Fracture incidence in nursing homes in Japan.
We conducted the first study to determine fracture incidence in institutionalized elderly people in East Asia. Fracture incidence was generally higher than in the general population but was not for all fracture types. Specific fracture prevention strategies for institutionalized people are needed. Ethnic differences in fracture incidence are also discussed.


BACKGROUND
The aim of this study was to determine the incidence of fractures in nursing homes in Japan, where fracture is becoming an increasingly problematic health issue.


METHODS
We conducted a cohort study with a 1-year follow-up. Subjects were 8,905 residents (average age, 84.3 years) in nursing homes. Caregivers assessed activities of daily living levels using Barthel's index, and we collected demographic data of each resident. Fracture diagnosis was based on medical records from the hospitals where patients were admitted.


RESULTS
Incidence of hip fracture was 14.9 per 1,000 person-years for women and 9.7 for men. Incidence of forearm and upper-arm fractures was 1.9 and 5.1 for women and 0.5 and 2.1 for men, respectively. Hip and upper-arm fracture rates were higher than in the general population, but forearm fracture rates were lower. Hazard ratio of fracture incidence in totally dependent to partially dependent or independent subjects was 0.14 (95%CI 0.05-0.33) for hip fracture and 0.34 (95%CI 0.23-0.50) for all fractures.


CONCLUSIONS
Fracture incidence in institutionalized elderly people is generally higher but is not higher for all types of fractures than the general population. In addition, totally dependent persons had a much lower risk of hip fracture.
Nakamura
K
K
Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Chuo-ku, Niigata, Japan. kazun@med.niigata-u.ac.jp
Oyama
M
M
Takahashi
S
S
Yoshizawa
Y
Y
Kobayashi
R
R
Oshiki
R
R
Saito
T
T
Tsuchiya
Y
Y
D000203:Activities of Daily Living; D017677:Age Distribution; D000368:Aged; D001134:Arm Injuries / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000469:parasitology; D016330:Frail Elderly / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D017678:Sex Distribution