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Comparing Frailty and Traditional Risk Models in Predicting 6-Month Mortality After Hip Fracture in Older Adults: A
Merve Güner1,2, Eda Ural Karaman3, Yavuz Şahbat4,5
1Division of Geriatric Medicine, Erzurum City Hospital, Ministry of Health, Erzurum 25240, Türkiye.
Journal of Clinical Medicine
|July 28, 2026
Summary
Frailty assessment using the Clinical Frailty Scale (CFS) better predicts 6-month mortality in hip fracture patients than traditional risk scores. This finding supports integrating frailty into care planning for better outcomes.
Area of Science:
- Geriatric Medicine
- Orthopedic Surgery
- Epidemiology
Background:
- Hip fractures carry significant mortality risk, influenced by age, comorbidities, and frailty.
- Traditional risk models include American Society of Anesthesiologists (ASA) classification, Hip Fracture Estimator of Mortality of Amsterdam (HEMA), and Nottingham Hip Fracture Score (NHFS).
- The predictive value of frailty assessment against these traditional models for mortality after hip fracture requires further investigation.
Purpose of the Study:
- To compare the 6-month mortality prediction accuracy of frailty assessment (Clinical Frailty Scale - CFS) against established risk models (ASA, HEMA, NHFS) in hip fracture patients.
- To evaluate the role of frailty in medium-term prognosis following hip fracture surgery.
- To determine if incorporating frailty assessment improves risk stratification for hip fracture patients.
Main Methods:
- Retrospective analysis of 164 patients with hip fractures (femoral neck or intertrochanteric) treated surgically.
- Data collected included demographics, comorbidities, and surgical details; 6-month survival determined via Turkish Death Registry.
- Frailty status retrospectively assessed using the Clinical Frailty Scale (CFS) from electronic medical records.
Main Results:
- The 6-month mortality rate was 31.1% in the study cohort (n=51).
- Clinical Frailty Scale (CFS) significantly predicted increased mortality risk (HR: 4.465, p < 0.001).
- CFS demonstrated superior predictive performance (AUC: 0.879) compared to ASA, HEMA, and NHFS for 6-month mortality.
Conclusions:
- Frailty assessment using CFS offers stronger discrimination for medium-term mortality prediction post-hip fracture than traditional risk scores.
- Integrating CFS assessment with existing perioperative risk evaluation can enhance risk stratification.
- Improved risk stratification supports better orthogeriatric care planning and postoperative management for high-risk hip fracture patients.