48 | Predictors of functional recovery after hip fracture in frail older adults: insights from a post-acute care cohort

A. Miucci¹, D. Pinto¹, M. Proni² | ¹Policlinico di S.Orsola; ²Bologna.

Introduction. Femoral fractures in older adults represent a significant cause of morbidity and mortality. To address this issue, multidisciplinary care models integrating geriatric, orthopedic, and rehabilitative expertise have been developed at the S. Orsola Polyclinic in Bologna.

Objectives. To evaluate, within the Post-Acute Care and Continuity of Care setting (PACA)—where patients with the highest clinical and social frailty are concentrated—the possibility of identifying clinical characteristics predictive of failure to recover functional autonomy.

Materials and Methods. This retrospective observational study included patients aged over 75 years who underwent surgery for femoral fracture and were admitted to PACA between August 2022 and September 2025. Frailty was assessed using the Clinical Frailty Scale (CFS), and comorbidities were evaluated using the Charlson Comorbidity Index (CCI). Rehabilitation outcomes were analyzed in comparison with pre-fracture functional status, along with complications and discharge setting.

Results. Out of 71 patients, 71% did not recover their pre-fracture functional autonomy. Patients with poor outcomes had higher mean CFS (5.87 vs 5.33; p=0.52) and CCI (7.33 vs 6; p=0.15) scores, although these differences were not statistically significant. Among patients with dementia (n=27), 88% failed to achieve rehabilitation goals. The most frequent complications hindering rehabilitation were infections (9 cases) and delirium (19 cases).

Conclusions. High levels of frailty, comorbidity, and the presence of dementia are associated with an increased risk of rehabilitation failure, despite geriatric care and early initiation of rehabilitation. Early planning of the post-discharge pathway is therefore essential, taking into account the likelihood of returning home with increased disability and care needs. Furthermore, a cut-off value of 6 for both CCI and CFS may help identify patients at higher risk of functional decline.