title: Risk factors for hip fracture in older home care clients.
abstract: BACKGROUND
  Little information is available on hip fracture risks among community-dwelling persons receiving home care. Our aim was to identify risk factors for hip fracture from health information routinely collected for older home care clients.
  
  
  METHODS
  This was a cohort study involving secondary analysis of data on 40,279 long-stay (>60 days) home care clients aged 65 and older in Ontario, Canada; occurrence of hip fracture as well as potential risk factor information were measured using the Resident Assessment Instrument (RAI)/Minimum Data Set-Home Care assessment instrument.
  
  
  RESULTS
  In all, 1,003 clients (2.5%) had hip fracture on follow-up assessment. Older (85+ vs 65-74, relative risk [95% confidence interval]: 0.52 [0.43-0.64]) clients are at increased risk; males are at reduced risk [0.60 (0.51-0.70)]. Other risk factors include osteoporosis (1.19 [1.03-1.36]), falls (1.31 [1.15-1.49]), unsteady gait (1.18 [1.03-1.36]), use of ambulation aide (1.39 [1.21-1.59]), tobacco use (1.42, [1.13-1.80]), severe malnutrition (2.61 [1.67-4.08]), and cognitive impairment (1.30 [1.12-1.51]). Arthritis (0.86 [0.76-0.98]) and morbid obesity (0.34 [0.16-0.72]) were associated with reduced risk. Males and females demonstrated different risk profiles.
  
  
  CONCLUSIONS
  Important risk factors for hip fracture can be identified from routinely collected data; these could be used to identify at-risk clients for further investigation and prevention strategies.
authors.affiliation: Department of Health Studies and Gerontology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada N2L 3G1. stolee@uwaterloo.ca
authors.forename: Paul
authors.initials: P
authors.lastname: Stolee
authors.forename: Jeff
authors.initials: J
authors.lastname: Poss
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cook
authors.forename: Kerry
authors.initials: K
authors.lastname: Byrne
authors.forename: John P
authors.initials: JP
authors.lastname: Hirdes
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D017102:Fracture Healing / Q000502:physiology; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D006699:Home Care Services; D006801:Humans; D015994:Incidence; D008297:Male; D009765:Obesity / Q000453:epidemiology; D009864:Ontario; D010024:Osteoporosis / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment; D012678:Sensation Disorders / Q000453:epidemiology; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D016019:Survival Analysis