Association between preoperative fear of falling and mortality after hip fracture surgery in older adults: a post-hoc analysis of a prospective cohort

Abstract Purpose To examine whether preoperative fear of falling, measured with the modified Falls Efficacy Scale (mFES), is associated with short-term (30-day) and long-term (3-year) postoperative mortality in older adults undergoing hip fracture surgery. Methods This post-hoc analysis was based on a prospective observational cohort study. Patients aged ≥ 65 years who underwent surgery for hip fractures between November 2018 and November 2019 were included. Fear of falling was assessed at admission using the mFES. All-cause mortality was assessed by telephone follow-up at 30-day, 120-day, 1-year, and 3-year after admission. Logistic regression and Cox proportional hazards models were used to evaluate the associations between mFES score and short-term and long-term mortality. Results A total of 1092 patients were enrolled. The median mFES score was 8.04 (IQR 5.75–10.00). In the multivariable logistic regression analysis, higher mFES scores were independently associated with lower odds of 30-day mortality (adjusted OR 0.780, 95% CI 0.625–0.974, P = 0.028). In the multivariable Cox proportional hazards model, higher mFES scores also remained independently associated with lower long-term mortality risk during the 3-year follow-up period (adjusted HR 0.925, 95% CI 0.874–0.979, P = 0.007). Conclusion Lower preoperative mFES scores were independently associated with increased postoperative mortality in older adults undergoing hip fracture surgery. The association was strongest for 30-day mortality, while a weaker but persistent association with long-term mortality was also observed over the 3-year follow-up period.