What is recovery like after a hip fracture in older adults?

Why is a hip fracture serious in older adults?

A hip fracture is a break at the top of the thigh bone, usually after a fall in someone whose bones have been weakened by osteoporosis. For older adults, it can lead to loss of mobility and independence, and recovery is often complicated by other health conditions, confusion, reduced appetite and muscle weakness.

With timely surgery, early mobilisation and coordinated care, many people regain much of their previous function.

What happens in hospital?

UK guidance on hip fracture recommends surgery on the day of, or the day after, admission, and that a physiotherapist assesses the person and starts mobilisation on the day after surgery, unless there are medical or surgical reasons not to 2. It also recommends care led by a team that includes specialists in the medical care of older people 2.

Pain control, prevention and treatment of delirium, nutrition support, bladder and bowel care and prevention of pressure sores are part of hospital care. Planning for discharge starts early.

Does rehabilitation improve walking?

A Cochrane review of 40 randomised trials with 4,059 participants, with an average age of 80, examined strategies to improve mobility after hip fracture surgery 1. In hospital, mobility strategies may lead to a moderate, clinically meaningful increase in mobility, based on low-certainty evidence 1.

After discharge, mobility strategies led to a small, clinically meaningful increase in mobility and walking speed, based on high-certainty evidence. Training that combined gait, balance and functional exercise improved mobility, and programmes with multiple components probably led to substantial improvement 1.

What does rehabilitation involve after leaving hospital?

Rehabilitation continues at home, in a rehabilitation unit or in outpatient settings. It typically includes progressive walking practice, standing up and sitting down, stair training, balance exercises and strengthening of the hip and thigh muscles.

Occupational therapists help with daily tasks such as bathing, dressing and getting in and out of bed, and may recommend equipment and home adaptations to support independence and safety.

How long does recovery take?

Recovery is gradual. Many people improve most in the first months, with further gains possible for a long time afterwards. Some people need a walking aid for longer than before the fracture, and some need additional support at home.

Recovery depends on previous mobility, memory and thinking, other health conditions, nutrition and motivation. Family involvement and continued exercise support better outcomes.

How can another fracture be prevented?

After a hip fracture, the risk of further falls and fractures is high. Bone health assessment and osteoporosis treatment, a falls risk assessment, review of medicines that cause drowsiness or dizziness, vision checks and removal of home hazards are important.

Ongoing strength and balance exercise helps reduce the risk of falls. Adequate calcium, vitamin D and protein intake support bone and muscle health.

How can nutrition support recovery after a hip fracture?

Many older adults with hip fracture are at risk of poor nutrition, which slows wound healing and muscle recovery. Eating regular meals and snacks that include protein, such as dairy, eggs, fish, meat, beans or lentils, and drinking enough fluids support recovery.

Appetite may be poor after surgery, so small, frequent meals and nutritional supplements recommended by the care team can help. Families can bring favourite foods if allowed and help at mealtimes.

Which symptoms need prompt medical attention after a hip fracture?

Seek medical advice for new confusion, chest pain or breathlessness, calf swelling or pain, increasing hip pain, wound redness or discharge, fever, or reduced ability to walk after initial improvement.

Sudden severe hip pain with the leg appearing shortened or turned may indicate a problem with the fixation or joint replacement and needs urgent review.

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