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Fracture risk assessment tool may be effective in nursing home setting
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A new fracture risk assessment tool for older adults living in a nursing home may be effective for predicting characteristics of those at increased risk for hip fracture, study data show.
Sarah D. Berry, MD, MPH, of the Institute for Aging Research at the Hebrew Rehabilitation Center in Boston, and colleagues evaluated data from a fee-for-service Medicare program on 419,668 adults (mean age, 83.9 years; 71.4% women) living in nursing homes to develop and validate the Fracture Risk Assessment in Long-term Care (FRAiL) model to predict 2-year risk for hip fracture. Mean follow-up was 1.8 years.
Variables to predict fracture were available from the Minimum Data Set and pharmacy claims data. The Minimum Data Set and Medicare Enrollment File were used to gather information on 34 characteristics from seven domains, including demographic, cognitive/function, neuropsychiatric, falls, pain, nutrition and comorbidities.
Through follow-up, 3.5% of participants were hospitalized with a hip fracture, and 42% died without hip fracture.
In the fully adjusted model, 15 of the 34 characteristics remained significant predictors of hip fracture, including older age, white race, female sex, impaired cognition, activities of daily living independence, locomotion independence, easy distraction, wandering, absence of osteoarthritis, absence of pressure ulcer, low BMI and diabetes.
The risk for fracture increased with previous falls (HR = 1.28; 95% CI, 1.24-1.33) and wandering (HR = 1.32; 95% CI, 1.26-1.39). However, the risk decreased with locomotion dependence (HR = 0.48; 95% CI, 0.45-0.52), activities of daily living dependence (HR = 0.6; 95% CI, 0.5-0.73), transfer dependence (HR = 0.6; 95% CI, 0.53-0.67) and urinary incontinence (HR = 0.75; 95% CI, 0.71-0.8).
Associations between characteristics and risk for fracture were similar between men and women; however, the risk for fracture was increased in women with diabetes (HR = 1.12; 95% CI, 1.07-1.17), but not in men with diabetes.
“Most of the differences in treatment variation are explained by individual provider preferences, rather than patient or facility characteristics, or even shared practice patterns, suggesting that a more standardized approach to screening and treatment is needed,” the researchers wrote. “The FRAiL tool would be an important first step in overcoming this key barrier to preventing fractures in the [nursing home] setting.” – by Amber Cox
Disclosures: Berry reports she receives grant funding from Amgen. Please see the study for all other authors’ relevant financial disclosures.
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