Clinical Audit of Hip Fracture Management in Elderly Patients (Aged 70 Years and Above): A Focus on Improving Standards of Care

Background: Hip fractures in the elderly constitute a significant public health burden in India, with reported in-hospital mortality of 3.8% and morbidity rates of up to 40%. The concept of comprehensive orthogeriatric care is largely absent across India, particularly in rural and semi-urban settings, where management remains predominantly fracture-centric. This gap is compounded by the catastrophic out-of-pocket healthcare cost burden faced by patients in low- and middle-income countries, a critical shortage of trained geriatric and rehabilitation personnel, and the near-total absence of dedicated orthogeriatric infrastructure. This audit evaluates compliance with evidence-based care standards at a Level 1 trauma center in Hyderabad and highlights the urgent need for a nationally coordinated orthogeriatric care framework in India. Materials and Methods: A retrospective clinical audit was conducted on 86 patients aged 70 years and above who sustained a hip fracture and were admitted to Sunshine Hospitals, Secunderabad, between January 1 and December 31, 2022. Key audit parameters included time to admission, pain assessment, comorbidity optimization, time to surgery, early mobilization, nutritional and cognitive assessment, bone mineral density (BMD) evaluation, and fall prevention measures. Results: The mean patient age was 77.4 years (range 70–90 years); 56 of 86 patients were female. All 86 patients received analgesics on admission; however, formal pain documentation was inconsistent. Only 52% underwent surgery within 48 h of admission, 31% within 72 h, and 17% beyond 72 h. Comorbidities were present in 84% of patients (20% with one, 64% with two or more). BMD assessment was not performed in any patient. Fall risk assessment was not documented in any case. Significant gaps were identified in the documentation of cognitive function, prefracture ambulatory status, and the cause of the fall. Conclusion: Management of hip fractures in the elderly requires a coordinated multidisciplinary orthogeriatric approach that goes beyond fracture fixation. Critically, the deficiencies identified in this audit were observed at a Level 1 trauma center with substantial resources, underscoring the scale of the problem at district and rural hospitals across India. There is an urgent need for national-level awareness and policy action to establish comprehensive orthogeriatric care as the standard of practice in India, to improve the quality of life and reduce preventable mortality in this population. Comprehensive orthogeriatric care is the need of the hour.