Elderly/Long-term Care

Certain resident and facility characteristics and medications increase the risk of fractures among nursing home residents

Nursing home residents are more likely to fall or suffer from fractures than elderly persons in the community because nursing home residents often have mobility, balance, cognition, and vision problems. Also, they take an average of seven to eight prescription medications, including many that increase the risk of falls and fractures.

Certain resident and facility characteristics and medications increase the likelihood of fall-related fractures in nursing homes, according to Agency for Healthcare Research and Quality researchers William Spector, Ph.D., and D.E.B. Potter, M.S., and colleagues. They conducted the first nationally representative study of nursing home residents to identify their risk factors for fractures.

Data from a sample of nursing homes in the 1996 Medical Expenditure Panel Survey and resident medical records revealed that 6 percent of nursing home residents suffered a fracture during their nursing home stay. For the vast majority (85 percent), a fall caused the fracture (41 percent of them in the hip or pelvis). Those who were 85 years and older were 61 percent more at risk for fractures than younger residents, and those admitted from the community were 50 percent more at risk compared to those admitted from another nursing home. Residents who were agitated were three times more at risk for fractures than those without agitation problems. Residents who used both a wheelchair and cane or walker were twice as likely to suffer fractures as those who used only a wheelchair.

Also, elderly residents who used anticonvulsants had 2.2 times greater risk, antidepressants, 1.5 times greater risk, and opioid analgesics, 1.5 times greater risk of fracture. Use of iron supplements (a marker of anemia) and bisphosphonates (a marker for loss of bone mass) increased the risk of fracture 1.6 and 6.4 times, respectively. Laxatives, which sometimes can lead to electrolyte imbalance and resulting dizziness, increased the risk of fracture 1.5 times. Finally, a high certified nurse aide to patient ratio (the only significant facility characteristic) reduced the risk of fractures.

More details are in "Risk factors associated with the occurrence of fractures in U.S. nursing homes: Resident and facility characteristics and prescription medications," by Dr. Spector, Thomas Shaffer, M.H.S., Ms. Potter, and others, in the March 2007 Journal of the American Geriatrics Society 55, pp. 327-333. Reprints (AHRQ Publication No. 07-R047) are available from the AHRQ Publications Clearinghouse.

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