Clinical StudiesFall Direction, Bone Mineral Density, and Function: Risk Factors for Hip Fracture in Frail Nursing Home Elderly☆
Section snippets
Study design
Ambulatory subjects who fell and fractured a hip (case patients) were compared with ambulatory fallers who did not (control subjects). A fall was defined as a sudden, unexpected descent from a standing, sitting, or horizontal position, without loss of consciousness. Ambulatory was defined as the ability to walk, regardless of whether an assistive device (ie, cane or walker) was used.
Subjects
Cases and controls were all 65 years of age and over, had suffered a fall, and were stable enough to undergo bone
Results
Of the 272 residents at Hebrew Rehabilitation Center for Aged who were eligible for the study, 49% (n = 132) agreed to participate. There were no significant differences between participants and nonparticipants in terms of proportion of patients with hip fracture, gender, age, weight, height, or body mass index (Table 1). Fall characteristics and most measures of functional assessment (mobility, dressing, toileting) or mental status were also similar (Table 1). Dining was the only functional
Discussion
Our primary objective was to determine whether four separate domains of risk—fall characteristics, body habitus, functional assessments, and bone mineral density—were risk factors for hip fracture in elderly nursing home residents. The data suggest that in such patients, a fall to the side, low hip bone density, and functional impairment in mobility are important and independent risk factors for hip fracture. Moreover, each assesses a unique domain of risk and is associated with different
Acknowledgements
We are indebted to the nursing staff of the Harvard-Thorndike General Clinical Research Center at the Beth Israel Deaconess Medical Center; to Lauri Maitland-Ramsey, MPH, Meryl Poku, and Clorinda Cali, for assistance with recruitment and bone density imaging; and to Dawn Griffiths for excellent assistance with preparation of the manuscript.
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Supported by NIH Grants CA41295, P30-AG08812, and M01-RR01032 (Beth Israel Deaconess Medical Center, General Clinical Research Center); and the Maurice E. Mueller Professorship in Biomechanics, Harvard Medical School, Boston, Massachusetts (Dr. Hayes).