Older adults living in economically disadvantaged neighbourhoods spend significantly fewer days at home in the year following a fall-related hip fracture than those in more affluent areas, according to an extensive national study published in JAMA Network Open. The findings highlight how recovery after a significant injury is shaped not only by medical care, but also by the social and physical conditions of the places where people live.
The researchers analysed Medicare data from more than 52,000 older adults who experienced a hip fracture. After accounting for individual factors such as age and chronic illness, they found that people living in the most economically disadvantaged neighbourhoods spent an average of 23 fewer days at home in the year after their injury compared with those in the least disadvantaged areas. Instead, they spent more time in skilled nursing facilities or long-term care settings, suggesting slower or more complicated recoveries.
The study’s senior author, Jason R. Falvey, Associate Professor of Physical Therapy and Rehabilitation Science at the University of Maryland School of Medicine, emphasised that neighbourhood context is often overlooked in hip fracture research. He noted that older adults in highly disadvantaged areas face multiple barriers to recovery, including limited access to rehabilitation services, fewer supports for caregivers, and environmental challenges such as damaged pavements that restrict safe mobility. Together, these factors make it harder for individuals to regain independence after injury.
To assess neighbourhood disadvantage, the researchers used the Area Deprivation Index, a national measure that incorporates income, education, employment, and housing quality. Participants living in the most deprived neighbourhoods were more likely to belong to racial or ethnic minority groups and to be dually eligible for Medicare and Medicaid—these overlapping forms of disadvantage point to broader structural inequalities that extend well beyond the hospital setting.
The findings matter because hip fractures are life-changing events and a leading cause of disability and loss of independence in older adults. “Days at home” is a patient-centred measure that captures quality of recovery, reflecting independence, well-being, and the ability to age in place. The study shows that even when medical factors are similar, place-based disadvantage reduces the likelihood of spending time at home after surgery, underscoring the role of environment in shaping outcomes.
The researchers argue that improving recovery after hip fracture will require action beyond clinical care alone. For clinicians, this means considering neighbourhood and social factors when planning discharge and rehabilitation. For health systems and policymakers, it points to the need for investment in community-based supports, transportation, caregiver resources, home health services, and safer neighbourhood infrastructure. Future research will focus on developing care models that address these barriers and help more older adults recover and remain at home, regardless of where they live.
More information: Alyssa M. Baginski et al, Neighborhood Deprivation and Days Spent at Home After Fall-Related Hip Fracture, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2025.49118
Journal information: JAMA Network Open Provided by University of Maryland School of Medicine
