Journal of Clinical Epidemiology
Volume 63, Issue 6 , Pages 679-685, June 2010

A selection strategy was developed for fracture reduction programs in frail older people

  • Jian Sheng Chen

      Affiliations

    • Institute of Bone and Joint Research, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia
    • Corresponding Author InformationCorresponding author. Tel.: +61-2-99267328; fax: +61-2-99061859.
  • ,
  • Philip N. Sambrook

      Affiliations

    • Institute of Bone and Joint Research, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia
  • ,
  • Judy M. Simpson

      Affiliations

    • School of Public Health, University of Sydney, Edward Ford Building A27, University of Sydney, New South Wales 2006, Australia
  • ,
  • Lyn M. March

      Affiliations

    • Institute of Bone and Joint Research, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia
  • ,
  • Robert G. Cumming

      Affiliations

    • Centre for Education and Research on Ageing, Concord Hospital, Building 18, Concord, New South Wales 2139, Australia
  • ,
  • Markus J. Seibel

      Affiliations

    • Anzac Research Institute, Concord Hospital, Concord, New South Wales 2139, Australia
  • ,
  • Stephen R. Lord

      Affiliations

    • Prince of Wales Medical Research Institute, University of New South Wales, Barker Street, Randwick, New South Wales 2031, Australia
  • ,
  • Ian D. Cameron

      Affiliations

    • Rehabilitation Studies Unit, University of Sydney, PO Box 6, Ryde, New South Wales 2112, Australia

Accepted 4 August 2009. published online 18 November 2009.

Abstract 

Objectives

The aims of this study were to develop and evaluate a simple index for assessing the risk of fractures after a fall and to propose a selection strategy for identifying elderly individuals at high risk of both falls and fall-related fractures.

Study Design and Setting

Two thousand five institutionalized older men and women were assessed for clinical risk factors and then followed up for falls and fall-related fractures for up to 2 years.

Results

Our fracture risk index is derived from seven previously identified significant independent risk factors: weight, lower leg length, balance, cognitive function, type of institution, fracture history, and falls in the past year. The fracture rate was 6.5 times greater in the one-sixth of the falls with the highest index (9.7/100 falls) than in the lowest sixth (1.5/100 falls). Our proposed approach (based on balance, risk of falls, and the fracture risk index) selected a group of older people with high risk of both falls and fall-related fracture. The fracture incidence rate was 144% higher, and the falls incidence rate was 31% higher in the selected residents than in the remainder.

Conclusion

The index could help rationalize fracture prevention programs for frail older people.

Keywords: Fractures, Falls, Risk factors, Assessment, Aged, Nursing home

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PII: S0895-4356(09)00271-6

doi:10.1016/j.jclinepi.2009.08.018

Journal of Clinical Epidemiology
Volume 63, Issue 6 , Pages 679-685, June 2010