Department of Medicine, McMaster University, Hamilton, Ontario, Canada; GERAS Centre for Aging Research, Hamilton, Ontario, Canada.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada; GERAS Centre for Aging Research, Hamilton, Ontario, Canada.
J Am Med Dir Assoc. 2021 May;22(5):1035-1042. doi: 10.1016/j.jamda.2020.08.023. Epub 2020 Sep 30.
The purpose of our study was to identify factors that predict 1-year incident hip and major osteoporotic non-hip fractures (ie, wrist, spine, pelvis, humerus) for home care recipients while accounting for the competing risk of death.
We conducted a retrospective cohort study with linked population data.
All home care recipients in Ontario, Canada, receiving services for more than 6 months with an admission assessment between April 1, 2011, and March 31, 2015, were included.
Clinical data from the Resident Assessment Instrument Home Care were linked to fracture data from the Discharge Abstract Database and the National Acute Care Reporting System. Competing risk proportional hazard regressions using the Fine and Grey method were performed to model the association between potential risk factors and fracture.
Previous fall, previous fracture, cognitive impairment, unsteady gait, alcohol use, tobacco use, and Parkinson disease were consistently associated with all fracture types. Cognitive impairment (hazard ratio 2.09; 95% confidence interval 1.86-2.36) and wandering [1.66 (1.06-1.27)] were most predictive of hip fractures and being female [1.86 (1.76-1.98)] and experiencing a previous fracture [1.86 (1.76-1.98)] were most predictive of non-hip fractures. Risk factors unique to non-hip fractures as compared with hip fractures were locomotion ability outdoors and psychotropic medication use.
Our results indicate that, in addition to typical fracture risk factors, home care recipients have unique characteristics that increase their risk. Fracture risk assessment tools and subsequent prevention strategies should be modified to accurately identify home care recipients at risk for imminent 1-year fracture.
本研究旨在确定预测居家护理接受者 1 年髋部和主要骨质疏松性非髋部骨折（即腕部、脊柱、骨盆、肱骨）发生的因素，同时考虑死亡的竞争风险。
我们进行了一项回顾性队列研究，并进行了人群数据的关联。
所有在加拿大安大略省接受居家护理服务超过 6 个月且在 2011 年 4 月 1 日至 2015 年 3 月 31 日期间接受入院评估的居家护理接受者均纳入研究。
从居民评估工具居家护理中提取临床数据，并与从出院摘要数据库和国家急性护理报告系统中提取的骨折数据进行关联。使用 Fine 和 Grey 方法的竞争风险比例风险回归模型来对潜在风险因素与骨折之间的关系进行建模。
既往跌倒、既往骨折、认知障碍、步态不稳、饮酒、吸烟和帕金森病与所有类型的骨折均呈一致性相关。认知障碍（危险比 2.09；95%置信区间 1.86-2.36）和徘徊[1.66（1.06-1.27）]与髋部骨折的相关性最强，而女性[1.86（1.76-1.98）]和既往骨折[1.86（1.76-1.98）]与非髋部骨折的相关性最强。与髋部骨折相比，非髋部骨折的独特风险因素是户外行动能力和精神药物的使用。
我们的研究结果表明，除了典型的骨折危险因素外，居家护理接受者还有一些独特的特征会增加他们的骨折风险。骨折风险评估工具和随后的预防策略应进行修改，以准确识别有即将发生 1 年骨折风险的居家护理接受者。
