Mortality Risk After Hip Fractures in Adults Over 65

Understanding the Mortality Risk After Hip Fractures in Adults Over 65

Hip fractures are a major health event in older adults, often leading to a cascade of health challenges. For individuals over age 65, a hip fracture doesn’t just affect mobility—it can also significantly increase the risk of death, particularly in the weeks and months following the injury. As physical therapists, it’s critical that we understand these risks to help guide recovery, support independence, and improve outcomes for our patients.

The Short-Term Mortality Risk: A Closer Look

Hip fractures in older adults are closely linked with short-term mortality. This includes deaths occurring during hospitalization or within the first 30 days, 90 days, 6 months, or 1 year following the injury.

Key statistics:

  • In-hospital mortality: Averages around 6.3%, with men at significantly higher risk (10.2%) compared to women (4.7%). Among those aged 90 or older, men had double the in-hospital mortality rate of women.

  • 30-day mortality: Ranges from 9.6% to 16.7%, with one study showing 15% in men and 8.2% in women.

  • 90-day mortality: Approximately 25% in men and 16% in women, with the highest risk occurring in the first three months post-injury.

  • 6-month mortality: Patients with coronary heart disease (CHD) had markedly higher mortality rates—79.4 per 100 person-years compared to 49.3 in those without CHD.

  • 1-year mortality: Up to 1 in 4 older adults die within a year after hip fracture. Rates vary widely, from 12% to 37%, with some studies noting 37.5% in men and 28.2% in women.

What Increases the Risk?

A number of factors have been identified as increasing the likelihood of short-term mortality after a hip fracture. These can be grouped into several key categories:

1. Age and Gender

  • Risk increases with age—every additional year adds nearly 10% more risk of death within a year.

  • Men are at consistently higher risk than women, even after adjusting for other health conditions.

2. Chronic Health Conditions (Comorbidities)

  • Patients with three or more comorbidities face up to 2.5 times higher 30-day mortality.

  • High-risk conditions include:

    • Malnutrition (increases 30-day mortality odds over 4-fold)

    • COPD

    • Congestive heart failure (65% mortality at 30 days; 92% at 1 year)

    • Pneumonia (43% mortality at 30 days)

    • Renal failure, stroke, cancer, previous heart attacks, and dementia

3. Functional Status Before the Fracture

  • Those living in nursing homes or needing help with Activities of Daily Living (ADLs) are at significantly higher risk.

  • Lower scores on the Lawton–Brody IADL scale were linked to higher mortality.

4. Laboratory Markers

  • Low albumin levels and high RDW (Red Cell Distribution Width) values are associated with poorer outcomes.

  • Low hemoglobin levels and a high RDW-to-albumin ratio may signal greater mortality risk.

5. Surgical and Postoperative Care

  • Timing matters: Delays in surgery increase risk. Each hour of delay raises 30-day mortality odds.

  • Patients with postoperative complications like heart failure, infections, anemia, or pressure ulcers are at greater risk of death.

  • Early ambulation and mobility recovery are essential—failure to walk post-surgery is linked to poorer long-term outcomes.

What This Means for Physical Therapy

As movement specialists, physical therapists play a critical role in the recovery journey after a hip fracture. Here’s how we can help reduce risk and improve survival:

  • Support early mobilization: Helping patients stand and walk safely as soon as medically appropriate improves outcomes and decreases the risk of complications.

  • Collaborate on nutrition and comorbidity management: Coordinating care with medical providers and dietitians can help address underlying conditions such as malnutrition or heart disease.

  • Tailor rehab plans to individual needs: Frail patients with multiple risk factors benefit from slower, supervised progress and longer-term follow-up.

  • Educate caregivers and families: Informing loved ones about the importance of activity, nutrition, and post-operative care can enhance recovery and quality of life.

Conclusion

Hip fractures are more than just broken bones—they’re a turning point in an older adult’s health journey. Understanding the significant mortality risk, especially in the first year post-fracture, allows healthcare professionals to act proactively. Timely surgery, multidisciplinary care, early physical therapy intervention, and comprehensive risk assessment can all contribute to better outcomes and a more successful return to independence.

Disease, Injury PreventionAndrew TomasHip, Elderly, Mortality, Death, FractureComment