Clinical studies often face the difficult problem of how to account for participants who die without experiencing the study outcome of interest. In a geriatric population with considerable comorbidities, the competing risk of death is especially high. Traditional approaches to describe risk of disease include Kaplan-Meier survival analysis and Cox proportional hazards regression, but these methods can overestimate risk of disease by failing to account for the competing risk of death. This report discusses traditional survival analysis and competing risk analysis as used to estimate risk of disease in geriatric studies. Furthermore, it illustrates a competing risk approach to estimate risk of second hip fracture in the Framingham Osteoporosis Study and compares the results with traditional survival analysis. In this example, survival analysis overestimated the 5-year risk of second hip fracture by 37% and the 10-year risk by 75% compared with competing risk estimates. In studies of older individuals in which a substantial number of participants die during a long follow-up, the cumulative incidence competing risk estimate and competing risk regression should be used to determine incidence and effect estimates. Use of a competing risk approach is critical to accurately determining disease risk for elderly individuals and therefore best inform clinical decision-making. J Am Geriatr Soc 58: 783-787, 2010.

OBJECTIVES-To identify risk factors for indoor and outdoor falls. DESIGN-Prospective cohort study. SETTING-MOBILIZE Boston, a study of falls etiology among community-dwelling older individuals.PARTICIPANTS-765 women and men, mainly of age 70 years and older, from randomly sampled households in the Boston MA area.MEASUREMENTS-Baseline data were collected by questionnaire and comprehensive clinic examination. During follow-up participants recorded falls on daily calendars. A telephone interview queried the location and circumstances of each fall. RESULTS-598indoor and 524 outdoor falls were reported over a median follow-up of 21.7 months. Risk factors for indoor falls included older age, being female, and various indicators of poor health. Risk factors for outdoor falls included younger age, being male, and being relatively physically active and healthy. For instance, the age-and gender-adjusted rate ratio (and 95% confidence interval) for having much difficulty or inability to perform activities of daily living relative to no difficulty was 2.57 (1.69-3.90) for indoor falls, but 0.27 (0.13-0.56) for outdoor Conflict of Interest:The authors have no conflicts of interest to report. Dr. Hannan had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.Author Contributions: The corresponding author affirms that everyone who contributed significantly to this paper is listed. JLK helped conceive and design the study, led the data analyses and the preparation of the manuscript. SDB helped conceive and design the study, and contributed to the analyses and preparation of the manuscript. EP-G contributed to the data preparation and analyses as well as preparation of the manuscript. LQ contributed to statistical analyses and contributed to the preparation of the manuscript. UN contributed to statistical analyses and contributed to the preparation of the manuscript. WL led the statistical analytic work and contributed to the preparation of the manuscript. DPK contributed to the operations of the study, study data collection and contributed to the preparation of the manuscript. LAL contributed to analytic interpretations and contributed to the preparation of the manuscript. preparation. MTH helped conceive and design the study, and contributed to the analyses and preparation of the manuscript. All authors read and approved the final manuscript. NIH Public Access

Falls are common in the elderly, and frequently result in injury, disability, and institutionalization. Although the causes of falls are complex, most falls result from an interaction between individual characteristics that increase an individual's propensity to fall and acute mediating risk factors that provide the opportunity to fall. Predisposing risk factors include age-associated changes in strength and balance, age-associated comorbidities such as osteoarthritis, visual impairment and dementia, psychotropic medications, and certain footwear. Fewer studies have focused on acute precipitating factors, but environmental and situational factors are clearly important to the risk of falls. Approximately 30% of falls result in an injury that requires medical attention and with fractures occurring in approximately 10% of falls. Fractures associated with falls are multi-factorial in origin. In addition to the traditional risk factors for falls, the fall descent, fall impact, and bone strength are all important determinants of whether a fracture will occur as a result of an event. In recent years, numerous studies have been directed toward the development of effective fall and fall-related fracture prevention interventions.

Background: Older persons with hip fractures remain at increased risk of subsequent hip fractures. However, little is known about the frequency and characteristics of persons who sustain a second hip fracture. Methods: Participants included 481 members of the Framingham Heart Study who sustained an initial hip fracture between April 1952 and December 31, 2003. Participants were followed up until a second hip fracture, death, dropout, or study completion. Age, sex, falls, stroke, dementia, residence, recent weight change, body mass index, and functional status were considered potential predictors of a second hip fracture. Results: During a median of 4.2 years of follow-up, 71 subjects (14.8%) experienced a second hip fracture. Following a first hip fracture, 2.5% of subjects experienced a second hip fracture within 1 year, and 8.2% of subjects (9.7% of women) experienced a second hip fracture within 5 years. One-year mortality following an ini

Objective To describe clinical characteristics and risk factors associated with coronavirus disease 2019 (COVID-19) in long-stay nursing home residents. Design and Participants Retrospective cohort study (March 16, 2020 to May 8, 2020). Setting Academic long-term chronic care facility (Boston, MA). Participants Long-term care residents. Methods Patient characteristics and clinical symptoms were obtained via electronic medical records and Minimum Data Set. Staff residence was inferred by zip codes. COVID-19 infection was confirmed by polymerase chain reaction testing using nasopharyngeal swabs. Residents were followed until discharge from facility, death, or up to 21 days. Risks of COVID-19 infection were modeled by generalized estimating equation to estimate the relative risk (RR) and 95% confidence intervals (CI) of patient characteristics and staff community of residence. Results Overall 146 of 389 (37.5%) long-stay residents tested positive for COVID-19. At the time of positive test, 66 of 146 (45.5%) residents were asymptomatic. In the subsequent illness course, the most common symptom was anorexia (70.8%), followed by delirium (57.6%). During follow-up, 44 (30.1%) of residents with COVID-19 died. Mortality increased with frailty (16.7% in pre-frail, 22.2% in moderately frail, and 50.0% in frail; P < .001). The proportion of residents infected with COVID-19 varied across the long-term care units (range: 0%‒90.5%). In adjusted models, male sex (RR 1.80, 95% CI 1.07, 3.05), bowel incontinence (RR 1.97, 95% CI 1.10, 3.52), and staff residence remained significant predictors of COVID-19. For every 10% increase in the proportion of staff living in a high prevalence community, the risk of testing positive increased by 6% (95% CI 1.04, 1.08). Conclusions and Implications Among long-term care residents diagnosed with COVID-19, nearly one-half were asymptomatic at the time of diagnosis. Predictors of COVID-19 infection included male sex, bowel incontinence, and staff residence in a community with a high burden of COVID-19. Universal testing of patients and staff in communities with high COVID-19 rates is essential to mitigate outbreaks.

Stürze von Senioren lassen sich nur vermeiden, wenn man deren Ursachen und die Umstände kennt. Aber nur selten ist jemand dabei, und die Betroffenen selbst geben nur die subjektive Wahrnehmung wieder. Kanadische Wissenschaftler installierten daher in Altersheimen Videokameras für eine objektive Sturzanalyse.

Background: Presently a median of 37.5% of the U.S. skilled nursing facility (SNF) workforce has been vaccinated for COVID-19. It is essential to understand vaccine hesitancy among SNF workers to inform vaccine campaigns going forward.Objective: To describe the concerns raised among healthcare workers and staff from SNFs during town hall meetings.Design: Sixty-three SNFs from four corporations were invited to send Opinion Leaders, outspoken staff from nursing, nurse aid, dietary, housekeeping or recreational therapy, to attend a 1-h virtual town hall meeting. Meetings used a similar format where the moderator solicited concerns that the attendees themselves had or had heard from others in the facility about the COVID-19 vaccine. Physicians and moderators used personal stories to address concerns and reaffirmed positive emotions.Setting: Twenty-six video town hall meetings with SNF staff.Participants: Healthcare workers and staff, with physicians serving as content experts.Measurement: Questions and comments about the COVID-19 vaccines noted by physicians.Results: One hundred and ninety three staff from 50 facilities participated in 26 meetings between December 30, 2020 and January 15, 2021. Most staff reported getting information about the vaccine from friends or social media.Concerns about how rapidly the vaccines were developed and side effects, including infertility or pregnancy related concerns, were frequently raised. There were no differences in concerns raised by discipline. Questions about returning to prior activities after being vaccinated were common and offered the opportunity to build on positive emotions to reduce vaccine hesitancy.Conclusions: Misinformation about the COVID-19 vaccine was widespread among SNF staff. Sharing positive emotions and stories may be more effective than sharing data when attempting to reduce vaccine hesitancy in SNF staff.

In addition to pre-fracture characteristics, potentially modifiable post-fracture complications including pressure ulcer and pneumonia were associated with increased mortality in nursing home residents with hip fracture. Prevention strategies to reduce pressure ulcers and pneumonia may help reduce mortality in this frail population.