Risk factors for hip fracture in very old people: a population-based study

Abstract

SummaryKnowledge of risk factors for hip fracture among very old people is limited. Walking indoors with help from ≤1 person, Parkinson’s disease, currently smoking, delirium in the previous month, underweight, and age were associated with increased risk of hip fracture and could be important for preventive strategy development.IntroductionThe purpose of this study is to investigate risk factors for hip fracture among a representative sample of very old people.MethodsIn total, 953 participants from the Umeå 85+/Gerontological Regional Database population-based cohort study were interviewed and assessed during home visits. Associations of baseline characteristics with hip fracture during the maximum 5-year follow-up period were analyzed using Cox proportional hazards regression.ResultsParticipants had a mean age of 89.3 ± 4.7 years; 65.8 % were women, 36.8 % lived in residential care facilities, 33.6 % had dementia, and 20.4 % had histories of hip fracture. During a mean follow-up period of 2.7 years, 96 (10.1 %) individuals sustained hip fracture. Walking indoors with help from no more than one person (hazard ratio [HR] = 8.57; 95 % confidence interval [CI], 1.90–38.71), Parkinson’s disease (HR = 5.12; 95 % CI, 1.82–14.44), currently smoking (HR = 4.38; 95 % CI 2.06–9.33), delirium in the previous month (HR = 2.01; 95 % CI, 1.15–3.49), underweight (body mass index <22; HR = 1.74, 95 % CI, 1.09–2.77), and age (HR = 1.09; 95 % CI, 1.04–1.14) were associated independently with an increased risk of hip fracture. Hip prosthesis at baseline decreased the risk of hip fracture (HR = 0.37; 95 % CI, 0.15–0.91), but only for those with bilateral hip prostheses.ConclusionsSeven factors were associated independently with incident hip fracture during follow-up in this sample of very old people. These factors could have important clinical implications in identifying persons at high risk of hip fracture, as well as in the development of effective preventive strategies.

Informed Consent to Research with Cognitively Impaired Adults: Transdisciplinary Challenges and Opportunities

“…Population-based studies in this country are limited secondary to lack of a high-quality national database, but other countries with similar socioeconomic structures suggest a bleak picture for older adults who sustain falls and concomitant fractures with dementia (Wiklund et al, 2015). Recently, it has been suggested that up to 90% of hospitalizations in patients with dementia are related to falls (Harvey, Mitchell, Brodaty, Draper, & Close, 2015).…”

“…Early outcomes are promising (Kelly & Kates, 2015), but long-term effects with meaningful functional outcomes are decidedly lacking, mostly secondary to study design. Many of these studies focus on cohorts of database-driven mortality results (Wiklund et al, 2015). Other studies are based on standard-of-care paradigm shifts in consecutive patient cohorts (Della Rocca et al, 2013), focusing on in-hospital mortality, complications, and re-admissions.…”

Ultrasound‐guided femoral nerve blocks are not superior to ultrasound‐guided fascia iliaca blocks for fractured neck of femur

“…Neck of femur and proximal femoral fractures predominantly occur in people over the age of 65, with a higher occurrence in older women . The presence of dementia is a significant issue in patients with hip fractures with 30–45% of this population having a diagnosis of dementia . Despite this, many randomised controlled trials investigating hip fractures have excluded patients with dementia and cognitive impairment …”

Community‐dwelling older men with dementia are at high risk of hip fracture, but not any other fracture: The Concord Health and Aging in Men Project

“…Several reports from different study populations have shown people with dementia and cognitive impairment have a higher prevalence and risk of hip fracture (see Supplementary references) . However, these studies did not consider bone mineral density (BMD).…”

“…3 Several reports from different study populations have shown people with dementia and cognitive impairment have a higher prevalence and risk of hip fracture (see Supplementary references). [4][5][6] However, these studies did not consider bone mineral density (BMD). Most studies only examined the relationship between dementia and fractures at the hip, but not at other sites.…”