In nursing homes, more independence tied to higher fracture risk

Reuters Health - Seniors living on their own may have a greater risk of fractures when they’re less mobile and less able to manage daily tasks without help, but in nursing homes the opposite may be true, a recent study suggests.

Among nursing home residents, risk factors for fracture included the ability to walk independently, wandering the halls, dementia and diabetes, the study found.

The findings are drawn from almost two years of data on 419,668 nursing home residents, including 14,553 who experienced hip fractures.

“In the community, individuals that need more assistance with mobility often have multiple health problems that place them at greatest risk for fracture,” said lead study author Dr. Sarah Berry of the Institute for Aging Research and Harvard Medical School in Boston.

“In the nursing home, all residents have health problems, but there is a tremendous variation in the ability of these residents to move independently,” Berry said by email. “Frail nursing home residents that are still mobile and independent have opportunity to fall, whereas residents that require extensive assistance have less opportunity to fall and fracture.”

Nearly 10 percent of hip fractures in the U.S. occur among nursing home residents, researchers note in The Journals of Gerontology: Series A. More than one-third of nursing home residents who fracture a hip will die within six months, and many others who were mobile before the fracture will become completely disabled.

Among residents who survive hip fractures, infections and pressure ulcers, or bed sores, are common, leading to functional decline and diminished quality of life.

The residents in the study ranged in age from 65 to 113; the average age was 84.

Nearly two years after enrollment in the study, roughly 3.5 percent had experienced a hip fracture.

People who had fallen in the past were 28 percent more likely to experience a hip fracture during the study than residents who had not fallen before.

Residents who wandered the halls independently were 32 percent more likely to experience a hip fracture than people who didn’t do this, the study also found.

People who move around the nursing home on their own may have more opportunities to fall, and they might also be taking medications such as sedatives or antidepressants that could make falls and fractures more likely, the authors note.

At the same time, nursing home residents were less likely to experience a hip fracture when they required assistance moving from bed, using the toilet or walking around.

One limitation of the study is that researchers relied on data from insurance claims for seniors covered by Medicare, which may not offer a complete picture of individual patient characteristics or health circumstances that might influence the odds of a fall or hip fracture.

Even if mobility might carry an increased fracture risk for nursing home residents, the fix isn’t staying in bed, said Dr. Joe Verghese, director of the Albert Einstein Jack and Pearl Resnick Gerontology Center in Bronx, New York.

That’s because being immobile is associated with an increased risk of blood clots, malnutrition and death for elderly people, Verghese, who wasn’t involved in the study, said by email.

To prevent falls, bright lighting during the day and night lights after dark can help boost visibility, said Jean-Michel Brismee of Texas Tech University Health Sciences Center in Lubbock. Removing rugs that might slip, placing hand rails in showers and tubs, and keeping walkers and canes within easy reach can also help, Brismee said in an email.

For stronger people, there are also classes to learn the safest ways to fall, which include bending, twisting and avoiding stiffening up to prevent fractures, added Brismee, who wasn’t involved in the study.

Outside of the nursing home, staying active, whether with gardening or jogging, also helps prevent falls and fractures, said Dr. Peter Svider of Wayne State University School of Medicine in Detroit, Michigan.

Inside the nursing home, more supervision to help people be as mobile as possible can help, too, Svider, who wasn’t involved in the study, said by email.

SOURCE: The Journals of Gerontology: Series A, online August 31, 2017.