Background <p>Hip fractures have a significant impact on morbidity and mortality in older adults, often leading to loss of function and an increased healthcare burden. The role of geriatric co-management in improving postoperative outcomes remains controversial. This meta-analysis evaluates the impact of geriatric care on functional recovery, complications, length of hospital stay, and one-year mortality in older patients with hip fractures.</p> Methods <p>A meta-analysis was conducted according to PRISMA guidelines. Randomized controlled trials (RCTs) and prospective cohort studies comparing standard orthopedic care with geriatric co-management were included. The primary outcomes examined were one-year mortality, functional independence (Barthel ADL scores, independent walking), length of hospital stay and postoperative complications (delirium, infections, falls).</p> Results <p>Six RCTs with 1,780 patients (894 geriatric care, 886 standard care) were analyzed. Geriatric care was associated with improved ADL scores (Cohen’s d = 0.066, 95% CI 0.027–0.105) and a 19% higher rate of independent walking (RR = 1.19, 95% CI 1.092–1.288). The length of hospital stay was reduced by 1.39 days (95% CI − 1.98 to − 0.80). Complication rates decreased slightly (− 3.60%), but no significant reduction in one-year mortality was observed (− 2.26%). Heterogeneity was high for functional outcomes (I² = 99.91%) and LOS (I² = 99.99%).</p> Conclusions <p>Geriatric care improves short-term functional outcomes, reduces complications and shortens hospital stay in elderly patients with hip fractures. However, its impact on one-year mortality is limited. Standardized geriatric care models and further research on long-term recovery strategies are needed to optimize outcomes.</p>