Loss of health related quality of life following low-trauma fractures in the elderly.
BACKGROUND
To estimate the long-term change in health related quality of life (HRQoL) following low-trauma fractures among individuals receiving home care (HC) services or living in long-term care (LTC) facilities using linked healthcare administrative data from Ontario, Canada.


METHODS
HRQoL was estimated using the Health Utility Index (HUI-2) with the InterRai Minimum Data Set (MDS), a mandatory questionnaire for LTC and HC in the province of Ontario (population 14 million). The HUI-2, a validated HRQoL instrument, allows the calculation of health utility where 0 represents death and 1 the best imaginable health state. For reference, the HUI-2 utility value for Canadians aged 80-84 years is 0.61 and the minimal clinically important difference is 0.03. The MDS was linked to Ontario acute care databases for fiscal years 2007-2011 to identify low-trauma fractures using ICD-10-CA codes. Regression models were used to identify predictors of change in HRQoL from pre-fracture levels to 3 years post fracture for several populations. Low-trauma fractures included hip, humerus, vertebral, wrist, multiple and other.


RESULTS
Twenty-three thousand six-hundred fifty-five unique patients with low-trauma fractures were identified with pre- and post-fracture HRQoL assessments, of which 5057 individuals had at least 3 years of follow-up. Compared to patients receiving HC services (N = 3303), individuals residing in LTC (N = 1754) were older, taking more medications, and had more comorbidities. LTC patients had more hip fractures (49 % of total versus 29 %). For all fracture types, HRQoL decreased immediately following fracture. Although levels rebounded after the first month, HRQoL up to 36 months never returned to pre-fracture levels even for non-hip fracture. For both HC and LTC cohorts, clinically important and statistically significant decreases in HUI-2 utility scores were observed 36 months post fracture. Of the 6 HUI-2 domains, mobility had the largest impact on change in HRQoL. Regression analysis indicated that living with a musculoskeletal disorder or a neurological condition and living in LTC were associated with greater decrements in utility following a fracture.


CONCLUSIONS
Based on the analysis of one of the largest studies on HRQoL to date, among individuals living in LTC facilities or receiving HC services, fractures have a significant permanent impact on HRQoL up to 3 years following fracture.
Programs for Assessment of Technology in Health (PATH), St. Joseph's Healthcare Hamilton, 25 Main Street West, Suite 2000, Hamilton, ON, L8P 1H1, Canada. tarride@mcmaster.ca.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. tarride@mcmaster.ca.
Jean-Eric
JE
Tarride
Programs for Assessment of Technology in Health (PATH), St. Joseph's Healthcare Hamilton, 25 Main Street West, Suite 2000, Hamilton, ON, L8P 1H1, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Natasha
N
Burke
Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
William D
WD
Leslie
Department of Medicine, McGill University, Montréal, Quebec, Canada.
Suzanne N
SN
Morin
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Jonathan D
JD
Adachi
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.|Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Alexandra
A
Papaioannou
Department of Medicine, Laval University, Quebec City, Quebec, Canada.
Louis
L
Bessette
Department of Medicine, Laval University, Quebec City, Quebec, Canada.
Jacques P
JP
Brown
Amgen Canada Inc., Mississauga, Ontario, Canada.
Louisa
L
Pericleous
Programs for Assessment of Technology in Health (PATH), St. Joseph's Healthcare Hamilton, 25 Main Street West, Suite 2000, Hamilton, ON, L8P 1H1, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Sergei
S
Muratov
Programs for Assessment of Technology in Health (PATH), St. Joseph's Healthcare Hamilton, 25 Main Street West, Suite 2000, Hamilton, ON, L8P 1H1, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Robert B
RB
Hopkins
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D006620:Hip Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D006699:Home Care Services / Q000639:trends; D006801:Humans; D008134:Long-Term Care / Q000523:psychology* / Q000639:trends; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires
Fractures; Frail elderly; Health-related quality of life