Frailty and Hip Fracture in Portugal: A Retrospective Single-Center Study Highlighting the Urgent Need to Expand Geriatric Care

Introduction and aim Proximal femoral fractures in older adults represent a growing public health challenge, associated with significant morbidity, mortality, frailty, and health costs. The study aimed to define the landscape of Portuguese orthogeriatric care and map pathways for future organizational improvement, education, and research; to characterize clinical and epidemiological features, frailty, fall mechanisms, and medication-related risks among older adults admitted with proximal femoral fractures to Portugal’s pioneer orthogeriatrics unit; and to identify system-level gaps requiring national action. The objective was to describe the clinical, functional, cognitive, and pharmacological profile of older adults with proximal femoral fractures treated in this unit and to contextualize these findings within international evidence to support expansion of geriatric and orthogeriatric services nationally. Methods A retrospective observational cohort of all patients aged ≥65 years admitted with proximal femoral fracture to the Unidade Local de Saúde de Gaia e Espinho (ULSGE) orthogeriatrics unit between 1 January and 31 December 2023 was analyzed. Comprehensive multidisciplinary geriatric assessment applied the following validated instruments: 4AT, Mini Nutritional Assessment (MNA), and social evaluation. Clinical Frailty Scale (CFS) and Charlson Comorbidity Index (CCI) were also performed. Polypharmacy was defined as ≥5 regular or potentially inappropriate medications (PIM); fall-risk-increasing drugs (FRIDs) were classified using the Beers Criteria and STOPP/START. Fall circumstances were categorized from patient/caregiver/eyewitness reports. Outcomes included in-hospital mortality and discharge destination. Results Among 230 admissions, the median age was 85 years (IQR: 80-89); 175 (76%) were women. Frailty was prevalent (140, 61% with CFS ≥5; 96, 42% with CFS 6-8), with substantial multimorbidity (mean CCI: 4.9). Cognitive vulnerability was frequent: 48 (21%) had probable delirium or severe impairment at admission, and 41 (18%) developed in-hospital delirium. Nutritional compromise: 55 (24%) malnourished, 106 (46%) at risk, and all with CFS ≥7 nutritionally compromised. Polypharmacy affected 183 (79.6%, mean: 7.2 drugs); FRID exposure was high (statins 120, 52%; PPIs 102, 44%; benzodiazepines 94, 41%; antipsychotics 61, 26%; loop diuretics 76, 33%). Falls were predominantly modifiable and extrinsic: hazardous home environments (64, 28%); imbalance/gait disturbance (44, 19%); non-adherence or improper use of mobility aids (29, 13%); postural instability (26, 11%). In-hospital mortality was two (0.87%); 150 (66%) were discharged home, 29 (13%) to rehabilitation units, and eight (3%) were newly institutionalized. Conclusion This orthogeriatric cohort demonstrates a high burden of frailty, malnutrition, cognitive impairment, and polypharmacy, together with modifiable environmental and medication‑related fall risks. The favorable in-hospital mortality supports the effectiveness of integrated orthogeriatric models compared to traditional wards. National priorities should include formal recognition of geriatrics, scale-up of orthogeriatric services beyond major cities, systematic nutrition and delirium pathways, and structured deprescribing programs targeting FRIDs to improve survival, function, quality of life, and equity of care for Portugal’s rapidly aging population.