Association between preoperative fear of falling and mortality after hip fracture surgery in older adults: a post-hoc analysis of a prospective cohort.

PURPOSE: To examine whether preoperative fear of falling, measured with the modified Falls Efficacy Scale (mFES), is associated with short-term (30-day) and long-term (3-year) postoperative mortality in older adults undergoing hip fracture surgery. METHODS: This post-hoc analysis was based on a prospective observational cohort study. Patients aged ≥ 65 years who underwent surgery for hip fractures between November 2018 and November 2019 were included. Fear of falling was assessed at admission using the mFES. All-cause mortality was assessed by telephone follow-up at 30-day, 120-day, 1-year, and 3-year after admission. Logistic regression and Cox proportional hazards models were used to evaluate the associations between mFES score and short-term and long-term mortality. RESULTS: A total of 1092 patients were enrolled. The median mFES score was 8.04 (IQR 5.75-10.00). In the multivariable logistic regression analysis, higher mFES scores were independently associated with lower odds of 30-day mortality (adjusted OR 0.780, 95% CI 0.625-0.974, P = 0.028). In the multivariable Cox proportional hazards model, higher mFES scores also remained independently associated with lower long-term mortality risk during the 3-year follow-up period (adjusted HR 0.925, 95% CI 0.874-0.979, P = 0.007). CONCLUSION: Lower preoperative mFES scores were independently associated with increased postoperative mortality in older adults undergoing hip fracture surgery. The association was strongest for 30-day mortality, while a weaker but persistent association with long-term mortality was also observed over the 3-year follow-up period.