Differences in age-related characteristics among elderly patients with hip fractures

Published:September 21, 2022DOI:



      Incidence of hip fracture among aging patients has been increasing annually in Japan; patients aged ≤74 years may be inappropriately classified as elderly. This study aimed to identify differences in the incidence of serious perioperative complications and in-hospital, 90-day, 6-month, and 1-year mortality rates according to three age groups among patients with hip fractures.


      Patients aged ≥65 years treated for hip fracture by our multidisciplinary treatment system were included in this study. They were divided into the pre-old age (65–74 years), old age (75–89 years), and super-old age (≥90 years) groups. The baseline characteristics and outcomes of the three groups were compared, and variables associated with in-hospital, 30-day, 6-month, and 1-year mortality were analyzed.


      In the older population, there was a higher proportion of female participants; those with trochanteric fractures, low bone mineral density, dementia, decreased walking ability and independence in performing activities of daily living; and those not living at home. Moreover, the proportion of patients with hypertension, diabetes mellitus, and circulatory disorders, American Society of Anesthesiologists Physical Status scores, and serum albumin levels significantly differed. Further, there was a significant difference in the incidence of serious complications among males and the 6-month and 1-year mortality rates among females. In addition, female patients in the pre-old age group had a higher mortality rate at any period compared with those in the old age group.


      Patients with hip fracture who were aged 65–74, 75–89, and ≥90 years differ in terms of baseline characteristics, incidence of complications, and mortality rates. Female patients aged<75 who had fragility hip fractures potentially had worse prognosis. Our findings may be useful in preoperative explanation, postoperative management, and prognostic prediction.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hagino H.
        • Endo N.
        • Harada A.
        • Iwamoto J.
        • Mashiba T.
        • Mori S.
        • et al.
        Survey of hip fractures in Japan: recent trends in prevalence and treatment.
        J Orthop Sci. 2017 Sep; 22: 909-914
        • Ouchi Y.
        • Rakugi H.
        • Arai H.
        • Akishita M.
        • Ito H.
        • Toba K.
        • et al.
        Redefining the elderly as aged 75 years and older: proposal from the joint committee of Japan gerontological society and the Japan geriatrics society.
        Geriatr Gerontol Int. 2017 Jul; 17: 1045-1047
        • Fitz-Henry J.
        The ASA, classification and peri-operative risk.
        Ann R Coll Surg Engl. 2011 Apr; 93: 185-187
        • Shigemoto K.
        • Sawaguchi T.
        • Goshima K.
        • Iwai S.
        • Nakanishi A.
        • Ueoka K.
        The effect of a multidisciplinary approach on geriatric hip fractures in Japan.
        J Orthop Sci. 2019 Mar; 24: 280-285
        • Shigemoto K.
        • Sawaguchi T.
        • Horii T.
        • Goshima K.
        • Iwai S.
        • Higashikawa T.
        • et al.
        Multidisciplinary care model for geriatric patients with hip fracture in Japan: 5-year experience.
        Arch Orthop Trauma Surg. 2022 Sep; 142: 2205-2214
        • Nakamura J.
        • Kamiya H.
        • Haneda M.
        • Inagaki N.
        • Tanizawa Y.
        • Araki E.
        • et al.
        Causes of death in Japanese patients with diabetes based on the results of a survey of 45,708 cases during 2001-2010: report of Committee on causes of death in diabetes mellitus.
        J Diabetes Investig. 2017 May; 8: 397-410
        • Shiga T.
        • Wajima Z.
        • Ohe Y.
        Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression.
        Can J Anaesth. 2008 Mar; 55: 146-154
        • Simunovic N.
        • Devereaux P.J.
        • Sprague S.
        • Guyatt G.H.
        • Schemitsch E.
        • Debeer J.
        • et al.
        Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis.
        CMAJ (Can Med Assoc J). 2010 Oct 19; 182 (2010; 182: 1609–1616. CMAJ): 1609-1616
        • Moja L.
        • Piatti A.
        • Pecoraro V.
        • Ricci C.
        • Virgili G.
        • Salanti G.
        • et al.
        Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients.
        PLoS One. 2012; 7 (Epub 2012 Oct 3)e46175
        • Sasabuchi Y.
        • Matsui H.
        • Lefor A.K.
        • Fushimi K.
        • Yasunaga H.
        Timing of surgery for hip fractures in the elderly: a retrospective cohort study.
        Injury. 2018 Oct; 49: 1848-1854
        • Logemann J.A.
        • Pauloski B.R.
        • Rademaker A.W.
        • Colangelo L.A.
        • Kahrilas P.J.
        • Smith C.H.
        Temporal and biomechanical characteristics of oropharyngeal swallow in younger and older men.
        J Speech Lang Hear Res. 2000 Oct; 43: 1264-1274
        • Byun S.E.
        • Shon H.C.
        • Kim J.W.
        • Kim H.K.
        • Sim Y.
        Risk factors and prognostic implications of aspiration pneumonia in older hip fracture patients: a multicenter retrospective analysis.
        Geriatr Gerontol Int. 2019 Feb; 19: 119-123
        • Downey C.
        • Kelly M.
        • Quinlan J.F.
        Changing trends in the mortality rate at 1-year post hip fracture - a systematic review.
        World J Orthoped. 2019 Mar 18; 10: 166-175
        • Loggers S.A.I.
        • Van Lieshout E.M.M.
        • Joosse P.
        • Verhofstad M.H.J.
        • Willems H.C.
        Prognosis of nonoperative treatment in elderly patients with a hip fracture: a systematic review and meta-analysis.
        Injury. 2020 Nov; 51: 2407-2413