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The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Advance Access published online on February 5, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, doi:10.1093/gerona/gln035
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Risk Factors for Hip Fracture in Older Home Care Clients

Paul Stolee1,2,3, Jeff Poss1, Richard J. Cook4, Kerry Byrne5 and John P. Hirdes1,6

1 Department of Health Studies and Gerontology
2 School of Optometry
3 Department of Statistics and Actuarial Science
4 Department of Rehabilitation Sciences, University of Waterloo, Ontario, Canada
5 R.B.J. Schlegel – University of Waterloo Research Institute for Aging, Ontario, Canada
6 Homewood Research Institute, Homewood Health Centre, Guelph, Ontario, Canada

Address correspondence to Paul Stolee, PhD, Department of Health Studies and Gerontology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada N2L 3G1. E-mail: stolee{at}uwaterloo.ca


  Abstract

Background: Little information is available on hip fracture risks among community-dwelling persons receiving home care. Our aim was to identify risk factors for hip fracture from health information routinely collected for older home care clients.

Methods: This was a cohort study involving secondary analysis of data on 40,279 long-stay (>60 days) home care clients aged 65 and older in Ontario, Canada; occurrence of hip fracture as well as potential risk factor information were measured using the Resident Assessment Instrument (RAI)/Minimum Data Set–Home Care assessment instrument.

Results: In all, 1,003 clients (2.5%) had hip fracture on follow-up assessment. Older (85+ vs 65–74, relative risk [95% confidence interval]: 0.52 [0.43–0.64]) clients are at increased risk; males are at reduced risk [0.60 (0.51–0.70)]. Other risk factors include osteoporosis (1.19 [1.03–1.36]), falls (1.31 [1.15–1.49]), unsteady gait (1.18 [1.03–1.36]), use of ambulation aide (1.39 [1.21–1.59]), tobacco use (1.42, [1.13–1.80]), severe malnutrition (2.61 [1.67–4.08]), and cognitive impairment (1.30 [1.12–1.51]). Arthritis (0.86 [0.76–0.98]) and morbid obesity (0.34 [0.16–0.72]) were associated with reduced risk. Males and females demonstrated different risk profiles.

Conclusions: Important risk factors for hip fracture can be identified from routinely collected data; these could be used to identify at-risk clients for further investigation and prevention strategies [22].

Keywords Hip fracture; Home care; Inter RAI

Received: December 21, 2007; Accepted: August 22, 2008

Decision Editor: Darryl Wieland, PhD, MPH


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