Geriatric Hip Fractures: Physiological and Psychological Determinants of Recovery — A Narrative Review

Abstract

Background: Hip fractures in older adults are sentinel events associated with substantial mortality and long‑term functional loss. Recovery trajectories are shaped by an interplay of physiological factors (frailty, sarcopenia, multimorbidity, malnutrition) and psychological/cognitive factors (depression, anxiety, fear of falling, delirium, and baseline cognitive impairment). Objective: To synthesize evidence available up to June 2020 on determinants of recovery after geriatric hip fracture with an emphasis on psychological aspects and to outline pragmatic care strategies. Methods: Narrative review of meta‑analyses, large cohorts, and guideline‑level syntheses published on or before June 30, 2020. Results: Frailty and sarcopenia independently predict complications, prolonged hospitalization, institutionalization, and mortality; comorbidity burden and surgical delay further worsen outcomes. Depression and fear of falling are consistently linked to reduced rehabilitation participation and poorer functional recovery, while postoperative delirium is associated with prolonged stay, loss of independence, and higher mortality. Orthogeriatric co‑management, early surgery, optimized multimodal analgesia, and nutrition support improve early mobilization and downstream outcomes. Conclusions: Recovery is biopsychosocial. Embedding mental‑health screening and interventions alongside delirium prevention, nutrition optimization, early mobilization, and secondary fracture prevention within orthogeriatric pathways can meaningfully improve independence after hip fracture. ^{1,3,5,7,11,14,15,17,18,19,20,22,23}