Journal of the American Medical Directors Association · Sep 14, 2025

Impact of Physical Resilience, Prefracture Characteristics, and Functional Status on Mortality After Hip Fracture

By Ek S, Ding M, Hedström M et al.

OBJECTIVES: Physical resilience after a hip fracture is key to independent, high-quality living after the fracture. We have previously shown that physical resilience can be achieved with different combinations of resilience characteristics, but it is unknown how physical resilience is associated with longer-term mortality. DESIGN: Register-based cohort study. SETTING AND PARTICIPANTS: The study population was 55,383 individuals aged ≥60 years with a first hip fracture between 2010 and 2020 in Sweden. METHODS: Two-year mortality risk was calculated among previously developed physical resilience profiles in patients with hip fracture. Physical resilience was defined as maintaining prefracture walking ability 4 months postfracture. Mortality risk was assessed using Cox proportional hazards model with 95% CIs, adjusted for age. Individuals with assisted vs independent walking ability before the hip fracture were analyzed separately. RESULTS: The mean age of all patients with hip fracture was 82.3 years, and 71% were women. The 2-year mortality risk was higher in men (21%) than women (13%). Among assisted walkers, resilient individuals had a 17% to 24% lower mortality risk compared with nonresilient individuals. Among independent walkers, the reduction in mortality risk among resilient individuals ranged from 50% to 82%, depending on prefracture characteristics, compared with nonresilient assisted walkers. Worth noting is that female patients with hip fracture who maintain independent walking ability and belong to the cluster with the most favorable characteristics had a 2-year mortality risk less than 5%. CONCLUSIONS AND IMPLICATIONS: Two-year survival after a hip fracture is more strongly influenced by independent walking ability than by maintaining prefracture walking status. Mortality also varies based on prefracture characteristics, with a low disease and medication burden having a greater protective effect than high socioeconomic status. A combination of favorable factors provides the greatest benefit. Rehabilitation planning should consider not only medical history but also socioeconomic factors and living conditions.

doi.org/10.1016/j.jamda.2025.105859 Open access PubMed 40945921 Populations