Individuals with neurological diseases are at increased risk of fractures within 180 days of admission to long-term care in Ontario.
BACKGROUND
Individuals residing in long-term care (LTC) are more likely to have a fragility fracture than community-dwelling seniors. The purpose of this study was to determine whether the presence of neurological diseases was associated with an increased risk of fracture within 180 days of admission to LTC.


METHODS
This retrospective cohort study used data collected in the LTC setting using the Resident Assessment Instrument (RAI) 2.0 during the period from 2006 to 2011 (N=42,089). Multivariable logistic regression analyses were conducted to determine the associations between the presence of neurological conditions and incident fractures, with and without adjustment for clinical variables.


RESULTS
The incident fracture rate for all LTC residents was 2.6% (N=1,094). Neurological condition group size ranged from n=21,015 for Alzheimer's disease or related dementias (ADRD) to n=21 for muscular dystrophy (MD). The incidence of fracture among residents with specific neurological diseases was as follows: ADRD, 3.2% (n=672), MD, 4.8% (n=1), Parkinson's disease, 2.5% (n=57), stroke, 2.3% (n=166), epilepsy, 2.5% (n=38), Huntington's disease, 1.4% (n=1), multiple sclerosis, 0.3% (n=1) and traumatic brain injury, 3.8% (n=11); among the comparison group with no neurological conditions, the fracture rate was 2.0% (n=366). The neurological diseases that were associated with a significantly greater odds of having an incident fracture in the first 180 days of LTC admission were as follows: ADRD (1.3; 95% CI: 1.1-1.5), epilepsy (1.5; 95% CI: 1.0-2.1) and traumatic brain injury (2.7; 95% CI: 1.4-5.0).


CONCLUSIONS
LTC residents with ADRD, epilepsy and traumatic brain injury are at a higher risk for sustaining an incident fracture in the first 180 days of admission and should be considered for fracture prevention strategies.
School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
Micaela
M
Jantzi
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Amy C
AC
Maher
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
George
G
Ioannidis
School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
John P
JP
Hirdes
Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
Lora M
LM
Giangregorio
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Alexandra
A
Papaioannou
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D016017:Odds Ratio; D009864:Ontario; D010343:Patient Admission; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
fracture; long-term care; neurological diseases; older people