Risk factors associated with the occurrence of fractures in U.S. nursing homes: resident and facility characteristics and prescription medications.
OBJECTIVE
To determine whether resident and facility characteristics and prescription medications influence the occurrence of fractures in nursing homes (NHs).


METHODS
Panel study with 1-year follow-up.


METHODS
A nationally representative sample of NHs from the Medical Expenditure Panel Survey (MEPS).


METHODS
Residents aged 65 and older who were in sample NHs on January 1, 1996.


METHODS
Health status measures were collected from facility records and abstracted using a computer-assisted personal interview instrument. Fracture and drug data were updated every 4 months to provide a full year of information. Drug data were obtained from monthly medication administration records. The occurrences of fractures were obtained from medical records. Administered medications were classified using the Department of Veterans Affairs medication classification system. Facility characteristics were based on MEPS survey data collected from NH sources.


RESULTS
In 1996, 6% of residents in a NH at the beginning of the year experienced a fracture during their NH stay(s). Resident risk factors included aged 85 and older, admitted from the community, exhibited agitated behaviors, and used both wheelchair and cane or walker. Use of anticonvulsants, antidepressants, opioid analgesics, iron supplements, bisphosphonates, thiazides, and laxatives were associated with fractures. A high certified nurse aide ratio was negatively associated with fractures.


CONCLUSIONS
The findings indicate that fractures are associated with resident and facility characteristics and prescribing practices. It reaffirms the importance of medication review with special attention on opioid analgesics, antidepressants, and anticonvulsants to reduce the risk of fractures.
Spector
William
W
Agency for Healthcare Research and Quality, Rockville, MD 20850, USA. William.Spector@ahrq.hhs.gov
Shaffer
Thomas
T
Potter
D E B
DE
Correa-de-Araujo
Rosaly
R
Rhona Limcangco
M
M
D000368:Aged; D000369:Aged, 80 and over; D002400:Cathartics / Q000008:administration & dosage / Q000009:adverse effects; D003430:Cross-Sectional Studies; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology*; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006306:Health Surveys; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D058085:Iron Compounds / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D051346:Mobility Limitation; D009728:Nursing Assistants / Q000600:supply & distribution; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors; D049993:Sodium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D013223:Statistics as Topic; D014481:United States
D002400:Cathartics; D004164:Diphosphonates; D058085:Iron Compounds; D011619:Psychotropic Drugs; D049993:Sodium Chloride Symporter Inhibitors