Revista Espanola de Geriatria y Gerontologia · Nov 11, 2026

Institutionalization as a marker of frailty and poor prognosis after a hip fracture in older adults: a cohort study

By Tejera Concepción AC, González Colaço-Harmand M, Ramallo Fariña Y et al.

Introduction Prognosis following a hip fracture in older adults depends heavily on their pre-existing functional reserve. This study aimed to analyze the association between residential destination at discharge (home vs. institutionalization), mortality, and functional outcomes at the end of follow-up, conceptualizing this destination as a marker of pre-fracture vulnerability rather than a causal factor of subsequent evolution. Material and methods A matched cohort study (1:1) was conducted in patients aged ≥ 65 years who underwent surgery for a fragility hip fracture between 2017 and 2022 in an orthogeriatric unit. Follow-up was completed via telephone interviews in 2023. A total of 78 patients were included, distributed into two groups matched by age, sex, and comorbidity (Charlson Comorbidity Index): return to home (n = 39) and institutionalization (n = 39). Hospital readmissions were excluded. Variables regarding mortality, functional status (Barthel Index and Lawton-Brody Scale) relative to baseline pre-fracture status, and nutritional parameters were recorded. The overall median follow-up was 23 months (IQR: 8-51). Results The institutionalized cohort exhibited higher pre-fracture cognitive impairment (64.1% vs. 35.9%; P = .013) and social risk at admission (89.7% vs. 43.6%; P < .001). Institutionalized patients demonstrated a lower final level of independence, with a significantly lower mean Barthel Index score compared to the home-return group (14 ± 15.3 vs. 48.6 ± 32.0 points; P < .001). Cumulative mortality at the end of follow-up was also higher in the institutionalized group (23.1% vs. 5.1%; P = .024). Conclusions Institutionalization at hospital discharge acts as an indirect marker of pre-fracture frailty and multidimensional vulnerability, showing an association with poorer functional and survival outcomes. Early intervention on modifiable factors, such as nutritional status and social support, could mitigate the impact of this decline.

doi.org/10.1016/j.regg.2026.101843PubMed 43014139Populations