Impacts of Dementia on In-Hospital Outcomes and Discharge Dispositions Following HIP Fracture Surgery in a Rural Appalachian Population

Hip fracture in the elderly is widely recognized as a sentinel event, yet the trajectory of care following fracture may differ substantially based on cognitive status. This study evaluated whether dementia significantly impacts the outcomes of patients with hip fractures at a rural level 1 trauma center and whether dementia patients follow a distinct post fracture care trajectory. A retrospective cohort analysis was performed including 2391 patients aged >65 years admitted with hip fractures from 2017 to 2024. Dementia patients were significantly less likely to be discharged home and more likely to be discharged to hospice. Combined mortality (morgue + hospice) was higher in the dementia group. Advance directive documentation was extremely low in both cohorts. Dementia is associated with worse outcomes following hip fracture, including higher end of life care utilization and reduced likelihood of discharge home. In a rural Appalachian setting where post acute resources are limited, these divergent care trajectories underscore the critical need for early goals of care discussions and may influence operative decision-making for this vulnerable population.