Acute Care and Rehabilitation After Low-Trauma Hip Fractures in Older Adults – Pathways and Functional Outcomes: A Retrospective Cohort Study

Background/Objectives: Older Adults experiencing low-trauma hip fractures (LTHF) may not regain pre-fracture functioning. This study examined whether different LTHF types (femoral neck (FN-F); trochanteric (Tr-F); acetabulum/periprosthetic (Ac/Pp-F) fractures) follow different healthcare pathways and achieve different functional outcomes. Methods: Retrospective cohort study 2020–2023 of (Bern Rehab Registry, 2020-2023; Swiss Ethics Project-ID 2024-00480) included patients aged ≥65 years with low-trauma FN-F, Tr-F, or Ac/Pp-F undergoing inpatient rehabilitation. Pathways comprised chronological stays in acute care, inpatient rehabilitation, and temporary nursing homes, bounded by pre-fracture situation and discharge destination. Pairwise standardized mean differences (SMDs) were calculated for between-group comparisons. Results: Of 294 individuals (mean age 81.0 ± 7.4 years; 191 (65%) women; 152 Tr-F, 118 FN-F, and 24 Ac/Pp-F) four main pathways were identified: (1) Acute care to inpa-tient rehabilitation in 208 (70.7%) individuals, 2) temporary nursing home stays before rehabilitation in 25 (8.5%), 3) temporary nursing home stays after rehabilitation in 17 (5.8%), and 4) re-hospitalization in 44 (15.0%). Median pathway length was 33.0 days (IQR 26.0–40.0) for FN-F, 35.0 (IQR 29.0–46.0) for Tr-F, and 60.5 (IQR 37.0–86.5) for Ac/Pp-F. Between-group differences in pathway type were moderate to large (SMDs: FN-F vs. TR-F = 0.47; FN-F vs. Ac/Pp-F = 1.25; TR-F vs. Ac/Pp-F = 0.84), and for length small to large (SMDs: FN-F vs. TR-F = 0.36; FN-F vs. Ac/Pp-F = 1.2; TR-F vs. Ac/Pp-F = 0.69). Overall, 246 (83.7%) returned to a private living setting. 88 (29.9 %) required new or increased home support or care. At discharge from rehabilitation, Functional Independence Measure (FIM) showed small to moderate and Timed Up and Go test (TUG) showed small between-group differences. Conclusions: Low-trauma hip fractures are not a uniform clinical entity. When pathways respect fracture-specific needs, functional outcomes and return to independent living can be comparable. Future rehabilitation should be tailored to these pathways and extended beyond inpatient rehabilitation to optimize care.