Neighborhood disadvantage shapes recovery after hip fracture

Older adults who live in economically disadvantaged neighborhoods spend significantly fewer days at home in the year after a fall-related hip fracture than those living in more affluent areas, according to a large national study published today in JAMA Network Open.

The study analyzed Medicare data from more than 52,000 older adults who experienced a hip fracture. Researchers found that people living in the most disadvantaged neighborhoods spent about 23 fewer days at home during the year after their injury compared with those in the least disadvantaged areas after considering individual factors such as age or chronic illnesses. 

"Neighborhood context is a critical determinant of health, but it's often overlooked in hip fracture research," said study senior author Jason R. Falvey, DPT, PhD, Associate Professor of Physical Therapy and Rehabilitation Science at the University of Maryland School of Medicine. "Older adults in neighborhoods like West Baltimore face compounded challenges-limited ability to get to rehabilitation services, fewer supports for caregivers, and neighborhood factors like broken sidewalks that impede mobility. These realities make it harder to regain independence after a hip fracture."

Using the Area Deprivation Index (ADI)-a national measure capturing factors such as income, education, employment, and housing quality-the researchers categorized patients' neighborhoods by level of economic deprivation. Those in the most deprived neighborhoods were also more likely to identify as members of racial or ethnic minority groups and to be dually eligible for Medicare and Medicaid.

"These findings point to the urgent need for community-tailored recovery programs and policy interventions that go beyond hospital walls," added Dr. Falvey, who is also Director of the School's Center for Disability Justice. "By investing in community-level resources, caregiver supports, and safe neighborhood infrastructure, we can help more older adults recover and age in place no matter where they live"

Why it matters

• Hip fractures are life-changing. They are one of the leading causes of disability and loss of independence in older adults.

• Home time reflects quality of recovery. Days spent at home is a patient-centered measure that captures independence, well-being, and the ability to age in place. People in more disadvantaged areas spent more time in skilled nursing facilities and long-term care settings.

• Place matters. Even after accounting for age and health conditions, people from more disadvantaged neighborhoods spent less time at home after surgery.

Q&A

Why is this study important?

Because it shows that recovery after a serious injury isn't just about medical care - it's also about where someone lives. Two people with the same injury and surgery can have very different recoveries depending on their neighborhood resources and supports.

What does "days at home" actually mean?

It's the number of days a person is alive and not in a hospital, nursing home, or other care facility. It's a simple way to measure independence and quality of life after a major health event.

What are the implications for health care providers?

Clinicians should consider neighborhood and social factors when planning recovery after a hip fracture. That could include earlier referrals to community resources, better coordination of post-hospital care, and tailored rehabilitation plans.

What does this mean for health systems and policymakers?

The findings suggest that improving recovery after hip fracture will require more than medical treatment alone. Investments in community-based supports, transportation, home health services, and neighborhood infrastructure could help more older adults recover at home.

What's next?

The researchers say future work should focus on designing care models that account for neighborhood conditions and address barriers that prevent older adults from safely aging in place after injury.