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Risk Factors Associated with the Occurrence of Fractures in U.S. Nursing Homes: Resident and Facility Characteristics and Prescription Medications

(See editorial comments by Drs. Magaziner, Miller, and Resnick on pp 464–466)

Authors

  • William Spector PhD,

    1. From the *Agency for Healthcare Research and Quality, Rockville, MDPeter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MarylandDepartment of Health and Human Services, Rockville, MD§Social and Scientific Systems, Silver Spring, Maryland.
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  • Thomas Shaffer MHS,

    1. From the *Agency for Healthcare Research and Quality, Rockville, MDPeter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MarylandDepartment of Health and Human Services, Rockville, MD§Social and Scientific Systems, Silver Spring, Maryland.
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  • D. E. B. Potter MS,

    1. From the *Agency for Healthcare Research and Quality, Rockville, MDPeter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MarylandDepartment of Health and Human Services, Rockville, MD§Social and Scientific Systems, Silver Spring, Maryland.
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  • Rosaly Correa-de-Araujo MD,

    1. From the *Agency for Healthcare Research and Quality, Rockville, MDPeter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MarylandDepartment of Health and Human Services, Rockville, MD§Social and Scientific Systems, Silver Spring, Maryland.
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  • M. Rhona Limcangco PhD

    1. From the *Agency for Healthcare Research and Quality, Rockville, MDPeter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MarylandDepartment of Health and Human Services, Rockville, MD§Social and Scientific Systems, Silver Spring, Maryland.
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Address correspondence to William Spector, PhD, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850. E-mail: William.Spector@ahrq.hhs.gov

Abstract

OBJECTIVES: To determine whether resident and facility characteristics and prescription medications influence the occurrence of fractures in nursing homes (NHs).

DESIGN: Panel study with 1-year follow-up.

SETTING: A nationally representative sample of NHs from the Medical Expenditure Panel Survey (MEPS).

PARTICIPANTS: Residents aged 65 and older who were in sample NHs on January 1, 1996.

MEASUREMENTS: Health status measures were collected from facility records and abstracted using a computer-assisted personal interview instrument. Fracture and drug data were updated every 4 months to provide a full year of information. Drug data were obtained from monthly medication administration records. The occurrences of fractures were obtained from medical records. Administered medications were classified using the Department of Veterans Affairs medication classification system. Facility characteristics were based on MEPS survey data collected from NH sources.

RESULTS: In 1996, 6% of residents in a NH at the beginning of the year experienced a fracture during their NH stay(s). Resident risk factors included aged 85 and older, admitted from the community, exhibited agitated behaviors, and used both wheelchair and cane or walker. Use of anticonvulsants, antidepressants, opioid analgesics, iron supplements, bisphosphonates, thiazides, and laxatives were associated with fractures. A high certified nurse aide ratio was negatively associated with fractures.

CONCLUSION: The findings indicate that fractures are associated with resident and facility characteristics and prescribing practices. It reaffirms the importance of medication review with special attention on opioid analgesics, antidepressants, and anticonvulsants to reduce the risk of fractures.

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