Abstract
BackgroundFractures have dire consequences including pain, immobility, and death. People receiving home care are at higher risk for fractures than the general population. Yet, current fracture risk assessment tools require additional testing and assume a 10-year survival rate, when many die within one year. Our objectives were to develop and validate a scale that predicts one-year incident hip fracture using the home care resident assessment instrument (RAI-HC).MethodsThis is a retrospective cohort study of linked population data. People receiving home care in Ontario, Canada between April 1st, 2011 and March 31st, 2015 were included. Clinical data were obtained from the RAI-HC which was linked to the Discharge Database and National Ambulatory Care Reporting System to capture one-year incident hip fractures. Seventy-five percent (n = 238,011) of the sample were randomly assigned to a derivation and 25% (n = 79,610) to a validation sample. A decision tree was created with the derivation sample using known fracture risk factors. The final nodes of the decision tree were collapsed into 8 risk levels and logistic regression was performed to determine odds of having a fracture for each level. c-Statistics were calculated to compare the discriminative properties of the full, derivation, and validation samples.ResultsApproximately 60% of the sample were women and 53% were 80 years and older. A total of 11,526 (3.6%) fractures were captured over the 1-year time period. Of these, 5057 (43.9%) were hip fractures. The proportion who experienced a hip fracture in the next year ranged from 0.3% in the lowest risk level to 5.2% in the highest risk level. People in the highest risk level had 18.8 times higher odds (95% confidence interval, 14.6 to 24.3) of experiencing a hip fracture within one year than those in the lowest. c-Statistics were similar for the full (0.658), derivation (0.662), and validation (0.645) samples.ConclusionsThe FRS-HC predicts hip fracture over one year and should be used to guide clinical care planning for home care recipients at high risk for fracture. Our next steps are to develop a fracture risk clinical assessment protocol to link treatment recommendations with identified fracture risk.
Highlights
Fractures have dire consequences including pain, immobility, and death
The consequence of the shift is that an increasing number of frail, medically-complex older adults are reliant on support from service such as home care which is defined as receiving nursing or professional services for 60 days or more within a person’s home [1]
Decision tree model The final decision tree model had 16 leaves (Fig. 2) that were collapsed into the eight risk levels of the Fracture
Summary
Fractures have dire consequences including pain, immobility, and death. People receiving home care are at higher risk for fractures than the general population. The consequence of the shift is that an increasing number of frail, medically-complex older adults are reliant on support from service such as home care which is defined as receiving nursing or professional services (e.g., physical or occupational therapy) for 60 days or more within a person’s home [1]. Because they are more medically complex, people receiving home care experience a higher incidence of negative events such as falls and fractures than the average population [2], further increasing their risk of functional dependence, institutionalization and mortality. Home care clients at risk for fractures must be identified and strategies must be implemented to prevent the loss of mobility and independence, and increased risk of death
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