Nocturia and Nighttime Falls in Older Adults With Hip Fractures: A Retrospective Observational Study

Hip fractures in older adults are associated with significant morbidity and mortality. Nocturia is a common but under-recognized symptom in this population and may contribute to increased nighttime fall risk. This study aimed to examine the relationship between nocturia severity and nighttime falls among older adults with hip fractures and to evaluate associated clinical and biochemical factors.

This retrospective observational study included 491 patients aged ≥55 years who underwent surgery for hip fractures between 2019 and 2024. Data were obtained from medical records and a structured questionnaire administered prior to hospital discharge or during follow-up. Patients were categorized into three nocturia groups: none, moderate (1 void/night), and severe (≥2 voids/night). Demographic, clinical, and laboratory parameters (including electrolytes and renal function) were analyzed. Univariate comparisons and multivariate logistic regression were performed to identify independent factors associated with nighttime falls.

Overall, 76.8% of patients reported at least one nocturnal void, and 44.2% had severe nocturia. Nighttime fall incidence increased with nocturia severity (20.4% in the non-nocturia group, 37.3% in moderate, and 40.6% in severe; P < .001). In multivariate analysis, male sex (OR = 1.56, 95% CI: 1.04-2.35), lower serum potassium (OR = 0.58, 95% CI: 0.36-0.94), moderate nocturia (OR = 3.17, 95% CI: 1.70-5.93), severe nocturia (OR = 3.94, 95% CI: 2.21-7.04), and lower serum calcium (OR = 0.65, 95% CI: 0.45-0.93) were independently associated with nighttime falls. Age, renal function, and serum sodium were not significant factors.

Nocturia, particularly at moderate and severe levels, is independently associated with nighttime falls in older adults with hip fractures. Male sex and mild disturbances in potassium and calcium were also associated with the occurrence of nighttime falls. Our results highlight the importance of incorporating nocturia assessment and basic biochemical screening into comprehensive fall-risk evaluation and prevention strategies in geriatric orthopedic care.