Abstract
ObjectivesTo investigate the risk of hospitalized fall or hip fracture among older adults using mental health services. DesignRetrospective cohort study. Setting and ParticipantsResidents of a South London catchment aged >60 years receiving specialist mental health care between 2008 and 2016. MeasuresFalls and/or a hip fracture leading to hospitalization were ascertained from linked national records. Incidence rates and incidence rate ratios (IRRs) were age- and gender-standardized to the catchment population. Multivariable survival analyses were applied investigating falls and/or hip fractures as outcomes. ResultsIn 22,103 older adults, incidence rates were 60.1 per 1000 person-years for hospitalized falls and 13.7 per 1000 person-years for hip fractures, representing standardized IRRs of 2.17 [95% confidence interval (CI) 2.07-2.28] and 4.18 (3.79-4.60), respectively. The IRR for falls was high in those with substance-use disorder [IRR = 6.72 (5.35-8.33)], bipolar disorder [IRR = 3.62 (2.50-5.05)], depression [IRR = 2.28 (2.00-2.59)], and stress-related disorders [IRR = 2.57 (2.10-3.11)]. Hip fractures were increased in all populations (IRR > 2.5), with greatest risk in substance use disorders [IRR = 12.64 (7.22-20.52)], dementia [IRR = 4.38 (3.82-5.00)], and delirium [IRR = 4.03 (3.00-5.29)]. Comparing mental disorder subgroups with each other, after the adjustment for 25 potential confounders, patients with dementia and substance use had a significantly increased risk of falls, and patients with dementia also had an increased risk of hip fractures. Conclusion and ImplicationsOlder people using mental health services have more than double the incidence of falls and 4 times the incidence of hip fractures compared to the general population. Although incidences differ between diagnostic subgroups, all groups have a higher incidence than the general population. Targeted interventions to prevent falls and hip fractures among older adult mental health service users are urgently needed.
Highlights
1708 falls occurred in the patient cohort in the year after index date and the age-and-gender-standardized incidence rate was 60.1 [95% confidence interval (CI): 57.3-64.0] falls per 1000 person-years
Comparing the patient and the general population the age- and gender-adjusted incidence rate ratios (IRRs) for falls was 2.17
The highest increase of falls compared with the general population was detected in people with a substance use disorder (IRR: 6.72) and bipolar affective disorder (IRR: 3.62), and the lowest in mild cognitive impairment (MCI) (IRR: 1.51) and anxiety disorder (IRR: 1.67)
Summary
To investigate the risk of hospitalized fall or hip fracture among older adults using mental health services. Results: In 22,103 older adults, incidence rates were 60.1 per 1000 person-years for hospitalized falls and 13.7 per 1000 person-years for hip fractures, representing standardized IRRs of 2.17 [95% confidence interval (CI) 2.07-2.28] and 4.18 (3.79-4.60), respectively. Comparing mental disorder subgroups with each other, after the adjustment for 25 potential confounders, patients with dementia and substance use had a significantly increased risk of falls, and patients with dementia had an increased risk of hip fractures. Conclusion and Implications: Older people using mental health services have more than double the incidence of falls and 4 times the incidence of hip fractures compared to the general population. Incidences differ between diagnostic subgroups, all groups have a higher incidence than the
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