Recent evidence demonstrates that severe injury in older adults is associated with prolonged risks of mortality and institutionalization, highlighting the importance of long-term functional outcomes such as ageing in place. While current trauma care models primarily emphasize physical recovery and frailty status, emerging research suggests that cognitive processing, psychological resilience, and emotional regulation also play significant roles in recovery trajectories among older patients. Studies on cognitive frailty indicate strong associations with mortality, disability, and fall risk, while longitudinal findings after hip fracture show that depressive symptoms and cognitive status influence frailty progression over time. Furthermore, resilience has been consistently linked to successful ageing across physical and psychosocial domains. Integrating medical psychology perspectives into geriatric trauma pathways-through early psychological screening, cognitive-support interventions, and resilience-oriented rehabilitation-may help improve long-term independence and community dwelling among older trauma survivors. A biopsychosocial extension of current trauma care models is therefore warranted to optimize outcomes in ageing populations following severe injury.

This Letter to the Editor responds to Erdogan-Yildirim et al.'s review on the psychological and behavioral consequences of physical injuries after road traffic crashes. While the review highlights posttraumatic stress symptoms, driving-related avoidance, trauma-focused cognitive behavioral therapy, and virtual reality-based exposure, the operational integration of these components into post-crash rehabilitation requires further clarification. The novelty of this perspective lies in reframing recovery as a staged transition from physical healing to psychological readiness. We propose that virtual reality-based CBT may reduce post-crash psychological distress by modifying catastrophic driving-related appraisals, decreasing avoidance behavior, and strengthening driving self-efficacy through graded, therapist-guided driving simulations. This approach could be embedded after medical stabilization through early psychological screening, brief CBT, controlled virtual exposure, and gradual return-to-mobility planning. Future studies should test whether reduced driving avoidance and improved self-efficacy mediate psychological recovery after road traffic crashes.

Pathologic hip fractures present complex challenges and are associated with higher postoperative complication rates and mortality compared with non-pathologic fractures. This study aimed to compare 30-day outcomes between pathologic and non-pathologic hip fracture patients and identify factors associated with 30-day mortality and postoperative complications among patients with pathologic hip fractures using the National Surgical Quality Improvement Program database. A retrospective analysis was conducted from 2006 to 2023. Patients aged ≥ 18 years undergoing hip fracture surgery were included. Patients with non-pathologic hip fractures were compared with those with pathologic hip fractures. Univariate analyses and multivariable logistic regression models were used to identify factors associated with pathologic hip fracture 30-day mortality and complications. Among 204,675 hip fracture patients, 6159 (2.9%) had pathologic hip fractures. Patients with pathologic hip fractures had higher rates of 30-day mortality (7.8% vs. 5.1%, p < 0.001), any postoperative complication (35.3% vs. 30.2%, p < 0.001), cardiac/transfusion complications (27.5% vs. 22.2%, p < 0.001), renal complications (0.5% vs. 0.3%, p = 0.017), and venous thromboembolic complications (3.4% vs. 1.7%, p < 0.001). Infectious complications and neurological complications were not significantly different between groups. In multivariable analyses, prominent protective factors associated with decreased 30-day mortality included absence of disseminated cancer (aOR 0.4, p < 0.001), independent functional status (aOR 0.2, p < 0.001), and absence of sepsis history (aOR 0.4, p = 0.02). Thrombocytopenia (aOR 1.9, p < 0.001) and anemia (aOR 1.9, p < 0.001) were prominent risk factors for 30-day mortality. Thrombocytopenia and anemia were also significant risk factors for any complications and cardiac/transfusion complications. These findings underscore the importance of comprehensive preoperative assessment and multidisciplinary care to optimize outcomes for patients with pathologic hip fractures. Patients with multiple risk factors for adverse postoperative morbidity and mortality should receive appropriately tailored care.