Deaths from broken bones in older adults

Sometimes, a simple broken bone for an older adult can result in severe injury and even death, and this can be confusing to younger people who can often make a full recovery from the same injury. Here, we are exploring the reasons why some older people can die from a broken bone, the chain reaction that happens after a fracture, the highest-risk fractures an older person can experience, the key factors that increase mortality risk, how caregivers can help prevent broken bones in older loved ones, and how they can provide the right care.

At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For over 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about broken bones in an older person, we can help.

Why do older people sometimes die from a broken bone?  

It can be difficult to imagine why older people might die from something as simple as a broken bone, but this can cause a chain reaction of health issues that are more challenging to recover from in older age. These include: 

• A higher likelihood of accompanying chronic health conditions, such as diabetes, that can be exacerbated after a broken bone.
• An increased likelihood of developing a blood clot due to limited mobility following an accident.
• An increased likelihood of catching pneumonia or another infection while recovering in hospital – research indicates the most important factors in healing are blood supply, the characteristics of the fracture, and the incidence of infections. 
• Pressure sores (due to immobility) that can become infected.
• Further weakened muscles due to inactivity, and an associated loss of independence, leading to a decline in overall health.
• Underlying conditions such as heart disease that complicate healing and recovery – a 2013 study of 58 patients with fractures found 3.6% died within 30 days of a fracture, and 7.5% of them died within 90 days of a fracture, most frequently due to cardiovascular issues. 
• Stress from surgery, which can trigger a decline in health.

Generally, older adults tend to lack the strength and health to recover from an injury as quickly as younger people do, so this may take them longer due to complications. 

“I had a hip fracture after a fall at home. It was very painful and I was very nervous about walking around again after the operation. But the physiotherapists helped me get out of bed straight after surgery and came to see me every day. They helped me get my strength back and I’m now back home and doing well.”

– William, aged 74, via the National Institute for Health and Care Excellence

Although there are many more risks for older people when it comes to broken bones, it is important to remember this is not always the case. There are ways to prevent injuries, and to manage them if they do happen in order to keep an older person in the best health possible until they can get back on their feet.

What are the stages of a fracture that could lead to an older person dying? 

Initial Trauma Impact  

Broken bones are usually painful in the moment, and this initial trauma can be more severe in older people due to:

• Pain –The initial impact may also be challenging for those who struggFe to communicate their discomfort, such as older adults with cognitive issues or dementia. They may feel pain or that something is wrong, but are unable to tell their caregiver. 
• Shock – Shock can manifest in different ways, and in older people, they may get such a fright from a broken bone that even if they do fully heal, they may become more cautious, hesitant and fearful of moving around independently. 
• Fracture-related blood loss – In major fractures, there could be issues such as internal bleeding, blood loss or low blood pressure, all of which can have immediate health implications and need to be addressed straight away, particularly if they have additional chronic health conditions. 
• Fat embolism syndrome – This is where fat from the bone marrow enters the bloodstream after a break in the bone. This is more common in long bones or in the pelvis, and they can be dangerous if they travel to the lungs or the brain. 

Hospitalisation Dangers  

Spending prolonged time in hospital can increase the risk of infections for anyone, and this is especially dangerous for older people with weaker immune systems. Whether a general infection from spending time in hospital, or a postoperative infection, this can cause a lot of issues for an older person. 

Pneumonia is one of the most common hospital-acquired infections in older people; around 1.5% of hospital patients will get pneumonia, and research finds that older age means a person is more likely to develop pneumonia while in hospital. Many factors can influence the chances of developing pneumonia, such as:

• The need for catheters and other post-surgery devices 
• Having pre-existing chronic health conditions like chronic obstructive pulmonary disease (COPD), which older people are also more likely to have
• Sarcopenia (a natural muscle decline that happens with age), which makes older adults 2.62x more likely to develop postoperative pneumonia

Studies suggest hospitalisation, surgery requirements and immobility can all contribute to an older person developing infections like pneumonia or sepsis, which can cause further complications and potential death. 

These risk factors when entering hospital mean that a broken bone in an older person must be carefully monitored and managed to reduce the likelihood of developing the above issues, and keep them as healthy and strong as possible while they recover. 

Immobility Complications  

One of the primary reasons an older person’s health can significantly decline after a broken bone is due to associated immobility or severely limited mobility, as it can be difficult for them to move around with a broken bone, and could potentially be dangerous. Rest, either in bed or in a comfortable chair, is usually recommended in order to reduce pain and discomfort following a broken bone, but this can lead to additional complications, such as:

• A risk of pressure ulcers, which are skin wounds that develop from prolonged pressure on the area when lying down for a prolonged period of time, and they can become infected if not managed and treated. As older skin is often thinner and takes longer to fully heal, ulcers can become a problem for this age group. In a 2022 review of studies involving 8,956 patients, prevalence of pressure injuries was 20.4% in fracture patients, and 23.9% in spinal and hip fracture patients.
• A risk of deep vein thrombosis (DVT), for which older adults are already more susceptible. This happens when a blood clot forms in the leg due to poor circulation after a period of inactivity, and it can be life-threatening if it makes its way to the lungs and causes a pulmonary embolism, which is thought to be fatal in around 1 in 7 people. Even if this does not occur, research suggests around 33% of people with a blood clot will have a secondary clot within 10 years, so DVT could cause long-term problems for those with mobility issues. 

Safe and supported movement as soon as possible (under the instruction of a doctor or physiotherapist) is usually the best way to minimise these risks, and taking preventive measures with tools such as pressure relief cushions and blood-thinning medications can help older people avoid pressure sores and DVT.

Health and Mental Health Decline  

Generally, immobility for an extended period of time can lead to weakened muscles, and since older people already suffer from sarcopenia, this can lead to a faster decline in strength, balance, and ultimately a decline in their independence. Loss of muscle mass is known to happen quickly for older adults on bedrest; according to a 2024 study, while a typical rate is 2-5% decline in muscle mass each day of not walking, in older people, this is significantly higher, so they may lose up to 10% of their muscle mass in just 7 days of immobility.

Cardiac deconditioning is another major concern for those spending long hours at rest due to a broken bone. When physical activity is reduced, an older person’s heart can become less efficient, which affects their stamina and increases their risk of complications such as fatigue or shortness of breath. Frailty is associated with heart failure in some cases. 

In addition to the physical implications of prolonged immobility, an older person’s mental health may suffer after a broken bone due to isolation, loneliness, loss of independence, and worries about their future health. They may have concerns that they will never regain the abilities they had previously, leading to anxiety and depression. For this reason, companionship and mental health support can be just as vital to an older person’s recovery as physiotherapy and health monitoring.

What are the key factors that increase mortality risk in older people with a broken bone?  

To summarise, there are several key factors that increase risk of mortality in older adults following a broken bone, and it is often a combination of these factors that leads to diminished health and mental health. These factors include:

• Having a pre-existing condition such as chronic obstructive pulmonary disease (COPD), heart disease or diabetes
• Post-surgery hospital-acquired infections like pneumonia
• Poor nutrition which can make healing slower, reduce the effectiveness of the immune system, and increase vulnerability to things like pressure ulcers – vitamin D and calcium deficiencies could impact older adults and cause slower healing   
• Delayed treatment due to late diagnosis or a long wait for surgery – previously recorded NHS wait times resulted in poorer outcomes due to some patients being referred to fracture clinics but having to wait up to 2 weeks to be seen
• Cognitive factors such as existing dementia – dementia exacerbates an older person’s vulnerability and increases their risk of fractures, and dementia patients are thought to be more likely to experience delirium in hospital, and more likely to die after a fracture than those without cognitive decline
• Challenges with medication adherence, especially in those who live with dementia and cannot easily communicate their needs, increasing their risk of complications
• Social circumstances such as living alone with little or no support or aftercare, or the cost of living affecting their nutrition choices – without support, an older person with a broken bone may be unable to attend physiotherapy appointments or stick to nutritional requirements, increasing their mortality risk
• Extreme stress from the injury – stress can impact the person’s motivation to take steps to improve, and their mental health

How to prevent fractures

1 in 10 falls is thought to result in some form of injury that leads to restricted activities for at least one day. If you are concerned about how well a loved one will cope with a broken bone, you can channel this worry into practical methods of prevention, such as getting regular bone density scans (DEXA scans) to identify osteoporosis early. This can help to access treatments like medications, advise on appropriate supplements, and encourage older people to take more caution. Regular scans are particularly important for postmenopausal women and those with additional risk factors. The Royal Osteoporosis Society has a helpful bone health checklist if you have questions, and you can learn more in our guide to understanding osteoporosis T score.

Caregivers can also help by making home adaptations and modifications to help prevent falls, which are one of the main causes of fractures in older people. This may mean installing grab rails in bathrooms, removing trip hazards, making it easier to see with improved lighting, or installing a stair lift. You can learn more in our guide to home adaptations for disabled elderly people.

Other ways to prevent fractures include: 

• Encouraging fitness, particularly strength and balance exercises to improve muscle mass and stability, and reduce the chances of a fall
• Encouraging a healthy, balanced diet with adequate protein intake for muscle maintenance, and calcium and vitamin D for bone strength
• Getting regular vision checks to avoid falls due to poor eyesight
• Getting regular medication reviews to avoid side effects like dizziness
• Making sure older adults always wear sturdy footwear to support fall prevention
• Understanding how to help an older person who falls, such as not trying to move them straight away – you can learn more in our guide on what to do if an elderly person falls.

How to treat fractures in the elderly

Immediate post-fracture care for older adults is so important for their recovery and to avoid complications. 

1. In the first 72 hours, the focus should be on managing pain effectively and resting to mentally recover from the shock. Initial treatment for fractures such as a broken hip will include painkillers to manage pain, an X-ray to assess the extent of the damage, and in some cases, surgery to treat the fracture by adding plates or pins where needed, or by inserting an artificial hip. Pressure relief strategies should begin straight away to avoid pressure ulcers, which means frequent repositioning and using pressure-relieving cushions or mattresses.
2. In weeks 1 and 2, and especially in the days after surgery, deep vein thrombosis (DVT) could be a concern, so it is essential to prevent this with blood-thinning medications, and as much movement as is safely possible. 
3. In the first month and beyond, the focus should be on gradually increasing the weight on the affected area to improve mobility, under the guidance of a doctor or physiotherapist, and regular mobility training exercises to restore function to as close to normal as possible. Data suggests early physical activity can reduce mortality risk after fractures.

How can home care help older adults with broken bones?

Patients who receive home-based care after a fracture are thought to be less likely to be hospitalised, so this could have many benefits for those who are unable to take care of themselves following an accident. During recovery from a broken bone, home care may be essential for an older person’s health, confidence, and mental health as they work through the phases of healing. Caregivers can help with:

• Providing personal care if the person cannot do this independently 
• Housekeeping while the person is unable to maintain their home 
• Overnight care to take over from family caregivers if the person needs support during the night
• Respite care to give family caregivers longer breaks 
• Postoperative recovery if the person is transferred home to rest after surgery 
• Catheter care for those who cannot get up to the bathroom at all 
• Regular repositioning and wound care to manage pressure ulcers and avoid infections 
• Mobility support as they start to move around independently again, to prevent falls 
• General companionship and support for the unique mental health challenges that come with reduced mobility 
• Monitoring for signs of complications like deep vein thrombosis (DVT) or infections like pneumonia 

Our experienced Care Professionals can provide dedicated, personalised care at home for those who have suffered a fracture, and help to minimise the chances of complications or further accidents. With home care, you can help your older loved one to recover in the place where they feel most safe and comfortable. For the support you need, reach out to your local Home Instead office to discuss your options.

We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.