Contemporary Management of Hip Fractures in Older Adults: Current Evidence and Guideline Updates

Abstract

Hip fractures are a major cause of morbidity, mortality, functional decline, and loss of independence among older adults, with the increasing prevalence of osteoporosis, frailty, sarcopenia, and falls contributing to their growing healthcare burden. Management of these fractures has evolved from an isolated surgical approach toward an integrated strategy involving early diagnosis, timely operative treatment, perioperative optimization, orthogeriatric co-management, complication prevention, and structured rehabilitation. This review summarizes current evidence and guideline-based approaches to the management of hip fractures in older adults, with emphasis on epidemiology, risk factors, fracture classification, initial assessment, preoperative optimization, surgical decision-making, perioperative care, and postoperative rehabilitation. Contemporary treatment options including internal fixation, hemiarthroplasty, total hip arthroplasty, sliding hip screws, and cephalomedullary nails are discussed according to fracture pattern, stability, bone quality, and patient-related factors. The review also highlights the importance of venous thromboembolism prophylaxis, multimodal analgesia, delirium prevention, early mobilization, nutritional support, osteoporosis management, and secondary fracture prevention. Current evidence supports timely surgery following appropriate medical optimization, together with multidisciplinary orthogeriatric care to reduce complications and facilitate functional recovery. Overall, an individualized, evidence-based and coordinated management pathway is essential to improve survival, mobility, independence, and quality of life following hip fracture in older adults.