Emergency Department Encounters Preceding Hip Fracture in Older Adults: A Window for Future Risk Identification

Objectives To describe the frequency of prior emergency department (ED) encounters before hip-fracture encounters among older adults in the United States (US). Methods This was a retrospective descriptive study of US older adults aged 65 to 110 years (January 1, 2016 to December 31, 2025) using Epic Cosmos. We identified hip-fracture encounters and evaluated the proportion with an ED encounter in the preceding 12 months, overall and stratified by demographic characteristics. Results Among 1,873,342 hip fracture-encounters representing 1,355,249 distinct patients, 37.2% had ≥ 1 ED encounter in the prior 12 months. This proportion increased with age: (≥65 to <75, 34.7%; ≥75 to <85, 36.8%; ≥85, 39.4%). Proportions slightly varied by sex (women 36.7% vs men 38.5%, and other/unknown 21.0%), by ethnicity (Hispanic/Latino 35.5%, non-Hispanic/Latino 38.1%, nonclassified 31.7%), and by region (37.5% South, 32.6% West, 40.1% Midwest, 36.4% Northeast, and 36.6% in regions not otherwise classified). Conclusion ED encounters frequently preceded older adults' hip fractures. These findings may help inform future studies examining opportunities for earlier identification of vulnerable older adults.