Management of hip fracture in older adults with cognitive impairment: a narrative review
Abstract
Background: Hip fractures in older adults are costly and often fatal. Cognitive impairment (CI) complicates pain assessment, raises delirium risk, and hinders early mobilization and rehabilitation. This review synthesizes recent evidence on postoperative care, covering epidemiology, mechanisms, delirium, rehab, outcomes, and practical bedside strategies.
Methods: A narrative review was performed to inform postoperative management of older adults hip-fracture patients with CI. PubMed and Web of Science were searched from 2018 to 2025 using MeSH and free-text terms for hip fracture, cognitive dysfunction/dementia/MCI, and rehabilitation, delirium, perioperative care, orthogeriatrics, and outcomes. Only English-language human studies were included. CI was defined by DSM-5/ICD-10 dementia, Petersen MCI, or MMSE <24/MoCA <26. Two reviewers independently screened studies; disagreements were resolved by a senior researcher. Case reports, protocols, abstracts, animal studies, <50 participants, non-core topics, and short follow-up were excluded. Additional 2023-2025 studies were identified by targeted searches and reference tracing. No risk-of-bias or GRADE assessment was applied.
Results: Among older adults with hip fracture, approximately 20-40% have CI, making it a prominent clinical characteristic of this population. Dementia and even mild cognitive deficits increase the risk of falls and hip fractures by two- to threefold. After fracture, CI is linked to worse outcomes,…
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