Risk of Hip Fracture in Disabled Community-Living Older Adults

Authors

  • Louise C. Walter MD,

    1. Division of Geriatrics, San Francisco VA Medical Center,
      San Francisco, California;
    2. University of California at San Francisco, San Francisco, California;
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  • Li-Yung Lui MA, MS,

    1. Division of Geriatrics, San Francisco VA Medical Center,
      San Francisco, California;
    2. University of California at San Francisco, San Francisco, California;
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  • Catherine Eng MD,

    1. Division of Geriatrics, University of California at
      San Francisco, San Francisco, California; and
    2. On Lok Senior Health Services, San Francisco, California.
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  • Kenneth E. Covinsky MD, MPH

    1. Division of Geriatrics, San Francisco VA Medical Center,
      San Francisco, California;
    2. University of California at San Francisco, San Francisco, California;
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  • An abstract of this study was presented at the annual meeting of the Society of General Internal Medicine in Chicago, Illinois, May 2001.

Address correspondence to Louise C. Walter, MD, Division of Geriatrics, VA Medical Center 181G, 4150 Clement Street, San Francisco, CA 94121. E-mail: louisew@itsa.ucsf

Abstract

OBJECTIVES: To determine the rate of hip fracture and risk factors associated with hip fractures in disabled older persons who enroll in the Program of All-Inclusive Care for the Elderly (PACE), a program providing comprehensive care to community-living nursing-home-eligible persons.

DESIGN: Prospective cohort study between January 1990 and December 1997.

SETTING: The twelve PACE demonstration sites: San Francisco, California; Columbia, South Carolina; Detroit, Michigan; Denver, Colorado; East Boston, Massachusetts; El Paso, Texas; Milwaukee, Wisconsin; Oakland, California; Portland, Oregon; Rochester, New York; Sacramento, California; and the Bronx, New York.

PARTICIPANTS: Five thousand one hundred eighty-seven individuals in PACE; mean age 79, 71% female, 49% white, 47% with dementia.

MEASUREMENTS: Functional status, cognitive status, demographics, and comorbid conditions were recorded on all the participants, who were tracked for occurrence of a hip fracture. The goals were to determine the rate of hip fracture and identify risk factors.

RESULTS: Two hundred thirty-eight hip fractures (4.6%) occurred during follow-up. The rate of hip fracture was 2.2% per person-year. Four independent predictors of hip fracture were identified using Cox proportional hazard analysis: age of 75 and older (adjusted hazard ratio (HR) = 2.0, 95% confidence interval (CI) = 1.4–2.8); white ethnicity (HR = 2.1, 95% CI = 1.6–2.8); ability to transfer independently to and from bed, chair, and toilet (HR = 3.0, 95% CI = 1.2–7.2); and five or more Short Portable Mental Status Questionnaire errors (HR = 1.6, 95% CI = 1.3–2.1). The incidence of hip fracture ranged from 0.5% per person-year in persons with zero to one independent risk factors to 4.7% per person-year in those with all four independent risk factors.

CONCLUSIONS: The rate of hip fracture in this cohort of disabled community-living older adults was similar to that reported in nursing home cohorts. Older age, white race, ability to transfer independently, and cognitive impairment were independent predictors of hip fracture. Persons with these risk factors should be targeted for preventive interventions, which should include strategies for making transferring safer.

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