Retirement timing, living arrangements and mental health: a multi-method investigation using Survey of Health, Ageing and Retirement in Europe.

Hip fracture is a common condition in the older adult population and is frequently associated with prolonged hospitalization and high mortality rates [,]. The high prevalence of comorbidities and reduced cardiopulmonary reserve in geriatric patients create substantial challenges for perioperative anesthetic management [,]. Severe perioperative pain is common, and although oral or intravenous analgesics are typically used as first-line therapy, increased drug sensitivity and susceptibility to adverse effects in this population necessitate safer and more tolerable analgesic strategies [–]. Despite their effectiveness in pain control, the use of opioids is often restricted due to a range of established adverse effects, such as gastrointestinal symptoms, altered mental status, and respiratory suppression [,]. Regional anesthesia techniques reduce opioid consumption, lower pain scores, and facilitate postoperative mobilization; therefore, they are frequently preferred over systemic opioid-based regimens [,]. In the emergency department setting, a recent randomized controlled trial demonstrated that ultrasound-guided femoral nerve block provides superior analgesia, reduces rescue opioid requirements, and is associated with fewer adverse effects compared with intravenous opioid analgesia in patients with hip fracture, including those with cognitive impairment []. However, conventional regional approaches for hip analgesia, including femoral nerve block and fascia iliaca block, may not consistently provide adequate analgesia of the hip joint capsule and can be associated with quadriceps weakness, potentially delaying postoperative mobilization and functional recovery [,]. As a relatively novel regional anesthesia technique, the ultrasound-guided pericapsular nerve group (PENG) block targets the articular branches of the femoral, obturator, and accessory obturator nerves by depositing local anesthetic in the musculofascial plane between the psoas tendon and the pubic ramus [,]. Clinical studies suggest that the PENG block provides effective analgesia with minimal motor impairment in patients with hip-related pain; however, the extent and consistency of its clinical benefits remain under investigation [,].