Hip Fractures in Elderly Adults: Symptoms, Prevention, and Treatment

Hip fracture complications in elderly adults can be life-threatening, even after surgery. Mortality risks are especially high for people who:

• Have chronic health conditions
• Are experiencing dementia or another type of cognitive impairment
• Choose to treat the hip fracture without surgery
• Can’t walk independently
• Don’t have proper fall-protection installed in their home or community

Fractured hip complications can seriously affect mobility in seniors. When elderly adults aren’t mobile for an extended period of time, they can develop serious conditions such as:^[01]

• Blood clots in the legs or lungs
• Pneumonia
• Urinary tract infections
• Bedsores
• Balance issues, which can also increase risk of falls for the elderly

The risk of falls increases with age, and 95% of hip fractures are the result of a fall, according to the CDC.^[02]

Risk factors for hip fractures in elderly adults include:^[03]

• Osteoporosis. This condition causes the bones to weaken, making them more likely to break.
• Gender. Women are more likely to have osteoporosis, which increases their risk of fractures. They also tend to live longer, and the likelihood of hip fractures increases with age.
• Medications. Certain drugs can make seniors drowsy or dizzy, increasing the risk of falls. Other medications may weaken bones and increase the risk of fractures.
• Malnutrition. Seniors with poor nutrition as children have increased risk of fractures later in life. As you age, it’s important to keep a healthy diet that includes enough calcium and vitamin D.
• Inactive lifestyle. Not getting enough physical exercise leads to weaker bones and muscles, increasing the risk of broken hips in elderly adults.
• Other medical conditions. Conditions such as diabetes, an overactive thyroid, or intestinal problems can lead to weaker bones. Mental impairment such as Alzheimer’s disease, Parkinson’s disease, or complications from a stroke can increase the risk of falls and fractures.
• Alcohol and tobacco use. Drinking alcohol and smoking contribute to weaker bones. Plus, excess alcohol consumption can lead to dizziness, impaired coordination, and falls.
• Unsafe home environment. Trip hazards in the home, such as throw rugs and electrical wires, along with unstable furniture and poor lighting, increase a senior’s risk for falls. It’s important to ensure the home is safe if your loved one chooses to age in place.
• Previous hip fracture. Seniors who’ve fractured a hip before are more likely to suffer another fracture.

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You can help your aging loved one prevent hip fractures by making sure their home is safe and free of trip hazards.

• Ensure rooms are well lit. Lighting should not be too dim or too direct. Make sure light switches are accessible.
• Tack down or remove rugs and carpets. Loose carpet edges can pose trip hazards.
• Make bathrooms safe. Add a chair for bathing and skid-resistant mats in the shower. Install grab bars where needed. Ensure toilet seats are tall enough for easy transferring.
• Check your chairs. Make sure chairs are stable and have armrests.
• Safeguard against fall hazards in the kitchen. Place a rubber mat in front of the sink and use nonslip wax on the floor. Organize frequently used items so they can be easily reached on low shelves.
• Consider stairway safety. Install handrails in stairways and make sure steps aren’t slippery. If your loved one plans to age at home over time, consider a stair lift to reduce hazards.

You may also talk to your loved one about:

• Having regular eye checkups
• Wearing sensible, flat shoes
• Being mindful of each medication’s side effects
• Talking with their doctor about supplements to increase bone density, including calcium and vitamin D

• Staying as physically active as possible with exercises that help with balance and leg strength, such as walking regularly, gentle yoga, or tai chi

Sometimes a hip fracture isn’t immediately obvious, especially in older adults with already-reduced mobility or preexisting chronic pain. However, because hip fractures can lead to potentially life-threatening complications, it’s important to know which signs to look out for.

Symptoms of a fractured hip include:^[04]

• Swelling or bruising around the hip, buttocks, or thigh
• Difficulty or inability to get up from a fall
• Inability to put weight on the leg on the side of the affected hip
• Leg shortening on the side of the affected hip
• Significant pain in the hip or groin
• Change in gait or walking patterns
• An outward-turning leg on the injured side of the body

Some of these signs of a broken hip are more immediately evident than others. Even if your loved one is able to walk, be sure to check for bruising and swelling after any falls. If your relative is experiencing significant pain or difficulty putting weight on one leg, make an urgent appointment with their doctor or visit the emergency room.

Note that some of these symptoms could lead to a diagnosis other than a broken hip.

“Torn hamstrings and fractures of the pelvis are often detected upon examination that may have originally presented as or [were assumed to be] a hip fracture,” says Dr. Lawrence Samuels, a radiologist based in Chattanooga, Tennessee.

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Often, a hip fracture can be diagnosed through a physical examination. However, your loved one’s doctor may request imaging tests such as X-rays, MRIs, or CT scans to confirm the diagnosis or learn more about the fracture.

Here’s what you can expect for each type of test:

• Physical examination. Your loved one’s doctor will check their body to make sure there aren’t other injuries. They’ll check the leg and thigh for abnormalities. “Often, the injured leg will appear shorter, or twisted in an abnormal position,” says Dr. Samuels. “The doctor may inspect sensation and circulation as well, if the patient indicates there’s pain or is unable to lift the affected leg or bear weight.”
• X-ray. If the physical examination is inconclusive, your loved one’s doctor may order an X-ray, which is how most hip fractures are diagnosed. An X-ray can help determine the type of fracture a patient has.
• MRI scan. “If clinical suspicion of a fracture remains strong despite negative results on an X-ray, a doctor may order more advanced imaging — especially in patients with osteoporosis, severe arthritis, or inability to achieve normal X-ray positioning,” says Dr. Samuels.

If your aging parent has a hip fracture, they’ll most likely need surgery, a hospital stay, and rehabilitation to help heal a broken hip. The type of surgery your loved one will have depends on their overall health condition and age, the type of fracture, and its severity.

Here’s some more information about types of hip fractures:^[05]

• Femoral neck fracture. The femoral neck is right below the ball part of the ball-and-socket hip joint in the upper part of the thigh bone (femur). This type of fracture can reduce or stop the flow of blood to the broken part of the bone. Surgery is almost always needed to facilitate a broken hip recovery.
• Intertrochanteric region fracture. An intertrochanteric region fracture is a subcategory of femoral neck fractures. The intertrochanteric region is just below the femoral neck, where the thigh bone juts out. “What we refer to as a hip fracture usually means femoral neck fracture — it’s the bone, not the actual hip joint,” says Dr. Samuels.

Depending on the type of fracture, methods of hip surgery in elderly adults include:^[04]

• Hip repair using screws. This type of hip surgery in elderly adults uses metal screws to hold together the broken bone. In some cases, a metal plate is placed on the femur with screws attached to it.
• Partial hip replacement. In a partial hip replacement, the doctor replaces the head and neck of the femur with a metal device. A partial hip replacement might be recommended when the patient has other health conditions that could affect broken hip recovery, or if they’re experiencing cognitive impairment that could lead to another fall.
• Total hip replacement. If your loved one needs to have a total hip replacement, the upper part of the femur and the socket in the pelvic bone will be replaced with artificial parts.

Can a hip fracture heal on its own without surgery?

A hip fracture usually can’t heal on its own. In rare instances, doctors may recommend hip fracture treatment without surgery. Your loved one might not need surgery if the bone is fractured but remains in place.

Also, surgery might not be recommended for seniors whose quality of life would be negatively affected by an operation. For example, patients who are too sick to endure it, who were unable to walk before the fracture occurred, or who are terminally ill may not benefit from hip surgery.^[06] In these cases, treatment consists of pain management, physical therapy, and different techniques to avoid straining and putting weight on the affected hip.

Recovery after hip surgery is a lengthy process — it’ll take some time to return to everyday activities. Your loved one will likely stay in the hospital for a few days after surgery. Physical and occupational therapy for broken hip recovery may start while your parent is still at the hospital.

Physical therapists can develop a program for your loved one to help them strengthen muscles and improve balance and mobility. Occupational therapists focus on activities of daily living that allow your parent to live as independently as possible. They may also need home care after hip replacement surgery. For more intensive rehabilitation, seniors may need a short-term stay in a skilled nursing facility or rehab center.

If your loved one’s hip fracture has left them unable to live on their own, or if they need additional assistance to prevent future falls, it may be time to consider assisted living or another type of senior living community. Reach out to one of A Place for Mom’s Senior Living Advisors if you’re interested in one of these options. They can help guide you through the senior living search, answer questions about nearby communities, and schedule tours, all at no cost to you.

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