Place of residence and risk of fracture in older people: a population-based study of over 65-year-olds in Cardiff

Abstract

Fracture prevention strategies will be most cost-effective if targeted on groups of frail elderly people who are at particularly high risk of falls and fractures. Elderly people living in care homes are one potential target population, but fracture incidence in this setting remains poorly defined in many countries. We used the All Wales Injury Surveillance System (AWISS) in a population-based study of people aged over 65 years living in the city of Cardiff. We linked a postcode-based register of all sheltered accommodation and all residential and nursing homes in the city with injury data from Cardiff's single Accident and Emergency Department. Cardiff has 47,700 residents aged over 65 years with 1918 (4.0%) living in residential or nursing homes and 1868 (3.9%) in sheltered accommodation. In 1999 we identified a total of 1305 fractures including 366 hip fractures, giving a crude fracture incidence of 27.4/1000 per year and 7.7/1000 per year, respectively. Care home residents suffered 213 fractures, 95 of which were of the hip, giving a crude fracture incidence of 111.1/1000 per year and 49.5/1000 per year, respectively. People living in sheltered accommodation suffered 94 fractures, including 28 at the hip, giving a crude fracture incidence of 51.4/1000 per year and 15.3/1000 per year, respectively. People in care homes and sheltered accommodation tend to be older than those living in the community, and we adjusted for this by calculating age- and gender-standardized relative ratios for each setting. Compared with the community dwelling population, care home residents had an overall fracture risk of 2.9 (95% CI 2.5-3.3) and a hip fracture risk of 3.3 (95% CI 2.6-4.2). People in sheltered accommodation had a total fracture risk of 1.7 (95% CI 1.4-2.1), and a hip fracture risk of 1.6 (95% CI 1.1-2.4). Such figures support the potential cost-effectiveness of strategies that seek to prevent fractures in care homes and sheltered accommodation, and are of special interest to those planning intervention studies in these settings.

Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis

“…Furthermore, application of hip protectors in nursing homes by staff may be considered an important cointervention, not available in other group residence settings; this issue could be another contributor to clinical heterogeneity of pooled analyses of mixed populations. The nursing home population was of greatest clinical interest, as this population is known to be at extremely high risk for osteoporosis [14][15][16], falls [17], cognitive impairment (leading to falls and hip fracture) [16], and hip fracture [18][19][20].…”

Ocorrência de quedas em idosos residentes em instituições de longa permanência em Pelotas, Rio Grande do Sul, Brasil

“…Estudos internacionais realizados com idosos em instituições de longa permanência apresentaram diferentes freqüências de quedas como nos Estados Unidos 42,9% (34.163 idosos em 437 instituições) 9 e 49% (462 idosos em 56 instituições) 10 , no Canadá 10,6% (14.744 idosos em 71 instituições) 11 , na Austrália 11% (2.005 idosos em 81 instituições) 12 no Japão 12,5% (746 idosos em 10 instituições) 13 , no Chile 24% (453 idosos em 8 instituições) 14 , na Colômbia 36% (116 idosos em uma instituição) 15 e em Cuba 78% (23 idosos em uma instituição) 16 . Do mesmo modo, os estudos brasileiros apresentam 40% (105 idosos em 4 instituições) em São Paulo 17 , 64,6% (312 idosos em um asilo) na Bahia 18 , e o Instituto Nacional de Traumato-Ortopedia (INTO) 19 faz uma estimativa de 50% de quedas de idosos residentes em instituições asilares brasileiras.…”

Socioeconomic and living conditions are determinants of hip fracture incidence and age occurrence among community-dwelling elderly

“…First, the inclusion of institutionalized elderly may bias the relationship between area-level socioeconomic indicators and risk of hip fracture in oldest old populations. Nursing homes, where the risk of hip fracture is much greater because of higher prevalence of physical and mental impairments [18,19], may be located in rich or poor areas. Furthermore, because of place restrictions in nursing homes, some of the oldest persons (30% in Geneva between 1995 and 2000) [20] had to leave the districts where they had lived for a long time when they moved to a nursing home.…”