International Journal of Clinical Case Reports 2025, Vol.15 http://medscipublisher.com/index.php/ijccr © 2025 MedSci Publisher, registered at the publishing platform that is operated by Sophia Publishing Group, founded in British Columbia of Canada. All Rights Reserved.
International Journal of Clinical Case Reports 2025, Vol.15 http://medscipublisher.com/index.php/ijccr © 2025 MedSci Publisher, registered at the publishing platform that is operated by Sophia Publishing Group, founded in British Columbia of Canada. All Rights Reserved. MedSci Publisher is an international Open Access publisher specializing in clinical case, clinical medicine, new variations in disease processesregistered at the publishing platform that is operated by Sophia Publishing Group (SPG), founded in British Columbia of Canada. Publisher MedSci Publisher Editedby Editorial Team of International Journal of Clinical Case Reports Email: edit@ijccr.medscipublisher.com Website: http://medscipublisher.com/index.php/ijccr Address: 11388 Stevenston Hwy, PO Box 96016, Richmond, V7A 5J5, British Columbia Canada International Journal of Clinical Case Reports (ISSN 1927-579X) is an open access, peer reviewed journal published online by MedSci Publisher. The journal is considering all the latest and outstanding research articles, letters and reviews in all aspects of clinical case, containing clinical medicine which advance general medical knowledge; the event in the course of observing or treating a patient; new variations in disease processes; as well as the expands the field of clinical relating to case reports. All the articles published in International Journal of Clinical Case Reports are Open Access, and are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. MedSci Publisher uses CrossCheck service to identify academic plagiarism through the world’s leading plagiarism prevention tool, iParadigms, and to protect the original authors’ copyrights.
International Journal of Clinical Case Reports (online), 2025, Vol. 15, No.4 ISSN 1927-579X http://medscipublisher.com/index.php/ijccr © 2025 MedSci Publisher, registered at the publishing platform that is operated by Sophia Publishing Group, founded in British Columbia of Canada. All Rights Reserved. Latest Content Nursing Interventions of Early Postoperative Mobilization on Recovery Outcomes in Elderly Patients with Hip Fractures JieWang International Journal of Clinical Case Reports, 2025, Vol. 15, No. 4, 148-158 Polypharmacy in Elderly Individuals with Multimorbidity, Risks and Management Approaches ManmanLi International Journal of Clinical Case Reports, 2025, Vol. 15, No. 4, 159-170 Personalized Dietary and Pharmacological Management of Hyperuricemia in Patients with Chronic Kidney Disease (CKD) Lihui Xu, Keyan Fang International Journal of Clinical Case Reports, 2025, Vol. 15, No. 4, 171-181 A Meta-Analysis of the Impact of Rooming-In Care Model on Postpartum Depression Symptoms in Mothers Xiaopen Liu, Jie Zhang International Journal of Clinical Case Reports, 2025, Vol. 15, No. 4, 182-189 Nursing Monitoring and Immunological Trends After Influenza Vaccination in Institutionalized Elderly Populations Jianmin Liu International Journal of Clinical Case Reports, 2025, Vol. 15, No. 4, 190-199
International Journal of Clinical Case Reports, 2025, Vol.15, No.4, 148-158 http://medscipublisher.com/index.php/ijccr 148 Systematic Review Open Access Nursing Interventions of Early Postoperative Mobilization on Recovery Outcomes in Elderly Patients with Hip Fractures JieWang Zhuji People’s Hospital, Zhuji, 311800, Zhejing, China Corresponding email: 2308763906@qq.com International Journal of Clinical Case Reports 2025, Vol.15, No.4 doi: 10.5376/ijccr.2025.15.0016 Received: 07 May, 2025 Accepted: 16 Jun., 2025 Published: 07 Jul., 2025 Copyright © 2025 Wang, This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Preferred citation for this article: Wang J., 2025, Nursing interventions of early postoperative mobilization on recovery outcomes in elderly patients with hip fractures, International Journal of Clinical Case Reports, 15(4): 148-158 (doi: 10.5376/ijccr.2025.15.0016) Abstract This study explores the current evidence regarding the impact of early postoperative activity as a nursing intervention on the rehabilitation effect of elderly patients with hip fractures. Hip fractures can seriously affect mobility, self-care ability and quality of life, and also bring a relatively high risk of illness, death and long-term disability. Early activities usually start within 24 to 48 hours after surgery. Facts have proved that it can promote functional recovery, enhance walking autonomy, and reduce complications such as postoperative delirium, pneumonia, and deep vein thrombosis. Nursing intervention measures, including preoperative education, psychological support, pain control and multidisciplinary collaboration, play a crucial role in enhancing patient cooperation and ensuring the safety and effectiveness of activities. This study also explored some challenges, such as inconsistent protocols, patient cooperation issues, and the lack of high-quality evidence, while emphasizing the need for standardized and personalized care models, as well as more randomized controlled trials. The results of this study provide guidance for optimizing postoperative care for elderly patients with hip fractures and improving their quality of life. Keywords Early mobilization; Hip fracture; Elderly patients; Nursing interventions; Postoperative recovery I Introduction Hip fractures are a major health problem faced by the elderly. As the population ages, the possibility of it happening is expected to increase. This kind of injury often causes difficulty in walking, loss of the ability to take care of oneself, and a significant reduction in the quality of life. Elderly patients with hip fractures have a higher risk of illness, death and long-term mobility issues. Therefore, effective treatment and recovery are of great significance for regaining physical function and health (Aprisunadi et al., 2021; Aborukbah et al., 2024; Catalano-Nadakhovskaia et al., 2025). The recovery of postoperative mobility is crucial for resuming an independent life and reducing health issues such as mental confusion, infection, and longer hospital stays. Early activities, which usually start within 24 to 48 hours after surgery, have become an important nursing approach. Studies show that early activity enables elderly patients with hip fractures to walk more smoothly, have more people who can walk independently, have fewer chances of health problems, have shorter hospital stays, and have a higher quality of life (Baer et al., 2019; Goubar et al., 2021; Aprisunadi et al., 2021; Aborukbah et al., 2024; Nakamura et al., 2025). Nursing methods include intensive rehabilitation programs, psychological assistance, and evidence-based nursing. These methods play a significant role in encouraging patients, reducing their fears, enhancing rehabilitation cooperation, and achieving better rehabilitation outcomes (Jin et al., 2019; Fu et al., 2022; Ai and Cheng, 2023; Wang et al., 2023). This study will explore the role of nursing methods (especially early activities after surgery) in the recovery effect of elderly patients with hip fractures. Understanding the effects of these methods is of great significance for formulating evidence-based programs, improving functional recovery, reducing health problems, and enhancing the overall quality of life of this elderly population. This study aims to provide references for practical nursing work and point out the direction for future research on geriatric orthopedic nursing.
International Journal of Clinical Case Reports, 2025, Vol.15, No.4, 148-158 http://medscipublisher.com/index.php/ijccr 149 2 The Current Situation and Postoperative Recovery of Hip Fractures n The Elderly 2.1 Common types and surgical treatment methods of hip fractures in the elderly The most common hip fractures in the elderly are femoral neck fractures and intertrochanteric fractures of the femur. These injuries are mainly caused by low-energy trauma, such as falls, which are related to age-related bone brittleness and osteoporosis. With the global aging of the population, the incidence of such fractures is increasing, becoming a major public health problem (Figure 1) (Alexiou et al., 2018; Lee et al., 2020; Seong et al., 2020) Figure 1 (A) Ankle pumps. Ankle plantar flexion (left) and ankle dorsiflexion (right); (B) Knee-extension strength training. While supine, the patient tightens quadriceps in an attempt to straighten the knee (hold for 5~10 seconds); (C) Straight leg raise. While supine, the patient tightens the quadriceps, flexes the hip and keeps the knee straight while lifting the extremity off the bed (hold for 5~10 seconds), then lowers it slowly (Adopted from Lee et al., 2020) Surgical treatment is a common approach for most elderly patients with hip fractures, with the aim of restoring mobility and reducing complications. The treatment methods include internal fixation, hemihip arthroplasty and total hip arthroplasty. For displaced femoral neck fractures, joint replacement surgery (whether hemihip or total hip) usually enables patients to restore better function and a higher quality of life than internal fixation. It is generally recommended to have the operation as soon as possible, preferably within 48 hours after admission. This can lead to better recovery and reduce adverse outcomes (Pepeters et al., 2016; Alexiou et al., 2018; Seong et al., 2020; Sun et al., 2023). 2.2 Common postoperative health issues and adverse conditions Elderly patients with hip fractures have a higher risk of developing various health problems such as confusion, lung infections, urinary tract infections, blood clots in the legs, and persistent pain after surgery. These problems may significantly prolong the length of hospital stay, increase the possibility of death, and affect the patient's return to the state before injury (Alexiou et al., 2018; Yu and Zheng, 2022; Sun et al., 2023; Tang et al., 2025). For example, blood transfusion during surgery may increase the possibility of postoperative delirium and also hinder functional recovery (Li et al., 2025).
International Journal of Clinical Case Reports, 2025, Vol.15, No.4, 148-158 http://medscipublisher.com/index.php/ijccr 150 Health problems not only affect physical recovery but also cause serious psychological and social difficulties. Persistent pain and confusion can make it difficult for patients to move around, prevent them from living independently, and also reduce their related quality of healthy life. In addition, the possibility of rehospitalization and long-term hospitalization increases, further affecting the overall recovery and living conditions of elderly patients (Pepeters et al., 2016; Alexiou et al., 2018; Yu and Zheng, 2022; Sun et al., 2023). 2.3 Main factors affecting postoperative recovery The postoperative recovery of elderly patients with hip fractures is influenced by the interaction of physiological, psychological and social factors. Key factors include age, physical condition before fracture, cognitive ability, other diseases, nutritional status and the presence or absence of complications (Kim et al., 2012; Yu and Zheng, 2022). For instance, patients who are elderly, have cognitive problems, or suffer from poor nutrition often have poor recovery and a high risk of death (Peters et al., 2016; Alexiou et al., 2018; Araiza-Nava et al., 2022). The quality of social support and care during the rehabilitation period is also very important for rehabilitation. The psychological state of family caregivers directly affects the physical and mental recovery of patients. When the nursing staff are in good condition, patients will recover better (Liu et al., 2015). In addition, new biomarkers such as lymphocyte calcium-specific index (LRCa3) are emerging as useful tools for predicting long-term functional recovery, enabling more personalized patient management (Wu et al., 2025). 3 The Theoretical Basis and Mechanism of Early Mobilization 3.1 Definition and implementation standards of early mobilization Early activity generally refers to the fact that patients should start to engage in activities such as sitting, standing or walking within 24~48 hours after hip fracture surgery. The implementation standards emphasize the need for the collaboration of multiple disciplines, including nurses, physical therapists, and doctors, to ensure safety and restore physical functions to the best possible state. The treatment plan is usually to gradually increase the activity level, starting with someone helping to sit down, and then perform more intense activities within the range that the patient can tolerate (Sallehuddin and Ong, 2020; Said et al., 2021; Mashimo et al., 2022; Catalano-Nadakhovskaia et al., 2025). It is very important to adhere to these standards because research shows that allowing patients to move within 48 hours after surgery can improve their walking ability, increase their discharge rate, and enable them to complete daily life more independently. Late initiation of physical therapy, unstable physical condition, and complications before and after surgery are all common problems that affect timely activities. This also indicates that it is necessary to coordinate care and formulate clear plans (Said et al., 2021; Mashimo et al., 2022). 3.2 Physical principles for promoting blood flow and restoring muscle function Early activity can accelerate blood flow, reduce the risk of blood vessel blockage, and provide more oxygen to body tissues. Exercise can activate the muscle pump function in the legs, which helps prevent blood clots from forming in the legs and keeps the heart and vascular system stable. This physical response is particularly important for elderly patients because they have a higher risk of circulatory system problems when they stay in bed for a long time (Baer et al., 2019; Aprisunadi et al., 2021; Aborukbah et al., 2024). In addition, early activity helps maintain muscle mass and function, and prevents rapid muscle loss and joint stiffness caused by inactivity. Weight-bearing and strength training shortly after surgery can accelerate the recovery of mobility, improve balance, and help return to the walking state before injury, which is very crucial for regaining the ability to take care of oneself (Aprisunadi et al., 2021; Aborukbah et al., 2024). 3.3 The effect of improving psychological state and reducing complications Early activities are of great benefit to the mind, as they can reduce anxiety, improve mood and enhance confidence in recovery. Patients who engage in early activities are usually more satisfied with the rehabilitation process and have a more positive perspective, which can further motivate them to participate in the treatment and adhere to the rehabilitation plan (Aprisunadi et al., 2021; Aborukbah et al., 2024; Choudhury, 2024).
International Journal of Clinical Case Reports, 2025, Vol.15, No.4, 148-158 http://medscipublisher.com/index.php/ijccr 151 From a clinical perspective, early activity can significantly reduce the occurrence of common postoperative complications, such as delirium, pneumonia, urinary tract infections, pressure sores, etc. Studies have shown that patients who lie down for a long time have a higher risk of these adverse conditions, while those who are active early have fewer complications, shorter hospital stays, and a higher survival probability (Baer et al., 2019; Kenyon-Smith et al., 2019; Warren et al., 2019; Aprisunadi et al., 2021; Goubar et al., 2021). 4 Early activity Care Methods 4.1 Preoperative knowledge explanation and psychological assistance It is very important to explain the relevant situation clearly to elderly patients and their families before the operation and help them prepare for the recovery after hip fracture surgery. Clearly telling them the benefits of early activities and the possible situations can alleviate their concerns, make them more cooperative, and also encourage them to actively participate in rehabilitation. This kind of explanation should emphasize the importance of activities, methods to relieve pain and ways to prevent health problems, so that patients have the confidence to participate in the rehabilitation process (Aprisunadi et al., 2021; Aborukbah et al., 2024; Huang et al., 2024). Psychological assistance is equally important, as fear, uncertainty and lack of motivation can affect early activities. Nurses play a significant role in comforting patients, answering their questions and providing mental support. Such a form of assistance as heart-to-heart talks helps reduce psychological barriers, makes patients more satisfied and more optimistic about recovery (Aprisunadi et al., 2021; Aborukbah et al., 2024). 4.2 Time, frequency and safety guarantee of postoperative activities Starting activities in a timely manner - preferably within 24~48 hours after surgery-can help with better recovery, reduce health problems and shorten hospital stays. Nursing staff should determine whether each patient is ready and then arrange activities based on individual circumstances, starting with someone helping to sit up and gradually transitioning to tolerable standing and walking (Baer et al., 2019; Aprisunadi et al., 2021; Catalano-Nadakhovskaia et al., 2025). It is recommended to participate in more activities with the help of physical therapists and caregivers, so that the recovery effect will be better (Purcell et al., 2021; Aborukbah et al., 2024). Safety during activities is particularly important. One must prevent falls, pain and other adverse situations from occurring. Nurses must pay attention to the patient's physical reaction, check the degree of pain, and ensure that appropriate assistive tools are used. Continuous care and clear communication among teams help to identify and handle potential dangers, ensuring that the activities of elderly patients are both effective and safe (Baer et al., 2019; Aprisunadi et al., 2021; Purcell et al., 2021). 4.3 Multiple professional collaborations and tailor-made care plans Effective early activities require the joint efforts of nurses, physical therapists, doctors and other healthcare providers. Unified nursing procedures and standardized nursing methods can enhance communication, simplify rescue measures, and ensure that all aspects of the patient's recovery are taken into account. Studies have shown that people from different specialties working together can reduce the readmission rate after hip fractures and improve the quality of life (Viberg et al., 2021; Sarkies et al., 2023; Aborukbah et al., 2024; Sharma, 2025). A tailor-made care plan is crucial for addressing the specific needs and deficiencies of each patient. These plans should take into account factors such as the patient's mental state, other diseases and pre-injury mobility. Formulating assisent methods and rehabilitation goals based on patients' abilities and preferences can enhance patients' willingness to participate, better restore physical functions, and reduce the risk of health problems (Baer et al., 2019; Aborukbah et al., 2024; Catalano-Nadakhovskaia et al., 2025). 5 New Discoveries on the Rehabilitation Effect of Early Exercise on Elderly Patients with Hip Fractures 5.1 Impact on the recovery of physical functions and activity capabilities Early activities usually start within 24~48 hours after surgery, which helps restore physical functions and improve the ability to walk independently. One year after the surgery, patients who were active early were approximately
International Journal of Clinical Case Reports, 2025, Vol.15, No.4, 148-158 http://medscipublisher.com/index.php/ijccr 152 four times more likely to be able to walk independently than those who were active late (Nakamura et al., 2025). Even when age and mental condition are taken into account (Catalano-Nadakhovskaia et al., 2025), sitting up and moving within 24 hours after surgery means a better recovery of mobility within 30 days. These practices can enhance the activity ability of patients, improve the Barthel index and Harris score, and also help patients recover to the pre-injury state more quickly (Kuru and Olaperar, 2019; Xiang et al., 2021). In addition, arranging activities as early as possible, including bed exercises and gradually increasing the physical burden, can accelerate the improvement of gait, muscle strength and balance ability. Walking analysis revealed that regardless of the surgical method used, the number and duration of walking during hospitalization increased significantly, indicating that early activity has universal benefits for physical recovery (Figure 2) (Aborukbah et al., 2024; Hecht et al., 2025). Figure 2 Averaged (SD) sagittal joint kinematics of the operated (blue) and healthy (green) leg for the hip, knee, and ankle as a function of the gait cycle (0~100%) (Adopted from Hecht et al., 2025) Image caption: The gray shaded areas indicate significant differences in averaged sagittal joint kinematics between the operated and healthy leg (Adopted from Hecht et al., 2025) 5.2 Role in preventing postoperative health problems Starting to be active immediately after surgery can significantly reduce the risk of common postoperative health problems. Patients who were active as early as possible had a lower incidence of confusion, pulmonary infection, urinary tract infection, leg blood clots and pressure sores (Baer et al., 2019; Aprisunadi et al., 2021; Goubar et al., 2021). Studies have found that patients who lie down for a long time are approximately twice as likely to have health problems as those who move early (Kenony-smith et al., 2019; Ma et al., 2025). Early recovery can also shorten the length of hospital stay and reduce the risk of death, which is an important way to improve overall outcomes (Baer et al., 2019; Aprisunadi et al., 2021; Tang et al., 2025). Moreover, early activity is most useful for patients with poor preoperative physical condition, which can reduce health problems and make recovery safer and more effective (Kenony-Smith et al., 2019). These findings suggest that early activity can serve as a key measure for postoperative care in elderly patients with hip fractures (Goubar et al., 2021; Aprisunadi et al., 2021). 5.3 Improvement of psychological state and quality of life Early activities not only help the body recover, but also benefit mental health and quality of life. Patients who participated in early activities said that they had less anxiety, stronger confidence and were more satisfied with the rehabilitation process (Xiang et al., 2021; Aborukbah et al., 2024). Quality of life indicators such as the EQ-5D index were significantly better in the early activity group, although the difference might not be significant (Xiang et al., 2021). In addition, early activity can make people more independent and reduce the fear of falling, which is very common among elderly patients after hip fractures. These psychological benefits can encourage people to persist in rehabilitation, contribute to long-term functional improvement, and ultimately enhance the overall quality of life (Aprisunadi et al., 2021; Aborukbah et al., 2024).
International Journal of Clinical Case Reports, 2025, Vol.15, No.4, 148-158 http://medscipublisher.com/index.php/ijccr 153 6 Factors Influencing the Effectiveness of Early Mobilization 6.1 Patient compliance, pain management and psychological status Whether the patient cooperates is the key to the success of early mobilization. Pre-existing cognitive impairment, delirium, depression and other problems can seriously affect patients' willingness or ability to participate in activities (Said et al., 2021). Pain is also a major obstacle. If pain is not well controlled, patients may be reluctant or refuse to move. However, effective pain relief methods can make patients more willing to move earlier and have better recovery effects (Buecking et al., 2015; Gray et al., 2023). Psychological factors, such as the fear of falling, anxiety and lack of energy, are also crucial. Patients with strong activity ability and good psychological state before fracture are more willing to participate in early activities. Patients with mental confusion or depression tend to be active later and have poorer recovery (Buecking et al., 2015; Said et al., 2021; Gray et al., 2023). Solving these psychological problems with targeted methods can make patients more cooperative and make the rehabilitation process smoother. 6.2 The technical capabilities of nursing staff and the implementation of intervention measures The technical proficiency and active participation of nursing staff are crucial for the safe and effective implementation of early mobilization programs. Staff members must be proficient in determining whether patients are suitable for activity, controlling pain, providing appropriate physical support during activity, and minimizing the risk of falls or hypotension as much as possible (Aprisunadi et al., 2021). If the staff are inadequately trained or lack confidence, it may lead to inconsistent implementation of the mobilization plan and thus miss the opportunity for early activities (Gray et al., 2023). In addition, there are clear guiding principles and standard procedures in the medical environment, which can help patients receive consistent and timely mobilization. Organizational factors such as staffing, workload, and communication among multidisciplinary team members can either facilitate or hinder the implementation of early mobilization measures (Sallehuddin and Ong, 2020; Gray et al., 2023). Therefore, continuously providing education and support to nursing staff is of great significance for ensuring high-quality care and enabling patients to achieve the best rehabilitation outcomes. 6.3 Availability of family support and rehabilitation resources The participation and support of family members are of great help for early mobilization. Encouragement and assistance from family members can enhance patients' enthusiasm, reduce anxiety and help overcome psychological barriers during activities (Gray et al., 2023). On the contrary, the lack of family support may make patients feel lonely, reduce their enthusiasm for participating in rehabilitation and slow down their recovery. Whether rehabilitation resources are sufficient and accessible, such as physical therapy services and specialized equipment, is also very important. Hospitals with well-developed rehabilitation plans and sufficient personnel are more likely to enable patients to move around in a timely manner, resulting in better rehabilitation outcomes (Sallehuddin and Ong, 2020; Gray et al., 2023). Insufficient resources may delay mobilization, increase the possibility of complications and prolong hospital stays, which indicates that investment is needed to build complete rehabilitation facilities. 7 Existing Difficulties and Challenges 7.1 There is a lack of unified activity time standards and operation methods One of the main problems faced by early activities is the lack of generally recognized definitions, standards and plans. Research shows that there are significant differences in how to define early activities (such as within 24, 36 or 48 hours after surgery) and how to measure their impact. This makes it extremely difficult to compare the results and determine the best practices among different hospitals (Said et al., 2021; Gray et al., 2023; Sarkies et al., 2023). Due to the lack of a unified standard, some hospitals may postpone the "as soon as possible" activity because of unclear guidance or different understandings, resulting in inconsistent practices and different rehabilitation effects
International Journal of Clinical Case Reports, 2025, Vol.15, No.4, 148-158 http://medscipublisher.com/index.php/ijccr 154 for patients (Said et al., 2021). Furthermore, clinical guidelines often fail to take into account the total time patients spend in bed before and after surgery, which may affect the occurrence and recovery of health problems. The lack of a complete evidence-based program for the needs of elderly patients with hip fractures has hindered early activity from becoming a routine practice (Gray et al., 2023; Horton et al., 2023). 7.2 Elderly patients have significant individual differences and poor compliance There are significant differences in health status, cognitive ability and psychological state among elderly patients with hip fractures before the onset of the disease, all of which can affect their ability and willingness to participate in early mobilization (Gray et al., 2023). Delirium, mental confusion, low blood pressure and risks of manual operation are all common obstructive factors. Many patients may refuse or be unable to follow the activity suggestions (Kammerlander et al., 2018). For instance, studies have shown that less than half of the patients were active within 48 hours after surgery, and those with delirium or poor pre-illness activity ability were the least likely to be active early (Said et al., 2021). In addition, elderly patients often have difficulty adhering to the activity restrictions after surgery. Studies have shown that even with standard rehabilitation training, most patients are unable to meet the prescribed limits (Kammerlander et al., 2018). The differences among these individuals require highly tailored solutions, which also bring continuous pressure to caregivers and recovery teams. 7.3 The number of evidence-based clinical studies is small and their quality needs to be improved Although everyone understands that early activity is good, there are still few high-quality and powerful studies specifically examining its effect on elderly patients with hip fractures and the best practices (Agarwal et al., 2024). Many studies are observational in nature, involve a small number of people, or have inconsistent definitions and methods of evaluation results, which reduces the credibility and applicability of the research results. The systematic summary emphasizes the need for more experimental and quasi-experimental studies to explore the causal relationship and long-term effects of perioperative intervention on activity and function (Gray et al., 2023; Sarkies et al., 2023). Due to the lack of strong evidence, it is difficult to formulate clear, evidence-based guiding principles and have all relevant parties recognize the value of early activities. Future research should focus on large-scale, well-designed experiments and standardized reports to lay a more reliable evidence base for practical nursing work (Gray et al., 2023; Sarkies et al., 2023; Agarwal et al., 2024). 8 Future research and Nursing Work Directions 8.1 More strictly controlled experiments and high-quality research are needed Although everyone knows that it is better to get active as early as possible, there is still an urgent need for more high-quality, large-sample strictly controlled trials (RCTS) to develop a unified approach and identify which patient groups will benefit the most. Most of the current evidence comes from observational or retrospective studies, which may be interfered with by other factors, and the practices and definitions are often inconsistent (Aprisunadi et al., 2021). Strict controlled experiments are crucial for determining the optimal activity time, frequency and format, as well as evaluating long-term functional and quality of life outcomes (Catalano-Nadakhovskaia et al., 2025; Nakamura et al., 2025). In addition, future research should fill in some gaps, such as the impact of early activity on specific health issues, the effectiveness of spending, and the role of pre-injury health. The research should also examine the difficulties in actual implementation and how to improve cooperation, especially among people with weak bodies or unclear minds (Aprisunadi et al., 2021; Said et al., 2021; Catalano-Nadakhovskaia et al., 2025). 8.2 Development of individualized and intelligent technology-integrated nursing methods Individualized care methods that take into account the individual characteristics of patients (such as age, mental condition, other diseases, pre-injury activity ability, etc.) are very important for enhancing the effect of early activity. Tailoring assistance measures according to patients' needs can enhance cooperation, reduce health
International Journal of Clinical Case Reports, 2025, Vol.15, No.4, 148-158 http://medscipublisher.com/index.php/ijccr 155 problems and promote recovery (Said et al., 2021; Catalano-Nadakhovskaia et al., 2025). Incorporating patient feedback and preferences into the care plan also helps to enhance participation enthusiasm and satisfaction (Beer et al., 2021). Combining intelligent technologies, such as digital monitoring tools and intelligent assistive tools, can promote the development of individualized care. These new methods can help nurses track patients' progress, identify problems in a timely manner, and flexibly adjust assistance measures, thereby supporting safer and more effective activity strategies (Beer et al., 2021; Catalano-Nadakhovskaia et al., 2025). 8.3 Optimize multidisciplinary collaboration and promote the concept of ERAS Effective early activities require close collaboration among nurses, physical therapists, doctors and other healthcare workers. Optimizing multidisciplinary team collaboration can ensure comprehensive assessment, coordinated intervention and unified patient education, all of which are associated with better outcomes and shorter hospital stays (Sallehuddin and Ong, 2020; Purcell et al., 2021). Advanced trainee nurses can play a key role in nursing coordination, education and discharge planning, further improving the quality of hip fracture care (Allsop et al., 2020). Promoting the concept of enhanced recovery after surgery (ERAS), such as early activity, multiple ways to control pain and recovery that takes into account the needs of patients, should be the focus of future work. Incorporating ERAS principles into routine care procedures can unify best practices, enhance compliance with early activity guidelines, and ultimately lead to better recovery and fewer morbidity in elderly patients with hip fractures (Sallehuddin and Ong, 2020; Zuelzer et al., 2023). 9 Concluding Remarks There is ample evidence that early activity - typically carried out within 24 to 48 hours after hip fracture surgery - can significantly reduce the risk of short-term death and the probability of complications, including infection, delirium and other adverse conditions. Early activity is also associated with better functional recovery, such as more people being able to walk independently, being discharged from the hospital earlier, and not increasing the risk of pain or implant failure. These benefits can be observed in different patient groups, including those with cognitive impairments, which indicates that early activity is widely applied and very important in postoperative care. Nursing measures, such as explaining knowledge to patients, managing pain, providing psychological support and close observation, are crucial for the successful implementation of early activity programs. Nurses play a significant role in determining whether patients are suitable for activities, preventing complications and encouraging patients to participate in activities. Working with a multidisciplinary team, effective care can ensure that activities are safe and timely, and arranged according to the individual needs of patients, thereby maximizing the rehabilitation effect and shortening the hospital stay. Although the benefits are clear, difficulties still exist, such as inconsistent activity arrangements and insufficient patient cooperation. More high-quality evidence-based research is needed to refine best practices. Future work should focus on establishing unified and individualized nursing approaches and conducting large-scale strict controlled experiments to enhance evidence support. Optimizing the collaboration among multiple specialties and incorporating the concept of enhanced recovery will better promote the recovery of elderly patients with hip fractures. Acknowledgments I would like to thank Mrs Fang continuous support throughout the development of this study. Conflict of Interest Disclosure The author affirms that this research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest.
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International Journal of Clinical Case Reports, 2025, Vol.15, No.4, 159-170 http://medscipublisher.com/index.php/ijccr 159 Research Insight Open Access Polypharmacy in Elderly Individuals with Multimorbidity, Risks and Management Approaches ManmanLi Hainan Institute of Biotechnology, Haikou, 570206,Hainan, China Corresponding email: manmanm.li@hibio.org International Journal of Clinical Case Reports 2025, Vol.15, No.4 doi: 10.5376/ijccr.2025.15.0017 Received: 19 May, 2025 Accepted: 30 Jun., 2025 Published: 19 Jul., 2025 Copyright © 2025 Li, This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Preferred citation for this article: Li M.M., 2025, Polypharmacy in elderly individuals with multimorbidity, risks and management approaches, International Journal of Clinical Case Reports, 15(4): 159-170 (doi: 10.5376/ijccr.2025.15.0017) Abstract This study explored the issues and countermeasures of using multiple drugs in elderly patients with coexisting multiple diseases, and simultaneously described the clinical characteristics of such patients. This study also discussed the main challenges of multidrug therapy, such as the side effects brought by drugs, adverse effects between drugs, increased treatment costs, as well as individualized medication guidance, team collaboration intervention, and the use of medical information technology to assist in diagnosis and treatment systems. A comparative study of foreign experiences highlights the differences between good practices and policies, especially in light of the specific circumstances of China's medical system. This research also covers future development trends, including individualized medicine, the application prospects of artificial intelligence, and the formulation of medication norms suitable for the elderly. This study aims to improve the medication regimens for elderly patients with multiple coexisting diseases through an overall, patient-focused, and system-level strategy, in order to provide safer and more effective medical services. Keywords Polypharmacy; Multimorbidity; Elderly patients; Medication management; Deprescribing 1 Introduction The elderly often suffer from several diseases, so they need to take multiple medications-that is, multimedication -to control these chronic diseases. The physical condition that changes with age, the weakening of the body, and the lack of specialized treatment guidelines for elderly people suffering from multiple diseases make this situation even more complicated. Traditional single-disease guidelines often fail to address the issue of taking more and more medication, which increases the risks of adverse drug reactions, mutual influence between drugs, and patients not taking their medication as required. Neither patients nor doctors are confident when making decisions. They have difficulties in weighing the pros and cons of treatment, determining the sequence of treatment, and ensuring that care centers around the needs of patients (Bokhof and Junius-Walker, 2016; Stewart et al., 2016; Muth et al., 2018; Mangin et al., 2018; Dovjak, 2022; Van Onna and Boonen, 2022). It is common for the elderly to take multiple medications. Research shows that more than half of the elderly take five or more types of medicine, and in some cases, this proportion can be as high as 89% (Nicholson et al., 2024). The occurrence of multiple diseases and taking multiple medications increases with age and brings many adverse health outcomes, such as adverse drug reactions, hospitalization, geriatric syndrosts (like frailty and malnutrition), inappropriate medication prescriptions, and a higher risk of death (Wastesson et al., 2018; Lopez-Rodriguez et al., 2020; Schneider et al., 2021; Van Onna and Boonen, 2022; Guo et al., 2022). However, there is evidence suggesting that rational combined medication (necessary and well-managed drugs) may reduce the risk of death among hospitalized elderly people, indicating the need for individualized medication patterns (Zhao et al., 2023). This study will explore solutions that integrate patients, multi-disciplinary teams, and localized adjustments, which play a significant role in improving medication arrangements, reducing medication harm, and enhancing health levels. Methods such as drug examination, prescription, doctor-patient consultation, and management of multiple medications have shown effects, but more research is needed and they can also be applied to daily care. This study aims to address the issue of using multiple medications simultaneously, which is crucial for patients'
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