Risk factors for hip fracture in older home care clients.

BACKGROUND Little information is available on hip fracture risks among community-dwelling persons receiving home care. Our aim was to identify risk factors for hip fracture from health information routinely collected for older home care clients. METHODS This was a cohort study involving secondary analysis of data on 40,279 long-stay (>60 days) home care clients aged 65 and older in Ontario, Canada; occurrence of hip fracture as well as potential risk factor information were measured using the Resident Assessment Instrument (RAI)/Minimum Data Set-Home Care assessment instrument. RESULTS In all, 1,003 clients (2.5%) had hip fracture on follow-up assessment. Older (85+ vs 65-74, relative risk [95% confidence interval]: 0.52 [0.43-0.64]) clients are at increased risk; males are at reduced risk [0.60 (0.51-0.70)]. Other risk factors include osteoporosis (1.19 [1.03-1.36]), falls (1.31 [1.15-1.49]), unsteady gait (1.18 [1.03-1.36]), use of ambulation aide (1.39 [1.21-1.59]), tobacco use (1.42, [1.13-1.80]), severe malnutrition (2.61 [1.67-4.08]), and cognitive impairment (1.30 [1.12-1.51]). Arthritis (0.86 [0.76-0.98]) and morbid obesity (0.34 [0.16-0.72]) were associated with reduced risk. Males and females demonstrated different risk profiles. CONCLUSIONS Important risk factors for hip fracture can be identified from routinely collected data; these could be used to identify at-risk clients for further investigation and prevention strategies.

[1]  Charlie H Goldsmith,et al.  Evaluation of easily measured risk factors in the prediction of osteoporotic fractures , 2005, BMC musculoskeletal disorders.

[2]  John P Hirdes,et al.  The MDS‐CHESS Scale: A New Measure to Predict Mortality in Institutionalized Older People , 2003, Journal of the American Geriatrics Society.

[3]  J. Chandler,et al.  Prediction of Fracture in Nursing Home Residents , 2002, Journal of the American Geriatrics Society.

[4]  C. L. Lewis,et al.  Characteristics of individuals who fell while receiving home health services. , 2004, Physical therapy.

[5]  G. Breart,et al.  Fall-related factors and risk of hip fracture: the EPIDOS prospective study , 1996, The Lancet.

[6]  S. Pocock,et al.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies , 2007, The Lancet.

[7]  J. Hirdes,et al.  Factors associated with pharmacologic treatment of osteoporosis in an older home care population. , 2007, The journals of gerontology. Series A, Biological sciences and medical sciences.

[8]  David A Hanley,et al.  2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary , 2010, Canadian Medical Association Journal.

[9]  S. Jaglal,et al.  The impact and consequences of hip fracture in Ontario. , 1996, Canadian journal of surgery. Journal canadien de chirurgie.

[10]  Aaron Aragaki,et al.  Frailty: Emergence and Consequences in Women Aged 65 and Older in the Women's Health Initiative Observational Study , 2005, Journal of the American Geriatrics Society.

[11]  Pamela J Schreiner,et al.  Long‐Term Prediction of Incident Hip Fracture Risk in Elderly White Women: Study of Osteoporotic Fractures , 2004, Journal of the American Geriatrics Society.

[12]  P. Meunier.  Prevention of hip fractures. , 1993, The American journal of medicine.

[13]  Rosaly Correa-de-Araujo,et al.  An operational definition of frailty predicted death, hip fracture, and hospitalization in older women. , 2006, ACP journal club.

[14]  S. Pocock,et al.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. , 2008, Journal of clinical epidemiology.

[15]  M. Law,et al.  A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect , 1997, BMJ.

[16]  O. Löfman,et al.  Health-related quality of life after osteoporotic fractures , 2004, Osteoporosis International.

[17]  A. Hofman,et al.  Hip Fracture Prediction in Elderly Men and Women: Validation in the Rotterdam Study , 1998, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[18]  H. Menz,et al.  Home environment risk factors for falls in older people and the efficacy of home modifications. , 2006, Age and ageing.

[19]  S. Cummings,et al.  Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. , 1995, The New England journal of medicine.

[20]  D. Kiel,et al.  An Epidemiologic Study of Fall‐Related Fractures Among Institutionalized Older People , 1995, Journal of the American Geriatrics Society.

[21]  Jacques P. Brown,et al.  2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. , 2002, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[22]  R. Cumming,et al.  Health status before and mortality after hip fracture. , 1996, American journal of public health.

[23]  H. Pols,et al.  Assessment of fracture risk: who should be treated for osteoporosis? , 2005, Best practice & research. Clinical rheumatology.

[24]  J. Wark,et al.  The effects of smoking on bone health. , 2007, Clinical science.

[25]  F. Connell,et al.  Hip Fracture Incidence in Nursing Home Residents and Community‐Dwelling Older People, Washington State, 1993–1995 , 2002, Journal of the American Geriatrics Society.

[26]  R. Wallace,et al.  Hip fracture risk among community-dwelling elderly people in the United States: a prospective study of physical, cognitive, and socioeconomic indicators. , 2006, American journal of public health.

[27]  John P Hirdes,et al.  Risk factors for falling among community-based seniors using home care services. , 2002, The journals of gerontology. Series A, Biological sciences and medical sciences.

[28]  N. Ikegami,et al.  Comprehensive Clinical Assessment in Community Setting: Applicability of the MDS‐HC , 1997, Journal of the American Geriatrics Society.

[29]  J N Morris,et al.  Development of a minimum data set-based depression rating scale for use in nursing homes. , 2000, Age and ageing.

[30]  John P Hirdes,et al.  Restriction in activity associated with fear of falling among community-based seniors using home care services. , 2004, Age and ageing.

[31]  C. Goldsmith,et al.  The association between iliocostal distance and the number of vertebral and non-vertebral fractures in women and men registered in the Canadian Database For Osteoporosis and Osteopenia (CANDOO) , 2002, BMC musculoskeletal disorders.

[32]  G. Onder,et al.  Minimum Data Set for Home Care: A Valid Instrument to Assess Frail Older People Living in the Community , 2000, Medical care.

[33]  J. Hirdes,et al.  The Method for Assigning Priority Levels (MAPLe): A new decision-support system for allocating home care resources , 2008, BMC medicine.

[34]  J. Cauley,et al.  Hip fracture in women without osteoporosis. , 2005, The Journal of clinical endocrinology and metabolism.

[35]  B E Fries,et al.  Integrated Health Information Systems Based on the RAI/MDS Series of Instruments , 1999, Healthcare management forum.

[36]  J. Eisman,et al.  Identification of High‐Risk Individuals for Hip Fracture: A 14‐Year Prospective Study , 2005, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[37]  Catherine Eng,et al.  Risk of Hip Fracture in Disabled Community‐Living Older Adults , 2003, Journal of the American Geriatrics Society.

[38]  L. Hartling,et al.  A population-based study of hospitalized injuries in Kingston, Ontario, identified via the Canadian Hospitals Injury Reporting and Prevention Program. , 1997, Chronic diseases in Canada.

[39]  D. Mehr,et al.  MDS Cognitive Performance Scale. , 1994, Journal of gerontology.

[40]  B E Fries,et al.  Scaling ADLs within the MDS. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[41]  Jacques P. Brown,et al.  What predicts early fracture or bone loss on bisphosphonate therapy? , 2003, Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry.

[42]  C. Maxwell,et al.  Treatment of osteoporosis in an older home care population , 2005, BMC musculoskeletal disorders.