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Background: Cognitive function of older people is not routinely assessed in orthopedic rehabilitation, after elective and non-elective surgery. The aim of this study was to assess cognitive impairment and its impact on both length of stay and functional outcomes, of older people admitted to orthopedic rehabilitation. Methods: Retrospective audit, inclusion criteria: aged &gt;65 years, orthopedic diagnosis, discharged from hospital. Results: 116 files were audited, mean age of 82.3 (SD = 7.5) years. Diagnostic groups: fractured neck of femur, (<i>n</i> = 44, 37.98%); elective surgery (<i>n</i> = 42, 36.21%); and other orthopedic conditions (<i>n</i> = 30, 25.86%). Overall 71.55% (<i>n</i> = 83) had cognitive impairment, with a median of mild cognitive impairment across all diagnoses. Both measures of cognition (MoCA/FIM Cognitive) were significantly associated with length of stay (<i>p</i> &lt; 0.01), function (<i>p</i> &lt; 0.05), and discharge destination (<i>p</i> = 0.01). Conclusions: A high percentage of older orthopedic patients in rehabilitation with both elective and non-elective diagnoses have cognitive impairment. Cognitive screening is recommended for all older orthopedic patients in rehabilitation, to inform an individualized rehabilitation plan to improve outcomes and length of stay. Further research is required to explore cognitive strategies to maximize rehabilitation outcomes in the geriatric orthopedic population.