A Family Guide to Hip Fracture Surgery and the First Weeks of Recovery
Hip & Knee Orthopaedics
Sep 21, 2026
Non-Book Market
After a Fall: A Family Guide to Hip Fracture Surgery and the First Weeks of Recovery
The phone call usually comes without warning. A parent slipped in the bathroom, missed a step, or stood up too quickly and went down on one side. By the time the family reaches the hospital, the word "fracture" has already been said, and within hours someone is asking for consent to surgery.
A hip fracture is one of the most serious injuries an older adult can face, but it is also one that hospitals treat every day. Families who understand what happens next, and which decisions matter most, are in a much better position to help their loved one recover and stay independent.
Why hip fractures are so serious in later life
According to the Centers for Disease Control and Prevention, more than 300,000 older adults are hospitalized for hip fractures in the United States each year, and more than 95 percent of those fractures are caused by falling, usually sideways. Women account for about three quarters of hip fractures, largely because osteoporosis is more common and more advanced in older women.1
The fracture itself is fixable. What makes it dangerous is what can follow: time in bed, pain, confusion, infection and loss of strength. Studies consistently find that a significant share of older patients, often cited in the range of 20 to 30 percent, do not survive the first year after a hip fracture, and many survivors do not return to their previous level of mobility. Much of that risk is shaped by how quickly surgery happens and how quickly the patient starts moving again.
Why doctors move quickly to surgery
Almost every hip fracture in an older adult is treated with surgery, either by fixing the bone with screws, a plate or a rod, or by replacing part or all of the joint. Which option is chosen depends on where the break is and how the bone looks.
Timing matters as much as technique. Clinical guidelines from the American Academy of Orthopaedic Surgeons recommend surgery within 24 to 48 hours of hospital admission for most patients, because earlier surgery is associated with fewer complications and lower mortality.2 Clear explanations of the different fracture types and why the window matters, such as this overview of hip fracture treatment from an orthopedic practice, can help families follow what the surgical team is telling them in a stressful moment.
Families can help by having information ready: a current list of medications, especially blood thinners, any advance directive or health care proxy, and a sense of how active the person was before the fall. That baseline helps the team set realistic goals.
The first days in hospital
Most patients are helped out of bed the day after surgery, sometimes the same day. It can feel early and uncomfortable, but getting up quickly lowers the risk of pneumonia, blood clots and pressure sores, and it is one of the strongest predictors of how well someone walks later.
Watch closely for confusion. Delirium, a sudden change in attention and thinking, is common in older patients after hip fracture surgery and is often mistaken for dementia or simple tiredness. Familiar faces, glasses and hearing aids, a regular sleep routine, and good pain control all help. If your parent seems suddenly different, tell the nursing staff right away.
Choosing where recovery happens
After a few days in hospital, most patients move on to rehabilitation: an inpatient rehabilitation facility, a skilled nursing facility, or home with visiting therapy. The right choice depends on how much help is needed with walking, bathing and toileting, and on what support is available at home.
One Medicare rule catches many families by surprise. To qualify for Medicare coverage of a skilled nursing facility stay, the patient generally needs a qualifying inpatient hospital stay of at least three days. Time spent under "observation" status does not count, even if the patient was in a hospital bed. Ask the care team early whether your parent has been formally admitted as an inpatient.
Getting the home ready
Whether your loved one comes home in a week or a month, the house needs to work for someone using a walker. Remove loose rugs and cords, add night lights between the bedroom and bathroom, install grab bars by the toilet and in the shower, and consider a raised toilet seat and a shower chair. A sturdy chair with arms is easier to get out of than a low sofa. Keep the things used every day at waist height so nobody has to bend or climb.
Preventing the next fracture
Someone who has broken one hip is at higher risk of breaking the other, especially in the first year. Ask the doctor about a bone density assessment and whether osteoporosis treatment is appropriate, because it is often not started after a fracture even when it should be. Request a medication review, since some sleeping pills, blood pressure medicines and other drugs increase fall risk. Book an eye exam, check footwear, and look into a balance and strength program. The CDC's STEADI initiative offers free fall-prevention resources for older adults and caregivers.3
A long road, but a real one
Recovery from a hip fracture takes months, not weeks, and progress is rarely a straight line. But many older adults do walk again, return home and rebuild their confidence, especially when surgery is prompt, mobility starts early and family members stay involved. Your role is not to be the doctor. It is to ask good questions, keep the care team informed, and make the home and the routine safer, one step at a time.
References
Centers for Disease Control and Prevention. Facts About Hip Fractures. Atlanta: CDC.
American Academy of Orthopaedic Surgeons (2021) Management of Hip Fractures in Older Adults: Evidence-Based Clinical Practice Guideline. Rosemont, IL: AAOS.
Centers for Disease Control and Prevention. STEADI: Stopping Elderly Accidents, Deaths and Injuries. Atlanta: CDC.
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