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Fractures after nursing home admission: incidence and potential consequences

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Abstract

Summary

Fracture rates were examined in residents newly admitted to nursing homes. The risk of a fracture was highest during the first months after admission and declined thereafter. This risk pattern was observed independently of fracture site, gender or degree of care need.

Introduction and hypothesis

Residents of nursing homes are a high-risk group for fractures. The aim of the study was to analyse fracture rates as a function of time from admission to nursing home.

Methods

Fractures of the upper limb, femur, pelvis and lower leg, time to first and subsequent fractures, age, gender and care needs at admission were measured in 93,424 women and men aged 65 years and over and newly admitted to nursing homes in Bavaria between 2001 and 2006.

Results

Fracture incidence was highest during the first months after admission to nursing homes and declined thereafter. This pattern was observed for all fracture sites, in women and men and in residents with different care needs. For example, fracture rates of the upper limb declined from 30.0 to 13.5/1,000 person-years in the first 9 months after admission and for all fracture sites from 135.3 to 69.4/1,000 person-years in a corresponding time period.

Conclusion

Newly admitted residents have the highest fracture risk. The pattern of risk is similar across all fractures, suggesting a generic causal pathway. Implementation of effective fracture prevention efforts should be a priority at the time of admission to nursing homes.

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Acknowledgements

We thank Regina Merk-Bäuml, Ralf Brum, Johannes Laws-Hofmann, Gerhard Dahlhoff, Otto Gieseke, Michaela Heil, Stefanie Dörfler and Markus Gindl from the Allgemeine Ortskrankenkasse (AOK) and Ulrich Rissmann from the Robert-Bosch-Hospital, Stuttgart for the admission to the data and for the support of our analyses.

Conflicts of interest

None.

Funding

The analysis was supported by a grant of the Forschungskolleg Geriatrie of the Robert-Bosch Foundation and by the Bundesministerium für Bildung und Forschung (Förderkennzeichen: 01EL0702, 01EL0717, 01EL0718).

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Correspondence to K. Rapp.

Appendix

Appendix

Table A (Corresponds to Fig. 1a): Incidence rate of all fractures combined (admitted to hospital) and of femoral fractures (admitted to hospital) as a function of time since admission to a nursing home in the cohort of residents admitted to nursing homes in Bavaria between 2001 and 2006
Table B (Corresponds to Fig. 1b): Incidence rate of fractures of the upper limb and the lower limb (except femur; admitted to hospital) as a function of time since admission to a nursing home in the cohort of residents admitted to nursing homes in Bavaria between 2001 and 2006
Table C (corresponds to Fig. 2a): Incidence rate of all fractures combined (admitted to hospital) stratified by gender as a function of time since admission to a nursing home in the cohort of residents admitted to nursing homes in Bavaria between 2001 and 2006
Table D (Corresponds to Fig. 2b): Incidence rate of all fractures combined (admitted to hospital) stratified by care need (level of care) as a function of time since admission to a nursing home in the cohort of residents admitted to nursing homes in Bavaria between 2001 and 2006

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Rapp, K., Lamb, S.E., Klenk, J. et al. Fractures after nursing home admission: incidence and potential consequences. Osteoporos Int 20, 1775–1783 (2009). https://doi.org/10.1007/s00198-009-0852-y

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  • DOI: https://doi.org/10.1007/s00198-009-0852-y

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