Functional Outcomes After Hip Fracture Before and During the COVID-19 Pandemic in Adults Aged 65 Years and Older: A Retrospective Comparative Study

Background: The coronavirus disease (COVID-19) pandemic substantially altered the social environment and activity levels of older adults, potentially affecting their functional recovery following hip fractures. This study examined whether the pandemic influenced functional outcomes in adults aged ≥65 years admitted to a convalescent rehabilitation ward after hip fracture surgery. Methods: We retrospectively reviewed patients aged ≥65 years admitted to our rehabilitation ward after hip fracture surgery between January 2016 and December 2022. Patients were classified into two groups based on the date of injury: prepandemic (2016–2019) and pandemic (2020–2022). The functional Independence Measure (FIM) motor, cognitive, and total scores were calculated at discharge and compared between the two groups stratified by pre-injury living arrangements (home or facility). We also assessed baseline characteristics including age, sex, fracture type, surgical procedure, preoperative waiting time and length of hospital stay, to identify potential confounders. Results: Among the 650 eligible patients (median age, 85 years; 551 women), 357 sustained fractures before the pandemic and 293 during the pandemic. No significant differences were observed between the two groups in terms of age, sex distribution, fracture type, surgical procedure, or length of postoperative hospital stay. The preoperative waiting time was slightly shorter during the pandemic. The median motor FIM score at discharge decreased from 75 (prepandemic) to 71 (pandemic) in the overall cohort (p = 0.017) and from 78 to 75 among patients who lived at home before injury (p = 0.029). No significant differences were observed in cognitive or total FIM scores. The decline in motor FIM scores was significant among women but not among men. Conclusions: Functional recovery after hip fracture, as measured by the motor FIM score at discharge, significantly declined during the COVID-19 pandemic, particularly among older adults who lived at home before the injury. This decline likely reflects reduced pre-injury physical and ADL capacity resulting from lifestyle restrictions during the pandemic, rather than differences in in-hospital care. These findings highlight the long-term impact of societal restrictions on physical function in older adults and underscore the importance of maintaining opportunities for physical activity and rehabilitation even during public health crises.