这项基于人群的研究分析了老年人髋部骨折和骨质疏松症的治疗率,骨折前按居住地分层。居住在社区的老年人髋部骨折发生率较高,骨折后出院接受长期护理(LTC)。与居住在社区的LTC居民和老年人相比。只有23%的高骨折风险LTC居民接受了骨质疏松症治疗。
目的:这项基于人群的研究调查了年龄>65岁的长期护理(LTC)居民与社区居住的老年人在骨折时的髋部骨折率和骨质疏松症管理,并在骨折后接受LTC治疗。在安大略省,加拿大。
方法:使用独特的,来自ICES数据存储库的编码标识符,用于估计2014年4月1日至2018年3月31日期间66岁以上成人的髋部骨折(使用加拿大公共卫生署算法和国际疾病分类(ICD)-10编码进行识别)和骨质疏松管理(药物治疗).按骨折前居住和出院地点比较性别和年龄标准化率(即,LTC到LTC,社区到LTC,或社区到社区)。使用骨折风险量表(FRS)确定骨折风险。
结果:在基线(2014/15),LTC居民的总体年龄标准化髋部骨折率为223/10,000人-年(173/10,000女性和157/10,000男性),从社区到LTC队列,每10,000人年509人(每10,000女性468人,每10,000男性320人),和31.5/10,000人年(43.1/10,000女性和25.6/10,000男性)。在5年的观察期间,与社区至LTC组(AAPC=+2.5(95%CI-3.0至8.2;p=0.248))和社区至社区队列(AAPC-3.8(95%CI-6.7至0.7;p=030)相比,LTC组髋部骨折的总体年平均百分比变化(APC)显著增加(AAPC=+8.6(95%CI-5.0至12.3;p=0.004).然而,在研究期间,社区至LTC组的髋部骨折率仍然较高。有33,594名LTC居民被确定为骨折高风险(FRS评分4+),其中7777人正在接受治疗(23.3%)。
结论:总体而言,LTC和骨折后接受LTC治疗的社区成人髋部骨折发生率增加.然而,随着时间的推移,社区成人髋部骨折的发生率有所下降.在骨折高风险(FRS4)的LTC居民中,骨质疏松症的治疗率没有显着增加。LTC的居民骨折风险很高,需要根据护理目标和预期寿命进行个性化。
This population-based study analyzes hip fracture and osteoporosis treatment rates among older adults, stratified by place of residence prior to fracture. Hip fracture rates were higher among older adults living in the community and discharged to long-term care (LTC) after fracture, compared to LTC residents and older adults living in the community. Only 23% of LTC residents at high fracture risk received osteoporosis treatment.
OBJECTIVE: This population-based study examines hip fracture rate and osteoporosis management among long-term care (LTC) residents > 65 years of age compared to community-dwelling older adults at the time of fracture and admitted to LTC after fracture, in Ontario, Canada.
METHODS: Healthcare utilization and administrative databases were linked using unique, encoded identifiers from the ICES Data Repository to estimate hip fractures (identified using the Public Health Agency of Canada algorithm and International Classification of Diseases (ICD)-10 codes) and osteoporosis management (pharmacotherapy) among adults > 66 years from April 1, 2014 to March 31, 2018. Sex-specific and age-standardized rates were compared by pre-fracture residency and discharge location (i.e., LTC to LTC, community to LTC, or community to community). Fracture risk was determined using the Fracture Risk Scale (FRS).
RESULTS: At baseline (2014/15), the overall age-standardized hip fracture rate among LTC residents was 223 per 10,000 person-years (173 per 10,000 females and 157 per 10,000 males), 509 per 10,000 person-years (468 per 10,000 females and 320 per 10,000 males) among the community to LTC cohort, and 31.5 per 10,000 person-years (43.1 per 10,000 females and 25.6 per 10,000 males). During the 5-year observation period, the overall annual average percent change (APC) for hip fracture increased significantly in LTC (AAPC = + 8.6 (95% CI 5.0 to 12.3; p = 0.004) compared to the community to LTC group (AAPC = + 2.5 (95% CI - 3.0 to 8.2; p = 0.248)) and the community-to-community cohort (AAPC - 3.8 (95% CI - 6.7 to - 0.7; p = 030)). However, hip fracture rate remained higher in the community to LTC group over the study period. There were 33,594 LTC residents identified as high risk of fracture (FRS score 4 +), of which 7777 were on treatment (23.3%).
CONCLUSIONS: Overall, hip fracture rates have increased in LTC and among community-dwelling adults admitted to LTC after fracture. However, hip fracture rates among community-dwelling adults have decreased over time. A non-significant increase in osteoporosis treatment rates was observed among LTC residents at high risk of fracture (FRS4 +). Residents in LTC are at very high risk for fracture and require individualized based on goals of care and life expectancy.