Functional Fallout: Short-Term Outcomes Following Hip Fracture in Patients Aged 90 and Over at a United Kingdom District General Hospital

Introduction Hip fractures in patients aged ≥90 years pose distinct clinical and functional challenges due to advanced frailty and limited physiological reserve. While long-term outcomes are well documented in the elderly, short-term discharge-related functional outcomes remain underexplored in nonagenarians. This study evaluated post-operative mobility decline, discharge needs, and early mortality in this high-risk cohort. Methods We retrospectively reviewed 84 patients aged ≥90 years who underwent surgical fixation for radiologically confirmed hip fractures between August 2024 and April 2025 at a United Kingdom District General Hospital. Demographics, American Society of Anaesthesiologists (ASA) grade, fracture type, operative method, mobility (pre- and post-operative), discharge destination, length of stay, return to theatre, and 30-day mortality were analysed. Functional decline was defined as a drop in ordinal mobility score from baseline to discharge. Institutionalisation was defined as discharge to a care facility (rehabilitation, residential home, or nursing home) due to a decline in functional mobility. Results The mean age was 92.9 years (range 90-102); 69% were female. Intracapsular fractures comprised 57% of cases. Most patients (84.5%) were ASA grade 3. Hemiarthroplasty was the most common procedure (59.5%), followed by dynamic hip screws (21.4%), nail fixation (17.9%), and total hip replacement (1.2%). Functional mobility declined in 78% of patients and remained unchanged in 21%. Only one patient (1.2%) retained full independence. At discharge, 25% used a frame independently, 37% required one-person (AO1), and 16% required two-person (AO2) assistance. Thirty-day mortality was 8.3%; return to theatre occurred in 4.8%. Mean length of stay was 18.2 days. Discharge destinations included home (32%), rehab (26%), residential home (19%), and nursing home (13%). Institutionalisation due to mobility decline occurred in 41% of patients. Patients previously independent pre-fracture experienced the greatest average decline in mobility score (-2.35). Conclusion Hip fracture in nonagenarians is associated with high rates of early functional decline and institutionalisation. Despite established multidisciplinary care, outcomes suggest the need for age-specific discharge planning, tailored rehabilitation, and proactive functional risk stratification to support recovery.