Risk of Hospitalized Falls and Hip Fractures in 22,103 Older Adults Receiving Mental Health Care vs 161,603 Controls: A Large Cohort Study

Abstract

Objectives: To investigate the risk of hospitalized fall or hip fracture among older adults using mental health services. Design: Retrospective cohort study. Setting and Participants: Residents of a South London catchment aged >60 years receiving specialist mental health care between 2008 and 2016. Measures: Falls and/or a hip fracture leading to hospitalization were ascertained from linked national records. Incidence rates and incidence rate ratios (IRRs) were age-and gender-standardized to the catchment population. Multivariable survival analyses were applied investigating falls and/or hip fractures as outcomes. Results: In 22,103 older adults, incidence rates were 60.1 per 1000 person-years for hospitalized falls and 13.7 per 1000 person-years for hip fractures, representing standardized IRRs of 2.17 [95% confidence interval (CI) 2.07-2.28] and 4.18 (3.79-4.60), respectively. The IRR for falls was high in those with substance-use disorder [IRR ¼ 6.72 (5.35-8.33)], bipolar disorder [IRR ¼ 3.62 (2.50-5.05)], depression [IRR ¼ 2.28 (2.00-2.59)], and stress-related disorders [IRR ¼ 2.57 (2.10-3.11)]. Hip fractures were increased in all populations (IRR > 2.5), with greatest risk in substance use disorders )], dementia .00)], and delirium [IRR ¼ 4.03 (3.00-5.29)]. Comparing mental disorder subgroups with each other, after the adjustment for 25 potential confounders, patients with dementia and substance use had a significantly increased risk of falls, and patients with dementia also had an increased risk of hip fractures. Conclusion and Implications: Older people using mental health services have more than double the incidence of falls and 4 times the incidence of hip fractures compared to the general population. Although incidences differ between diagnostic subgroups, all groups have a higher incidence than the The authors declare no conflicts of interest.

Data Science Trends Relevant to Nursing Practice: A Rapid Review of the 2020 Literature

“…For the topic of falls, we identified 24 studies that met inclusion criteria. Of these studies, eight used a retrospective cohort design 40 41 42 43 44 45 46 47 ; seven used a prospective cohort design 48 49 50 51 52 53 54 ; six were secondary analyses of research data obtained from prospective, retrospective, and cross-sectional studies 55 56 57 58 59 60 ; one used mixed methods wherein data from a public dataset were used in conjunction with measurements collected from sensors 61 ; and one was a meta-analysis of prospective cohort and observational studies. 62 Ten of the studies used health records as a source of data but in two of these studies, 44 47 it was not clear whether the records were electronic when they were obtained.…”

“…Several of the studies, including two of the secondary analyses, incorporated data from mobility and gait sensors. 48 49 51 53 55 60 61 Registries and administrative datasets were used in eight studies, 40 41 42 43 45 46 50 56 while questionnaires or surveys were a source of data for four studies. 49 51 57 60 With the exception of one study that employed sensor data from 17-year-old persons, 55 all study participants were community dwelling, inpatient, and outpatient adults.…”

“…The conditions were postpolio syndrome, 51 neurology, neurosurgery, hematology, oncology, 52 and neurology. 53 Most studies were conducted in the United States, but studies were also completed in Italy, 49 England, 43 Japan, 44 51 Poland, 59 and South Korea. 52 The 11 studies included in the meta-analysis 62 were conducted in seven countries.…”

“…In several studies, the fall was self-reported, 49 51 57 60 63 but if it occurred while the participant was in an inpatient setting or being tracked in an outpatient setting, it was often documented in medical records, registries, or administrative databases used to track adverse events. 40 41 42 43 44 45 46 47 48 50 52 56 These differences in measuring the outcome are important, in that predictive models may then be more or less accurate, merely because of the accuracy or inaccuracy of the outcome measurement. The types of predictors across studies were quite consistent, nevertheless.…”

“…Diagnoses and/or symptoms of the participants were tested as predictors in most of the studies. 40 41 42 43 44 45 46 47 49 50 51 52 54 56 57 58 59 60 62 63 Several categories of predictors were noteworthy, including strength, balance, and gait test scores 40 46 47 48 49 50 51 52 53 54 55 56 57 59 60 61 62 63 and nutritional status. 42 56 59 In 15 studies, prediction models were developed and evaluated with regression models.…”