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Comparison of hospitalised trends, treatment cost and health outcomes of fall-related hip fracture for people aged ≥ 65 years living in residential aged care and the community

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Abstract

Summary

This study compared hip fracture rates and health outcomes of older people living in residential aged care facilities (RACFs) to the community. The RACF resident age-standardised hospitalisation rate was five times higher than the community rate and declining. RACF residents experience overall worse health outcomes and survival post-hip fracture.

Introduction

To compare hospitalisation trends, characteristics and health outcomes following a fall-related hip fracture of older people living in residential aged care facilities (RACFs) to older people living in the community.

Methods

A retrospective analysis of fall-related hip fracture hospitalisations of people aged ≥ 65 years during 1 July 2008 and 30 June 2013 in New South Wales (NSW), Australia’s largest populated state. Linked hospitalisation, RACF and Aged Care Assessment Appraisal data collections were examined. Negative binomial regression examined the significance of hospitalisation temporal trends.

Results

There were 28,897 hip fracture hospitalisations. One-third were of older people living in RACFs. The hospitalisation rate was 2180 per 100,000 (95%CI: 2097.0–2263.7) for RACF residents and 390 per 100,000 (95%CI 384.8–395.8) for older people living in the community. The hospitalisation rate for RACF residents was estimated to decline by 2.9% annually (95%CI: − 4.3 to − 1.5). Hospital treatment cost for hip fractures was AUD$958.5 million. Compared to older people living in the community, a higher proportion of RACF residents were aged ≥ 90 years (36.1% vs 17.2%), were female (75.3% vs 71.8%), had > 1 Charlson comorbidity (37.6% vs 35.6%) and 58.2% had dementia (vs 14.4%). RACF residents had fewer in-hospital rehabilitation episodes (18.7% vs 60.9%) and a higher proportion of unplanned readmissions (10.6% vs 9.1%) and in-hospital mortality (5.9% vs 3.3%) compared to older people living in the community.

Conclusions

RACF residents are a vulnerable cohort of older people who experience worse health outcomes and survival post-hip fracture than older people living in the community. Whether access to individualised hip fracture rehabilitation for RACF residents could improve their health outcomes should be examined.

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Acknowledgments

The authors wish to thank the NSW Ministry of Health for providing access to the NSW hospitalisation data, the National Aged Care Data Clearinghouse for providing access to the Residential Aged Care and the Aged Care Assessment Program data, and the CHeReL for hospitalisation data extraction and the AIHW Data Linkage Unit for conducting the record linkage. The data were analysed within the Secure Unified Research Environment.

Funding

This research was funded by the Dementia Centre for Research Collaboration. R. Mitchell was supported by a career fellowship from the NSW Ministry of Health under the NSW Health Early-Mid Career Fellowships Scheme.

Author information

Authors and Affiliations

  1. Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia

    R. Mitchell & M. Wadolowski

  2. Dementia Centre for Research Collaboration, University of New South Wales, Sydney, Australia

    B. Draper & H. Brodaty

  3. Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia

    B. Draper & H. Brodaty

  4. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia

    L. Harvey & J. Close

  5. Prince of Wales Clinical School, University of New South Wales, Sydney, Australia

    J. Close

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  1. R. Mitchell
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  4. M. Wadolowski
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Correspondence to R. Mitchell.

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Ethical approval was obtained from the NSW Population and Health Services Research Ethics Committee (2008/10/108) and the Australian Institute of Health and Welfare (AIHW) Human Research Ethics Committee (2015/1/159).

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Mitchell, R., Draper, B., Harvey, L. et al. Comparison of hospitalised trends, treatment cost and health outcomes of fall-related hip fracture for people aged ≥ 65 years living in residential aged care and the community. Osteoporos Int 30, 311–321 (2019). https://doi.org/10.1007/s00198-018-4800-6

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