baseline information about the patients, and the Care Dependency Scale was used to follow up with the older patients at 24 h postoperatively (T1), on postoperative day 7(T2), and on postoperative day 14 (T3) for longitudinal assessment. The Latent Growth Mixture Model (LGMM) was used to describe the overall trend of care dependence, and a multivariate logistic regression model was adopted to analyze the effects of relevant factors on the trajectory of change in care dependence among elderly patients. RESULTS: LGMM analysis revealed three distinct trajectories: a high dependency group (55.24%), a gradual decline group (37.62%), and a rapid decline group (7.14%). Compared to the high dependency group, membership in the gradual decline group was significantly associated with young-old, no complications, family members as the primary caregiver, and better social support (all p < 0.05). Lower education levels (both journal school and primary school or below, vs. high school or above) remained a negative predictor. For the rapid decline group, younger age and higher educational attainment (indicated by the negative effect of primary school or below education) were the significant predictors. CONCLUSIONS: Early post-THA care dependency follows heterogeneous trajectories in older patients, primarily driven by two mechanistic pathways: a compensatory pathway (where external support facilitates gradual recovery in vulnerable individuals) and an autonomous pathway (where intrinsic capacity enables rapid recovery). Early screening for age, education, and support systems allows for risk stratification and personalized interventions to improve recovery outcomes. CLINICAL TRIAL NUMBER: Not applicable.