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

## TL;DR

This study examines how orthopedic trauma affects mortality in Turkish centenarians and finds that higher frailty scores are unexpectedly linked to better survival.

## Contribution

The study reveals a paradoxical protective effect of frailty scores on mortality in centenarians following trauma, challenging current frailty conceptualizations.

## Key findings

- Hip fractures were the most common trauma in centenarians, with 76.8% of patients dying during the study period.
- Higher frailty scores were paradoxically associated with reduced mortality at 30, 90, and 365 days post-trauma.
- Frailty, as measured by CIHI-HFRM and mFI-5, was not a risk factor but appeared protective in long-term survival.

## Abstract

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.

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.

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).

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.

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The online version contains supplementary material available at 10.1007/s00068-026-03137-0.