Emergency trauma admissions in the oldest-old: short- and long-term mortality and the role of frailty in a Turkish national cohort of centenarians.

Abstract

INTRODUCTION: This study aimed to evaluate the impact of orthopedic trauma on mortality among centenarians presenting to the emergency department, to examine the relationship between frailty and longevity, and to provide insights into post-trauma survival in long-lived individuals, as well as the role of frailty mechanisms. METHODS: Data were retrieved from the National Personal Health Record System (NPHRS) of Türkiye. The study included patients aged ≥ 100 years who presented to emergency departments with trauma between January 2016 and July 2024 across all levels of healthcare institutions. Frailty was assessed using the Canadian Institute for Health Information Hospital Frailty Risk Measure (CIHI-HFRM) and 5-factor modified frailty index (mFI-5) based on ICD-10 codes. Survival status was determined retrospectively from national death registry. RESULTS: A total of 1,180 patients were included, with a mean age of 101.3 ± 3.9 years. Hip fractures were the most frequent presentation, accounting for more than 40% of all cases. Overall, 906 patients (76.8%) died, with a median survival of 7.2 months (range: 0.1–51.1 months). Higher frailty scores according to the CIHI-HFRM were paradoxically associated with reduced mortality across follow-up intervals: 30-day (HR = 0.026, 95% CI: 0.006–0.118, p < 0.001), 90-day (HR = 0.091, 95% CI: 0.031–0.271, p < 0.001), and one-year mortality (HR = 0.084, 95% CI: 0.036–0.195, p < 0.001). CONCLUSION: Frailty, as defined by CIHI-HFRM and mFI-5, was not a risk factor for mortality at 30-, 90-, or 1-year follow-up; rather, it appeared protective. This paradoxical finding highlights the need to reconsider how frailty is conceptualized and measured in centenarians. LEVEL OF EVIDENCE: 3. This study examined the short- and long-term mortality in centenarians admitted to the emergency department with an orthopedic trauma between 2016 and 2024 via a national cohort. It was revealed that the most frequent trauma is hip fracture, and the presence of hip fracture is an independent predictor of mortality. Additionally, factors at the facility level played a role, indicating that the availability of higher resources and healthcare could significantly impact survival rates after injuries, especially at very advanced ages. In contrast to expectations, frailty, as defined by electronic health records, was associated with improved survival. This paradox suggests that frailty measurement methods cannot be able to detect biological and psychosocial resilience mechanisms, and highlights the need to reconsider how frailty is conceptualized and measured in centenarians.