Recommendations for preventing fracture in long-term care

Abstract

• In older adults living in long-term care (residents), fractures cause pain, agitation, immobility and transfers to hospital.• Residents identified as being at high risk of fracture include those with prior fracture of the hip or spine, those with more than one prior fracture and those with one prior fracture and recent use of glucocorticoids.• Recommendations for preventing fracture in long-term care were developed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, with consideration of the quality of the available evidence, the balance between benefits and harms, the preferences of residents and their care providers, and the resources required to implement the recommendations.• Strategies to prevent fractures, including vitamin D and calcium supplementation, use of hip protectors, exercise, multifactorial interventions to prevent falls and pharmacologic therapies, should be tailored to each resident's level of fracture risk, mobility, life expectancy, renal function and ability to swallow.

Treatment of Osteoporosis in Australian Residential Aged Care Facilities: Update on Consensus Recommendations for Fracture Prevention

“…Our recommendations closely correspond with those recently published in Canada. 74 Although there are substantial differences between the Canadian and the Australian RACFs, we all agree that only by increasing awareness on the consequences of osteoporotic fractures in this population, we will generate an important change in practice with a major impact on quality of life in this high-risk population. Care Home Falls Screen (CaHFRIS).…”

Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002–2012

“…Both smoking cessation and an increase in body weight, in particular, have been suggested as lifestyle factors that may have a demonstrable impact on fracture risk [39]. In LTC, vitamin D supplementation is the only intervention that has been shown to decrease the rate of falls [40] and is recommended for fracture prevention, particularly those at high risk [41]; we have previously reported a considerable increase in vitamin D prescribing in LTC across the province during the study time period [42].…”

“…The osteoporosis care gap in LTC reflects the uncertainty many clinicians have regarding fracture risk assessment and optimal management of osteoporosis in LTC residents [46]. To address these concerns, osteoporosis guidelines targeting care for the frail elderly living in LTC were recently completed [41]. Improving uptake of evidence-based care in both the community and LTC is imperative to realizing further declines in fracture rates.…”

An evaluation of a walking and socialization program in long-term care: Impact on injurious falls

“…Various risk factors for falls have been described 2 , of which some, such as age may not be modifiable, but others, such as the use of psychotropic medications 3 , low levels of vitamin D 4 and rates of inactivity 5 , can be modified. With respect to vitamin D, while effects of vitamin D have not been consistently found with respect to fall rate or risk, there is moderate-quality evidence to recommend vitamin D supplementation in the LTC setting 6 , especially in those with low vitamin D status 7 . Depressive symptoms have also been reported to be independent risk factors for falls 8 through various mechanisms which include fear of falling, weight loss, and sleep fragmentation 9 .…”