Older adults living in economically disadvantaged neighborhoods spend fewer days at home following a hip fracture than those in more affluent areas, according to a new national study published in JAMA Network Open. The research analyzed Medicare data from over 52,000 older adults who suffered hip fractures and found that individuals residing in the most disadvantaged neighborhoods spent about 23 fewer days at home during the year after their injury compared to those from the least disadvantaged areas. This difference remained even after accounting for individual factors such as age and chronic illnesses.
"Neighborhood context is a critical determinant of health, but it's often overlooked in hip fracture research," said Jason R. Falvey, DPT, PhD, Associate Professor of Physical Therapy and Rehabilitation Science at the University of Maryland School of Medicine and senior author of the study. "Older adults in neighborhoods like West Baltimore face compounded challenges-limited ability to get to rehabilitation services, fewer supports for caregivers, and neighborhood factors like broken sidewalks that impede mobility. These realities make it harder to regain independence after a hip fracture."
The researchers used the Area Deprivation Index (ADI), which measures economic deprivation based on income, education, employment, and housing quality. They found that patients from highly deprived neighborhoods were also more likely to be members of racial or ethnic minority groups and dually eligible for Medicare and Medicaid.
"These findings point to the urgent need for community-tailored recovery programs and policy interventions that go beyond hospital walls," Dr. Falvey added. "By investing in community-level resources, caregiver supports, and safe neighborhood infrastructure, we can help more older adults recover and age in place no matter where they live"
The study highlights that recovery outcomes are influenced not only by medical care but also by neighborhood resources. The measure "days at home" refers to how many days an individual is alive outside hospitals or care facilities—a marker for independence after major health events.
For healthcare providers, the findings suggest considering social factors when planning post-hip fracture recovery—such as referring patients earlier to community resources or tailoring rehabilitation plans based on neighborhood conditions.
For policymakers and health systems leaders, improving outcomes may require investment beyond clinical treatment alone—including transportation options, home health services, community-based support programs, and improvements to local infrastructure—to enable more seniors to recover safely at home.
Researchers say future studies should focus on developing care models that address barriers posed by neighborhood disadvantage so older adults can better age in place after injury.
