title: Risk of Nursing Home Admission After Femoral Fracture Compared With Stroke, Myocardial Infarction, and Pneumonia.
abstract: OBJECTIVE
  To analyze the burden of institutionalizations after femoral fracture and compare it with other "catastrophic" disease entities like stroke, myocardial infarction, or pneumonia.
  
  
  METHODS
  Routine data of 414,000 hospitalized German patients aged 66 years and older were used to calculate institutionalization risks after femoral fracture, stroke, myocardial infarction, pneumonia or a combined group of "all other hospitalizations."
  
  
  METHODS
  Institutionalization was defined as nursing home admission within 6 months after discharge from hospital. Age- and sex-specific incidence and incidence rates of institutionalization were calculated. To compare the risk of institutionalization between the disease entities, age-standardized rates were computed and proportional hazards models were applied. In-house mortality and mortality after discharge from hospital were also calculated.
  
  
  RESULTS
  The risk of institutionalization increased exponentially with age in all disease entities. For example, the risk of institutionalization after femoral fracture increased from 3.6% in women aged 65 to 69 years to 34.8% in women aged 95 years and older. The highest institutionalization rates were observed in patients with stroke, followed by femoral fracture, pneumonia, and myocardial infarction. In men, the age-standardized risk of institutionalization was almost as high after femoral fracture as after stroke (7.5% vs 8.0%). In contrast to myocardial infarction and pneumonia, femoral fracture and stroke were more likely to be followed by institutionalization rather than death.
  
  
  CONCLUSIONS
  Femoral fractures result in high burden of institutionalizations. Prevention of falls, diagnosis and treatment of osteoporosis, and high-quality rehabilitation are challenges to tackle the burden of institutionalization in these patients in the future.
authors.affiliation: Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany; Institute of Epidemiology and Medical Biometrie, Ulm University, Ulm, Germany. Electronic address: kilian.rapp@rbk.de.
authors.forename: Kilian
authors.initials: K
authors.lastname: Rapp
authors.affiliation: Institute of Epidemiology and Medical Biometrie, Ulm University, Ulm, Germany.
authors.forename: Dietrich
authors.initials: D
authors.lastname: Rothenbacher
authors.affiliation: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Jay
authors.initials: J
authors.lastname: Magaziner
authors.affiliation: Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Becker
authors.affiliation: Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Benzinger
authors.affiliation: Institute of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
authors.affiliation: Institute of Epidemiology and Medical Biometrie, Ulm University, Ulm, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Jaensch
authors.affiliation: Institute of Epidemiology and Medical Biometrie, Ulm University, Ulm, Germany.
authors.forename: Gisela
authors.initials: G
authors.lastname: Büchele
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005264:Femoral Fractures / Q000401:mortality / Q000451:nursing*; D005858:Germany; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000451:nursing*; D009735:Nursing Homes; D010343:Patient Admission; D011014:Pneumonia / Q000401:mortality / Q000451:nursing*; D012306:Risk; D020521:Stroke / Q000401:mortality / Q000451:nursing*
keywords: Femoral fractures; institutionalization; myocardial infarction; nursing homes; pneumonia; stroke