Management of hip fracture in older adults with cognitive impairment: a narrative review

Background: Hip fractures in older adults are costly and often fatal. Cognitive impairment (CI) complicates pain assessment, raises delirium risk, and hinders early mobilization and rehabilitation. This review synthesizes recent evidence on postoperative care, covering epidemiology, mechanisms, delirium, rehab, outcomes, and practical bedside strategies. Methods: A narrative review was performed to inform postoperative management of older adults hip-fracture patients with CI. PubMed and Web of Science were searched from 2018 to 2025 using MeSH and free-text terms for hip fracture, cognitive dysfunction/dementia/MCI, and rehabilitation, delirium, perioperative care, orthogeriatrics, and outcomes. Only English-language human studies were included. CI was defined by DSM-5/ICD-10 dementia, Petersen MCI, or MMSE