HIP FRACTURES IN LONG TERM CARE FACILITIES IN BRITISH COLUMBIA: INCIDENCE AND RISK FACTORS

Abstract

Hip fractures (HFs) are common in long term care facilities (LTCFs). Reports on HF incidence for Canadian LTCFs are limited. To address the gap, this study analyzed retrospective databases from the Canadian Institute for Health Information (CIHI) from January 1, 2010, to December 31, 2014, for LTCFs in British Columbia (BC). Information for the first event of HF was extracted from the Discharge Abstract Database (DAD) and for explanatory variables (e.g., health behaviors, body mass index, clinical conditions) from the Continue Care Reporting System (CCRS), based on RAI-MDS 2.0, which is hosted by the Canadian Institute of Health Information (CIHI). Two research questions were addressed: 1) what is the incidence of hip fracture for residents aged 65 years and older living in LTCFs in BC, Canada, patterned by time (2010-2014), person-level (age and sex), and place (facility size, rural-urban locations, and health regions) factors? and 2) what person-level factors, health behaviors (smoking and alcohol consumption), place factors, and clinical factors (body mass index, diabetes mellitus, rheumatoid arthritis, osteoporosis, dementia, Parkinson’s disease, and falls) are associated with hip fractures in adults aged 65 years and older living in LTCFs in BC, Canada?

The cohort included 33,739 residents (age ≥ 65 years) who resided in 305 LTCFs across BC. Results showed a downward trend in HF incidence rates (IRs) in all age groups (approximately 18% from 2010-2014), which was more pronounced in females than males. Results stratified by a combination of person, place, and time characteristics showed quite nuanced patterns of HF in this population. The results of the multivariable logistic regression indicated that compared to the youngest age group, there were higher odds of HF in those aged >= 90 years [OR= 1.34 (95% CI: 1.18,1.51)]. The study also found greater odds of HF for females [OR=1.61 (95% CI: 1.45,1.78)], those with a BMI classification of underweight [OR=1.81 (95% CI: 1.47, 2.23)], normal [OR= 1.82 (95% CI: (1.52, 2.18)], or overweight [OR= 1.36 (95% CI: (1.12, 1.65)] compared to obese, those with dementia [OR=1.46 (95% CI: 1.33, 1.62)] and those who experienced a fall in the last month [OR=1.15 (95% CI: 1.02, 1.29)]. The results of this study provide important information on time trends in HFs among LTCF residents as well as risk factors. The results also offer preliminary information about the potential impact of rural-urban location and facility size on HF IRs, which can be the starting point for future studies on this topic beyond a single province.