Abstract:

Objective This study aims to investigate the multifactorial mechanisms underlying fear of falling in older patients with hip fractures after surgery and the pathways among various influencing factors，providing a basis for developing precise clinical nursing intervention. Methods A convenience sampling method was used to select 333 older patients with hip fractures admitted to 3 hospitals in Zhengzhou City from March to June 2025 as study subjects. A cross-sectional survey was conducted using a general information questionnaire，the Short Fall Efficacy Scale-International，the Charlson Comorbidity Index，the Berg Balance Scale，the Activities of Daily Living Scale，the Hospital Anxiety and Depression Scale，and the Perceived Social Support Scale. Correlation analysis was performed using SPSS 29.0，and a structural equation model was constructed using Mplus 8.7 to examine the direct and mediating effects of each variable on fear of falling. Multi-group analyses were conducted by age. Results A total of 304 valid questionnaires were ultimately included（a valid response rate of 91.29%）. The structural equation model showed good fit indices，indicating a good fit. Anxiety and depression had a significant positive effect on fear of falling（β=0.428，P<0.001）. Balance ability（β=-0.304，P<0.001），social support（β=-0.236，P=0.003），and daily living self-care ability（β=-0.135，P=0.048） all had significant negative direct effects on fear of falling. The comorbidity index had no statistically significant direct effect on fear of falling（β=0.053，P=0.396），but it indirectly affected it through the mediating effect of balance ability，with a mediation effect of 0.055（95% CI[0.020，0.104]）. Multi-group analysis showed that age had a significant moderating effect：anxiety and depression had a significantly stronger positive predictive effect on the younger age group（60-<70 years） than on the older age group（β=0.106 vs β=0.048）. Conclusion Postoperative fear of falling in older patients with hip fractures is influenced by multiple pathways of physiological，psychological，and social factors，with significant age differences. Anxiety and depression are core psychological factors that directly exacerbate this fear，while balance ability is a key mediator connecting comorbidities and fear of falling.

Key words: Hip Fracture, Aged, Fear of Falling, Structural Equation Model, Nursing Care

摘要：

目的 探讨老年髋部骨折患者术后跌倒恐惧的发生机制及各影响因素间的作用路径，为制订精准的临床护理干预策略提供依据。方法 采用便利抽样法，选取2025年3—6月郑州市3所医院骨科收治的333例老年髋部骨折患者为调查对象。使用一般资料调查问卷、简明跌倒效能量表国际版、查尔森合并症指数、Berg平衡量表、日常生活自理能力量表、医院焦虑抑郁量表及领悟社会支持量表进行调查。运用SPSS 29.0软件进行相关性分析，采用Mplus 8.7软件构建结构方程模型，验证各变量对跌倒恐惧的直接效应与中介效应，并以年龄进行多群组分析。结果 回收有效问卷304份，有效问卷回收率为91.29%；结构方程模型拟合指标良好，模型适配度高；焦虑抑郁对跌倒恐惧具有正向预测作用（β=0.428，P<0.001）；平衡能力（β=-0.304，P<0.001）、社会支持（β=-0.236，P=0.003）及日常生活自理能力（β=-0.135，P=0.048）均对跌倒恐惧产生负向直接影响；查尔森合并症指数对跌倒恐惧影响无统计学意义（β=0.053，P=0.396），但通过平衡能力的中介作用间接影响跌倒恐惧，中介效应值为0.055，95%CI（0.020，0.104）；多群组分析显示，年龄具有调节效应：焦虑、抑郁对60~<70岁患者的正向预测作用强于年龄≥70岁患者。结论 老年髋部骨折患者术后跌倒恐惧受生理、心理及社会因素的多条路径影响，且存在年龄差异。焦虑、抑郁是直接加重跌倒恐惧的核心心理因素，平衡能力在合并症与跌倒恐惧间发挥中介作用。

关键词: 髋部骨折, 老年人, 跌倒恐惧, 结构方程模型, 护理