It is unrealistic to have elderly patients follow a restricted-weight-bearing protocol (Kammerlander et al 2018).
Restriction on weight bearing results in a decreased mobility level in elderly patients (Pfeufer et al 2019).
Therefore, procedures allowing for immediate weight bearing as tolerated with walking aids should be selected.
Elderly hip fracture patients need comprehensive preoperative evaluation and management, often involving multiple specialties, because of their frequent comorbidities and complications. Many institutions have implemented hip fracture co-management programs to ensure this coordinated care. Within this environment, guidelines for intervention are established, and the great majority of patients can be medically optimized to undergo operation within 24 hours. It should be rare to require delays of more than 48 hours.
Anticoagulation presents an additional variable. Some medications can be actively reversed, whereas others may need to metabolize. The need for continuous anticoagulation, the extent of the surgical intervention, and the type of anesthesia required will influence the timing of surgery.
Postoperatively, 20% or more of elderly patients with hip fractures will develop at least one medical complication. The frequency of complications is predictably higher in those patients with more severe comorbidities, and they have expectedly higher risks of postoperative death. The involvement of anesthesia and medical consultants in the perioperative care (co-management) of these patients may improve results.
Routine perioperative care for the elderly hip fracture patient should include: