“It’s part of getting old”: ageing perceptions and cultural beliefs underpin hip recovery and refracture prevention experiences: a qualitative study

Background and Aims: Hip fractures are a leading cause of morbidity and mortality among older adults, with significant consequences for recovery and refracture risk. While recovery experiences have been explored and interventions established, limited understanding exists of how individual, social and cultural factors influence engagement with recovery and secondary prevention in multicultural systems. We explored these factors among culturally diverse older adults and caregivers following low trauma hip fracture. Methods: A qualitative study embedded within a prospective cohort at a metropolitan Australian trauma hospital. Participants included older adults with recent low-trauma hip fracture and their caregivers, purposively sampled for cultural diversity. Semi-structured interviews were conducted in English, Arabic, Assyrian or Vietnamese. Data were thematically analysed using a two-step inductive-deductive approach, mapping codes to Andersen’s Behavioural Model before theme development. Results: Twenty participants (mean age 74 years, 60% women, 75% culturally diverse) were interviewed. Three interconnected themes emerged: (i) ‘normalisation of pathological ageing’, shaping expectations and engagement with preventive care; (ii) ‘cultural orientations’ shaping motivations, expectations and family roles; and (iii) ‘care continuity,’ with refracture prevention clinics valued but access hampered by logistical and system barriers. These themes interacted across individual, social and health system levels to shape recovery trajectories and refracture prevention. Conclusions: Recovery and refracture prevention after hip fracture are strongly shaped by age-related beliefs, cultural context and care structures. By examining cross-cultural experiences in a multicultural setting, this study highlights the need for person-centred, culturally responsive and better-coordinated models to optimise engagement and outcomes in diverse ageing populations.