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Sagerfors M, Jakobsson H, Thórdardóttir Á, Wretenberg P, Möller M. Distal radius fractures in the superelderly: an observational study of 8486 cases from the Swedish fracture register. BMC Geriatr 2022; 22:140. [PMID: 35183121 PMCID: PMC8857784 DOI: 10.1186/s12877-022-02825-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background The distal radius fracture (DRF) is the most common fracture in adults. With an ageing population, the number of wrist fractures in the superelderly (≥ 80 years) is expected to rise. Optimal treatment for displaced DRFs remains controversial, especially in the superelderly group. In addition, basic knowledge of the outcome after a DRF in this heterogenic group is lacking. The aim of this study was to study injury characteristics, treatment and outcome of DRFs in superelderly patients using data from a large national register. Methods We used prospectively collected data from the Swedish Fracture Register. All distal radius fractures registered between April 2012 and December 2018 in patients ≥ 80 years of age were included. Data on epidemiology, fracture type, trauma mechanism and treatment are registered by the physician treating the patient. Patients are also sent a subjective outcome questionnaire including EQ-5D, EQ-VAS and Short Musculoskeletal Function Assessment questionnaire (SMFA-score) at the time of injury and after 12 months. The 12-month questionnaire was sent to those who had completed the questionnaire at the time of injury. A Mann–Whitney U-test was used to assess differences between treatment methods. Results Mean age for this population was 86 years (80–105 years), a majority of the patients were female (86.7%). The dominating injury mechanism was a simple fall (74.6%) in the patient’s residence. The majority of fractures were AO type A (70%) followed by AO type C (20.9%) and type B (8.6%). The incidence of open fractures was significantly higher in females (2.6%) compared to males (1.5%). A majority of the fractures were treated with a cast (87.5%) with volar locking plate as the second most common treatment method (6.6%). Patient-reported outcome measures (PROMs) EQ-5D, EQ-VAS and the Arm Hand Function Index of the SMFA-score deteriorated somewhat one year after injury compared to pre-injury. PROMs did not correlate to treatment with cast or a volar plate. Conclusions This nationwide register study provides detailed data on DRFs in the superelderly regarding epidemiology, treatment and self-reported outcome. A good self-reported outcome is possible, but many patients do not recover completely. PROMs did not correlate to type of treatment. The frequency of open fractures was significantly higher in females. The reason for this is unclear but different skin thickness in older males versus females may be one explanation.
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Affiliation(s)
- Marcus Sagerfors
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, 70182, Örebro, SE, Sweden.
| | - Hugo Jakobsson
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, 70182, Örebro, SE, Sweden
| | - Ásgerdur Thórdardóttir
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, 70182, Örebro, SE, Sweden
| | - Per Wretenberg
- Department of Orthopedics and Hand Surgery, Faculty of Medicine and Health, Örebro University, 70182, Örebro, SE, Sweden
| | - Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg/Mölndal, Sweden
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Stephens AR, Potter JW, Tyser AR, Kazmers NH. Evaluating the impact of social deprivation on Press Ganey® Outpatient Medical Practice Survey Scores. Health Qual Life Outcomes 2021; 19:167. [PMID: 34147118 PMCID: PMC8214262 DOI: 10.1186/s12955-020-01639-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 12/07/2020] [Indexed: 11/20/2022] Open
Abstract
Background Social deprivation has been shown to affect access to health care services, and influences outcomes for a variety of physical and psychological conditions. However, the impact on patient satisfaction remains less clear. The objective of this study was to determine if social deprivation is an independent predictor of patient satisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey (PGOMPS). Methods We retrospectively reviewed unique new adult patient (≥ 18 years of age) seen at a tertiary academic hospital and rural/urban outreach hospitals/clinics between January 2014 and December 2017. Satisfaction was defined a priori as achieving a score above the 33rd percentile. The 2015 Area Deprivation Index (ADI) was used to determine social deprivation (lower score signifies less social deprivation). Univariate and multivariable binary logistic regression were used to determine the impact of ADI on PGOMPS total and provider sub-scores while controlling for variables previously shown to impact scores (wait time, patient age, sex, race, specialty type, provider type, and insurance status). Results Univariate analysis of PGOMPS total scores revealed a 4% decrease in odds of patient satisfaction per decile increase in ADI (p < 0.001). Patients within the most deprived quartile were significantly less likely to report satisfaction compared to the least deprived quartile (OR 0.79, p < 0.001). Multivariable analysis revealed that the odds of achieving satisfaction decreased 2% for each decile increase in ADI on the Total Score (p < 0.001), independent of other variables previously shown to impact scores. For PGOMPS Provider Sub-Score, univariate analysis showed that patients in the lowest ADI quartile were significantly less likely be satisfied, as compared to the least deprived quartile (OR 0.77; 95% CI 0.70–0.86; p < 0.001). A 5% decrease in a patient being satisfied was observed for each decile increase in ADI (OR 0.95; 95% CI 0.94–0.96; p < 0.001). Conclusions Social deprivation was an independent predictor of outpatient visit dissatisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey. These results necessitate consideration when developing health care delivery policies that serve to minimize inequalities between patients of differing socioeconomic groups.
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Affiliation(s)
- Andrew R Stephens
- School of Medicine, University of Utah, 30N 1900E, Salt Lake City, UT, 84132, USA.
| | - Jared W Potter
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Nikolas H Kazmers
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
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Bergh C, Wennergren D, Möller M, Brisby H. Fracture incidence in adults in relation to age and gender: A study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area. PLoS One 2020; 15:e0244291. [PMID: 33347485 PMCID: PMC7751975 DOI: 10.1371/journal.pone.0244291] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/08/2020] [Indexed: 12/21/2022] Open
Abstract
Studies on fracture incidence have mostly been based on retrospectively registered data from local hospital databases. The Swedish Fracture Register (SFR) is a national quality register collecting data prospectively on fractures, at the time of care-seeking. In the present study the incidence of all different fractures, regardless of location, in adults’ ≥ 16 years treated at the only care provider for patients with fractures within a catchment area of approximately 550,000 inhabitants, during 2015‒2018 are described. Age, gender, and fracture location (according to AO/OTA classification) was used for the analyses and presentation of fracture incidences. During the 4-year study period, 23,917 individuals sustained 27,169 fractures. The mean age at fracture was 57.9 years (range 16‒105 years) and 64.5% of the fractures occurred in women. The five most common fractures accounted for more than 50% of all fractures: distal radius, proximal femur, ankle, proximal humerus, and metacarpal fractures. Seven fracture incidence distribution groups were created based on age- and gender-specific incidence curves, providing visual and easily accessible information on fracture distribution. This paper reports on incidence of all fracture locations based on prospectively collected data in a quality register. The knowledge on fracture incidence related to age and gender may be of importance for the planning of orthopaedic care, involving both in- and out-patients as well as allocating surgical resources. Further, this might be useful for organizing preventive measures, especially in countries with similar socioeconomic structure and fracture burden.
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Affiliation(s)
- Camilla Bergh
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
- * E-mail:
| | - David Wennergren
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Brisby
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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The Impact of Social Deprivation on Orthopaedic Outpatient Satisfaction Using the Press Ganey Outpatient Medical Practice Survey. J Am Acad Orthop Surg 2020; 28:e1111-e1120. [PMID: 32235241 DOI: 10.5435/jaaos-d-19-00852] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION In orthopaedics, multiple factors (patient age, wait time, and depression) have been associated with lower Press Ganey Outpatient Medical Practice Survey (PGOMPS) patient satisfaction scores. We hypothesized that increased social deprivation is an independent predictor of lower patient satisfaction, as measured by the PGOMPS. METHODS We retrospectively reviewed unique new outpatient orthopaedic surgery visits between January 1, 2014, and December 31, 2016, at a single tertiary academic institution. Given the high ceiling effects, satisfaction was defined a priori as achieving a score above the 33rd percentile. Social deprivation was determined using the 2015 Area Deprivation Index (ADI). Univariate and multivariable binary logistic regressions were used to detect factors associated with patient satisfaction for both the PGOMPS Total Score and Provider Sub-Score. RESULTS Of the 4,881 included patients, the mean age was 53.3 ± 15.9 years, 59.3% were women, and mean ADI was 30.1 ± 19.2. Univariate analysis revealed a significantly decreased odds of achieving satisfaction on the Total Score for each decile increase in ADI (odds ratio [OR] 0.94; P < 0.001). Compared with the least deprived quartile, patients of the most deprived quartile were significantly less likely to report satisfaction for both the Total Score (OR 0.56; P = 0.001) and Provider Sub-Score (OR 0.63; P = 0.011). Multivariable analysis revealed that the odds of achieving satisfaction for each decile increase in ADI were 0.96 for the Total Score (P = 0.014) and 0.95 for the Provider Sub-Score (P = 0.004), independent of age, wait time, race, subspecialty, provider type, and the clinic setting. CONCLUSIONS Increased social deprivation was an independent predictor of orthopaedic outpatient dissatisfaction on the PGOMPS. These findings should be considered when interpreting patient satisfaction scores and lend further support in an effort to improve healthcare inequalities. LEVEL OF EVIDENCE Level III.
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Elsoe R, Larsen P. Tibial plateau fractures are associated with a long-term increased risk of mortality: a matched cohort study of 7950 patients. Arch Orthop Trauma Surg 2020; 140:1705-1711. [PMID: 32172316 DOI: 10.1007/s00402-020-03408-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Disregarding proximal femoral fractures, the current literature includes only limited information regarding mortality following lower extremity fractures. Information regarding risk of mortality related to specific fracture patterns is essential when planning treatment modalities. The primary aim of this study was to report the long-term cumulative survival rate in patients with a tibial plateau fracture compared to an age- and gender-matched reference population. MATERIALS AND METHODS Patients who sustained a tibial plateau fracture in Denmark between 1996 and 2000 were included in the study. Survival status was monitored until 2015. We compared the mortality rate with a tenfold reference population matched on age and gender without a prior tibial plateau fracture. The study was based on register data from the Danish National Patient Register. RESULTS The study included 7950 patients sustaining 8065 tibial plateau fractures. The cohort had a mean follow-up period of 13.9 years. Patients with a tibial plateau fracture had a 1.52 (95% CI 1.46-1.58) times higher hazard ratio (HR) of death compared to the age- and gender-matched reference population. The 30-day, 6-month and 1-year mortality rates were 1.2%, 3.3% and 4.9%, respectively. CONCLUSION Patients with a proximal tibial plateau fracture have a higher cumulative risk of death during the mean 13.9-year observational period compared to an age- and gender-matched reference population.
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Affiliation(s)
- Rasmus Elsoe
- Department of Orthopaedic Trauma Surgery, Aalborg University Hospital, 18-22 Hobrovej, 9000, Aalborg, Denmark.
| | - Peter Larsen
- Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
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Tighe P, Modave F, Horodyski M, Marsik M, Lipori G, Fillingim R, Hu H, Hagen J. Geospatial Analyses of Pain Intensity and Opioid Unit Doses Prescribed on the Day of Discharge Following Orthopedic Surgery. PAIN MEDICINE 2020; 21:1644-1662. [PMID: 31800063 DOI: 10.1093/pm/pnz311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Inappropriate opioid prescribing after surgery contributes to opioid use disorder and risk of opioid overdose. In this cross-sectional analysis of orthopedic surgical patients, we examined the role of patient location on postoperative pain intensity and opioids prescribed on hospital discharge. METHODS We used geospatial analyses to characterize spatial patterns of mean pain intensity on the day of discharge (PiDoD) and opioid units prescribed on the day of discharge (OuPoD), as well as the effect of regional social deprivation on these outcomes. RESULTS At a 500-km radius from the surgery site, the Global Moran's I for PiDoD (2.71 × 10-3, variance = 1.67 × 10-6, P = 0.012) and OuPoD (2.19 × 10-3, SD = 1.87, variance = 1.66 × 10-6, P = 0.03) suggested significant spatial autocorrelation within each outcome. Local indicators of spatial autocorrelation, including local Moran's I, Local Indicator of Spatial Autocorrelation cluster maps, and Getis-Ord Gi* statistics, further demonstrated significant, specific regions of clustering both OuPoD and PiDoD. These spatial patterns were associated with spatial regions of area deprivation. CONCLUSIONS Our results suggest that the outcomes of pain intensity and opioid doses prescribed exhibit varying degrees of clustering of patient locations of residence, at both global and local levels. This indicates that a given patient's pain intensity on discharge is related to the pain intensity of nearby individuals. Similar interpretations exist for OuPoD, although the relative locations of hot spots of opioids dispensed in a geographic area appear to differ from those of hot spots of pain intensity on discharge.
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Affiliation(s)
| | | | - MaryBeth Horodyski
- Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida
| | - Matthew Marsik
- Data Science and Planning, University of Florida Health, Gainesville, Florida
| | - G Lipori
- Data Science and Planning, University of Florida Health, Gainesville, Florida
| | - Roger Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Hui Hu
- Department of Epidemiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jennifer Hagen
- Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida
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Héquette-Ruz R, Beuscart JB, Ficheur G, Chazard E, Guillaume E, Paccou J, Puisieux F, Genin M. Hip fractures and characteristics of living area: a fine-scale spatial analysis in France. Osteoporos Int 2020; 31:1353-1360. [PMID: 32140738 DOI: 10.1007/s00198-020-05363-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/19/2020] [Indexed: 12/21/2022]
Abstract
UNLABELLED We investigated the association between hip fracture incidence and living area characteristics in France. The spatial distribution of hip fracture incidence was heterogeneous and there was a significant relationship between social deprivation, urbanization, health access, and hip fracture risk. INTRODUCTION Several studies have shown great disparities in spatial repartition of hip fractures (HF). The aim of the study was to analyze the association between HF incidence and characteristics of the living area. METHODS All patients aged 50 or older, living in France, who were hospitalized for HF between 2012 and 2014 were included, using the French national hospital discharge database. Standardized incidence ratio (SIR) was calculated for each spatial unit and adjusted on age and sex. An ecological regression was performed to analyze the association between HF standardized incidence and ecological variables. We adjusted the model for neighborhood spatial structure. We used three variables to characterize the living areas: a deprivation index (French-EDI); healthcare access (French standardized index); land use (percentage of artificialized surfaces). RESULTS A total of 236,328 HF were recorded in the French hospital national database, leading to an annual HF incidence of 333/100,000. The spatial analysis revealed geographical variations of HF incidence with SIR varying from 0.67 (0.52; 0.85) to 1.45 (1.23; 1.70). There was a significant association between HF incidence rates and (1) French-EDI (trend p = 0.0023); (2) general practitioner and nurse accessibility (trend p = 0.0232 and p = 0.0129, respectively); (3) percentage of artificialized surfaces (p < 0.0001). CONCLUSION The characteristics of the living area are associated with significant differences in the risk of hip fracture of older people.
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Affiliation(s)
- R Héquette-Ruz
- CHU Lille, Geriatrics department, F-59000, Lille, France
| | - J-B Beuscart
- CHU Lille, Geriatrics department, F-59000, Lille, France.
- Univ. Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France.
| | - G Ficheur
- Univ. Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
- CHU Lille, Department of Methodology and Biostatistics, F-59000, Lille, France
| | - E Chazard
- Univ. Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
- CHU Lille, Department of Methodology and Biostatistics, F-59000, Lille, France
| | - E Guillaume
- U1086 INSERM, Université Caen Normandie-UFR Santé, Caen, France
| | - J Paccou
- MABLab UR 4490, Department of Rheumatology, Univ. Lille, CHU Lille, 59000, Lille, France
| | - F Puisieux
- CHU Lille, Geriatrics department, F-59000, Lille, France
- Univ. Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
| | - M Genin
- Univ. Lille, ULR 2694 - METRICS : Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
- CHU Lille, Department of Methodology and Biostatistics, F-59000, Lille, France
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Zoni AC, Domínguez-Berjón MF, Esteban-Vasallo MD, Velázquez-Buendía LM, Blaya-Nováková V, Regidor E. Socioeconomic inequalities in injuries treated in primary care in Madrid, Spain. J Public Health (Oxf) 2018; 39:45-51. [PMID: 26869695 DOI: 10.1093/pubmed/fdw005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Socioeconomic inequalities in injury morbidity are an important yet understudied issue in Southern Europe. This study analysed the injuries treated in primary care in the Community of Madrid, Spain, by socioeconomic status (SES), sex and age. Methods This was a cross-sectional study of injuries registered in the primary care electronic medical records of the Madrid Health Service in 2012. Incidence stratified by sex, SES and type of injury were calculated. Poisson regression was performed. Results A statistically significant upward trend in global injury incidence was observed with decreasing SES in all age groups. By type of injury, the largest differences were observed in injuries by foreign body in men aged 15-44 and in poisonings in girls under 15 years of age. Burns risk also stood out in the group of girls under 15 years of age with the lowest SES. In the group above 74 years of age, wounds, bruises and sprains had the lowest SES differences in both sexes, and the risk of fractures was lower in the most socioeconomically advantaged group. Conclusion People with lower SES were at a greater risk of injury. The relationship between SES and injury varies by type of injury and age.
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Affiliation(s)
- Ana Clara Zoni
- Area of Epidemiology, Subdirectorate for Health Promotion and Prevention, Madrid Regional Health Authority, 28035 Madrid, Spain
| | | | - María D Esteban-Vasallo
- Area of Epidemiology, Subdirectorate for Health Promotion and Prevention, Madrid Regional Health Authority, 28035 Madrid, Spain
| | - Luis M Velázquez-Buendía
- Area of Epidemiology, Subdirectorate for Health Promotion and Prevention, Madrid Regional Health Authority, 28035 Madrid, Spain
| | - Vendula Blaya-Nováková
- Agency for Health Technology Assessment, Institute of Health Carlos III, 28029 Madrid, Spain
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Universidad Complutense de Madrid, Ciudad Universitaria, 28040 Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Bhimjiyani A, Neuburger J, Jones T, Ben-Shlomo Y, Gregson CL. The effect of social deprivation on hip fracture incidence in England has not changed over 14 years: an analysis of the English Hospital Episodes Statistics (2001-2015). Osteoporos Int 2018; 29:115-124. [PMID: 28965213 DOI: 10.1007/s00198-017-4238-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/21/2017] [Indexed: 01/23/2023]
Abstract
Deprivation predicts increased hip fracture risk. Over 14 years, hip fracture incidence increased among men with persisting inequalities. Among women, inequalities in incidence were less pronounced; whilst incidence decreased overall, this improvement was seen marginally less in women from the most deprived areas. Hip fracture prevention programmes have not reduced inequalities. PURPOSE Deprivation is associated with increased hip fracture risk. We examined the effect of area-level deprivation on hip fracture incidence in England over 14 years to determine whether inequalities have changed over time. METHODS We used English Hospital Episodes Statistics (2001/2002-2014/2015) to identify hip fractures in adults aged 50+ years and mid-year population estimates (2001-2014) from the Office for National Statistics. The Index of Multiple Deprivation measured local area deprivation. We calculated age-adjusted incidence rate ratios (IRR) for hip fracture, stratified by gender and deprivation quintiles. RESULTS Over 14 years, we identified 747,369 hospital admissions with an index hip fracture; the number increased from 50,640 in 2001 to 55,092 in 2014; the proportion of men increased from 22.2% to 29.6%. Whereas incidence rates decreased in women (annual reduction 1.1%), they increased in men (annual increase 0.6%) (interaction p < 0.001). Incidence was higher in more deprived areas, particularly among men: IRR most vs. least deprived quintile 1.50 [95% CI 1.48, 1.52] in men, 1.17 [1.16, 1.18] in women. Age-standardised incidence increased for men across all deprivation quintiles from 2001 to 2014. Among women, incidence fell more among those least compared to most deprived (year by deprivation interaction p < 0.001). CONCLUSIONS Deprivation is a stronger relative predictor of hip fracture incidence in men than in women. However, given their higher hip fracture incidence, the absolute burden of deprivation on hip fractures is greater in women. Despite public health efforts to prevent hip fractures, the health inequality gap for hip fracture incidence has not narrowed for men, and marginally widened among women.
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Affiliation(s)
- A Bhimjiyani
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK
| | - J Neuburger
- Nuffield Trust, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - T Jones
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Y Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - C L Gregson
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK.
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Vafaei A, Pickett W, Zunzunegui MV, Alvarado BE. Relationships Between Neighborhood Social Capital and The Occurrence of Outdoor Falls in Canadian Older Adults: A Multilevel Analysis. J Aging Health 2017; 30:1108-1135. [PMID: 28553821 DOI: 10.1177/0898264317706236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to examine whether neighborhood-level social capital is a risk factor for falls outside of the home in older adults. METHODS Health questionnaires were completed by community-dwelling Canadians aged +65 years living in Kingston (Ontario) and St-Hyacinthe (Quebec), supplemented by neighborhood-level census data. Multilevel logistic regression models with random intercepts were fit. Variations in the occurrence of falls across neighborhoods were quantified by median odds ratio and 80% interval odds ratio. RESULTS Between-neighborhood differences explained 7% of the variance in the occurrence of falls; this variance decreased to 2% after adjustment for neighborhood-level variables. In the fully adjusted models, higher levels of social capital increased the odds of falls by almost 2 times: (odds ratio [OR] = 2.10, 95% confidence interval [CI] = [1.19, 3.71]). DISCUSSION Living in neighborhoods with higher levels of social capital was associated with higher risk of falling in older adults, possibly through more involvement in social activities.
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11
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Jodoin M, Rouleau DM, Charlebois-Plante C, Benoit B, Leduc S, Laflamme GY, Gosselin N, Larson-Dupuis C, De Beaumont L. Incidence rate of mild traumatic brain injury among patients who have suffered from an isolated limb fracture: Upper limb fracture patients are more at risk. Injury 2016; 47:1835-40. [PMID: 27291349 DOI: 10.1016/j.injury.2016.05.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study compares the incidence rate of mild traumatic brain injury (mild TBI) detected at follow-up visits (retrospective diagnosis) in patients suffering from an isolated limb trauma, with the incidence rate held by the hospital records (prospective diagnosis) of the sampled cohort. This study also seeks to determine which types of fractures present with the highest incidence of mild TBI. PATIENTS AND METHODS Retrospective assessment of mild TBI among orthopaedic monotrauma patients, randomly selected for participation in an Orthopaedic clinic of a Level I Trauma Hospital. Patients in the remission phase of a limb fracture were recruited between August 2014 and May 2015. No intervention was done (observational study). MAIN OUTCOME MEASUREMENTS Standardized semi-structured interviews were conducted with all patients to retrospectively assess for mild TBI at the time of the fracture. Emergency room related medical records of all patients were carefully analyzed to determine whether a prospective mild TBI diagnosis was made following the accident. RESULTS A total of 251 patients were recruited (54% females, Mean age=49). Study interview revealed a 23.5% incidence rate of mild TBI compared to an incidence rate of 8.8% for prospective diagnosis (χ(2)=78.47; p<0.0001). Patients suffering from an upper limb monotrauma (29.6%; n=42/142) are significantly more at risk of sustaining a mild TBI compared to lower limb fractures (15.6%; n=17/109) (χ(2)=6.70; p=0.010). More specifically, patients with a proximal upper limb injury were significantly more at risk of sustaining concomitant mild TBI (40.6%; 26/64) compared to distal upper limb fractures (20.25%; 16/79) (χ(2)=7.07; p=0.008). CONCLUSIONS Results suggest an important concomitance of mild TBI among orthopaedic trauma patients, the majority of which go undetected during acute care. Patients treated for an upper limb fracture are particularly at risk of sustaining concomitant mild TBI.
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Affiliation(s)
- Marianne Jodoin
- Research Center in Neuropsychology and Cognition (CERNEC), Department of Psychology, University of Montreal, Montreal, Quebec, Canada; Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada
| | - Dominique M Rouleau
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada, Canada.
| | | | - Benoit Benoit
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada, Canada
| | - Stéphane Leduc
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada, Canada
| | - G-Yves Laflamme
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada, Canada
| | - Nadia Gosselin
- Research Center in Neuropsychology and Cognition (CERNEC), Department of Psychology, University of Montreal, Montreal, Quebec, Canada; Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada
| | - Camille Larson-Dupuis
- Research Center in Neuropsychology and Cognition (CERNEC), Department of Psychology, University of Montreal, Montreal, Quebec, Canada; Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada
| | - Louis De Beaumont
- Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Psychology, University of Quebec at Trois-Rivieres, Trois-Rivieres, Quebec, Canada
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Vafaei A, Pickett W, Zunzunegui MV, Alvarado BE. Neighbourhood social and built environment factors and falls in community-dwelling canadian older adults: A validation study and exploration of structural confounding. SSM Popul Health 2016; 2:468-475. [PMID: 29349162 PMCID: PMC5757896 DOI: 10.1016/j.ssmph.2016.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 06/08/2016] [Accepted: 06/16/2016] [Indexed: 10/26/2022] Open
Abstract
Older persons are vulnerable to the ill effects of their social and built environment due to age-related limitations in mobility and bio-psychological vulnerability. Falls are common in older adults and result from complex interactions between individual, social, and contextual determinants. We addressed two methodological issues of neighbourhood-health and social epidemiological studies in this analysis: (1) validity of measures of neighbourhood contexts, and (2) structural confounding resulting from social sorting mechanisms. Baseline data from International Mobility in Aging Study were used. Samples included community-dwelling Canadians older than 65 living in Kingston (Ontario) and St-Hyacinthe (Quebec). We performed factor analysis and ecometric analysis to assess the validity of measures of neighbourhood social capital, socioeconomic status, and the built environment and stratified tabular analyses to explore structural confounding. The scales all demonstrated good psychometric and ecometric properties. There was an evidence of the existence of structural confounding in this sample of Canadian older adults as some combinations of strata for the three neighbourhood measures had no population. This limits causal inference in studying relationships between neighbourhood factors and falls and should be taken into account in aetiological aging research.
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Affiliation(s)
- Afshin Vafaei
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - William Pickett
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | | | - Beatriz E Alvarado
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
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13
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Abstract
Fractures in the elderly are increasing in incidence and becoming a major health issue in many countries. With an increasing number of the elderly living to an older age, the problems associated with fractures will continue to increase. We describe the epidemiology of fractures in the elderly and identify six fracture patterns in the population of patients who are sixty-five years of age or older. We also analyzed multiple fractures and open fractures in the elderly and we show that both increase in incidence with older age. The incidence of open fractures in elderly women is equivalent to that in young men. Many factors, including patient socioeconomic deprivation, increase the incidence of fractures in the elderly. More than 90% of fractures follow low-energy falls and the mortality is considerable. Mortality increases with older age and medical comorbidities, but there is also evidence that it relates to premature discharge from the hospital.
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Chan T, de Lusignan S, Cooper A, Elliott M. Improving Osteoporosis Management in Primary Care: An Audit of the Impact of a Community Based Fracture Liaison Nurse. PLoS One 2015; 10:e0132146. [PMID: 26313924 PMCID: PMC4552550 DOI: 10.1371/journal.pone.0132146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 06/10/2015] [Indexed: 11/18/2022] Open
Abstract
Background Osteoporosis and associated fragility fractures are a major health problem; they are more common in women over 50 years old. Fracture liaison nurses have been widely used in secondary care to promote the recognition of fragility fractures and to promote the use of bone-sparing medication to reduce the risk of recurrent facture. Objective Audit the impact of a primary care based fracture liaison nurse on the detection of fragility fractures in people with osteoporosis and their treatment with a bone-sparing medication. Method This audit took place in 12 GP practices using ‘before and after’ cross-sectional extractions of anonymised routine data. We report, for females 50–74 years and ≥75 years old, socio-economic deprivation index, the prevalence of osteoporosis, recording of fragility fractures, dual-energy X-ray absorptiometry (DXA), smoking, and body-mass index (BMI) and use of appropriate bone-sparing medication. We used Altman’s test of independent proportions to compare before and after data. Results Recording of the diagnosis of osteoporosis increased from 1.5% to 1.7% (p = 0.059); the rate of DXA scans fell (1.8% to 1.4%; p = 0.002); recording of fractures and fragility fractures more than doubled (0.8% to 2.0%; p<0.001 and 0.5% to 1.5%; p<0.001, respectively) with approximate doubling of the recording of smoking, and BMI (p<0.001 level). Fragility fracture recording rose from 8.8% to 15% in females aged 50 to 74, and from 0.8% to 2.3% in people aged ≥75years old (p<0.001). There appeared to be inequity in the service, people who were least deprived were more likely to receive DXA scans and the more deprived to be prescribed bone sparing agents. Conclusion A fracture liaison nurse in primary care has been associated with a period of improved management. Liaison nurses based in different parts of the health system should be tested in a prospective trial.
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Affiliation(s)
- Tom Chan
- Clinical Informatics, Department of Health Care Policy and Management, University of Surrey, Guildford, Surrey, United Kingdom
- * E-mail:
| | - Simon de Lusignan
- Clinical Informatics, Department of Health Care Policy and Management, University of Surrey, Guildford, Surrey, United Kingdom
| | - Alun Cooper
- Bridge Medical Centre, Three Bridges Road, Crawley, West Sussex, United Kingdom
| | - Mary Elliott
- Bridge Medical Centre, Three Bridges Road, Crawley, West Sussex, United Kingdom
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15
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Ong T, Tan W, Marshall L, Sahota O. The relationship between socioeconomic status and fracture in a fracture clinic setting: data from the Nottingham Fracture Liaison Service. Injury 2015; 46:366-70. [PMID: 25442710 DOI: 10.1016/j.injury.2014.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/02/2014] [Accepted: 10/05/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aims to better understand the relationship between socioeconomic status (SES), fractures in those that attend an outpatient fracture clinic and a diagnosis of osteoporosis. This will further aid our ability to risk stratify patients' with fractures for further investigation and secondary management of their bone health. METHOD This is a cross sectional analysis using data from the Nottingham Fracture Liaison Service of patients attending the outpatient fracture clinic from 1/01/08 to 31/12/11. Logistic regression adjusted for age and gender were used to investigate SES, fractures and a diagnosis of osteoporosis. Fisher's exact test was used to compare DXA attendance in those living in most deprived and least deprived area. A cut off of 65 years was used to conduct subset analysis of a younger and an older group. RESULTS 6362 patients (1346 male, 5016 female; mean (SD) age, 69 (12)) were included in the study. There was no relationship between SES, proportion of fracture types and having a diagnosis of osteoporosis. Prevalence of osteoporosis in each SES quintile from 1 (most deprived) to 5 (least deprived) was 26.68%, 29.04%, 24.83%, 25.67% and 26.68% respectively. The least deprived quintile compared with the most deprived was not associated with a diagnosis of osteoporosis (OR 0.97; 95% CI 0.76-1.25, p=0.837). Those living in the most deprived area were less likely to attend their bone density scan appointment compared to those living in the least deprived area (OR 0.56; 95% CI 0.44-0.7, p<0.0001). CONCLUSION This study has shown that there is no relationship between SES, fracture types and a diagnosis of osteoporosis in those that present to the fracture clinic. SES should not be used to risk stratify patients for further bone health management after fractures. Those living in the most deprived areas are less likely to attend their bone density scan and efforts need to be made to improve attendance in this group.
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Affiliation(s)
- Terence Ong
- Department of Healthcare of Older Person, Queens Medical Centre, Nottingham, United Kingdom.
| | - Wei Tan
- Nottingham Clinical Trials Unit, University of Nottingham, United Kingdom
| | - Lindsay Marshall
- Department of Trauma and Orthopaedics, Queens Medical Centre, Nottingham, United Kingdom
| | - Opinder Sahota
- Department of Healthcare of Older Person, Queens Medical Centre, Nottingham, United Kingdom
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Court-Brown CM, Biant LC, Clement ND, Bugler KE, Duckworth AD, McQueen MM. Open fractures in the elderly. The importance of skin ageing. Injury 2015; 46:189-94. [PMID: 25192864 DOI: 10.1016/j.injury.2014.07.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2014] [Indexed: 02/02/2023]
Abstract
Open fractures in the elderly are rare and there is little information about them. We have reviewed 484 open fractures in patients aged ≥65 years over a 15-year period and compared them with 1902 open fractures in patients <65 years treated in the same period. The incidence of open fractures increased significantly with age. The incidence of open fractures in patients aged <65 years was 296.6/10(6)/year compared which increased to 332.3/10(6)/year in patients aged ≥65 years and further still to 446.7/10(6)/year in the super-elderly aged ≥80 years The fracture distribution curves show that males aged 15-19 years and females aged ≥90 years have a very similar incidence of open fractures. In males the incidence declines almost linearly, whereas in females there is a steady increase in fracture incidence with age until the 7th decade of life when the incidence rises sharply. About 60% of open fractures in the elderly follow a fall and most fractures are caused by low energy injuries. Despite this there is a high incidence of Gustilo Type III fractures, particularly in females. The commonest open fractures in females are those of the distal radius and ulna, fingers, tibia and fibula and ankle, all fractures with subcutaneous locations. It has been shown that ageing alters the mechanical properties of skin and we believe that this accounts for the increased incidence of open fractures in elderly females which occurs about 1 decade after the post-menopausal increase in fracture incidence.
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Affiliation(s)
| | - L C Biant
- Royal Infirmary of Edinburgh, United Kingdom
| | - N D Clement
- Royal Infirmary of Edinburgh, United Kingdom
| | - K E Bugler
- Royal Infirmary of Edinburgh, United Kingdom
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17
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Duckworth AD, Wickramasinghe NR, Clement ND, Court-Brown CM, McQueen MM. Long-term outcomes of isolated stable radial head fractures. J Bone Joint Surg Am 2014; 96:1716-23. [PMID: 25320198 DOI: 10.2106/jbjs.m.01354] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is evidence to support primary nonoperative management of isolated stable fractures of the radial head, although minimal data exist regarding long-term outcomes. The aim of this study was to report subjective long-term outcomes of isolated stable fractures of the radial head and neck following primary nonoperative management. METHODS From a prospective database of proximal radial fractures, we identified all skeletally mature patients who sustained an isolated stable Mason type-1 or type-2 fracture of the radial head or neck during an eighteen-month period. Inclusion criteria were a confirmed isolated stable fracture of the proximal aspect of the radius, primarily managed nonoperatively. The primary long-term outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS The study cohort comprised 100 patients with a mean age of forty-six years (range, seventeen to seventy-nine years). A fall from a standing height accounted for 69% of all injuries. Thirty-five percent of the patients had one or more comorbidities. There were fifty-seven Mason type-1 fractures and forty-three Mason type-2 fractures. At a mean of ten years post injury (range, 8.8 to 10.2 years), the mean DASH score was 5.8 (range, 0 to 67.2) and the mean Oxford Elbow Score (OES) was 46 (range, 14 to 48). Fourteen (14%) of the patients reported stiffness and twenty-four (24%) reported some degree of pain. A worse DASH score was associated with older age (p = 0.002), one or more comorbidities (p = 0.008), increasing socioeconomic deprivation by Index of Multiple Deprivation quintile (p = 0.026), increasing amount of fracture displacement (p = 0.041), and involvement in compensation proceedings (p = 0.006). CONCLUSIONS Long-term patient-reported outcomes were excellent following the nonoperative management of isolated stable fractures of the radial head or neck. We suggest that routine primary nonoperative management of these fractures provides a satisfactory outcome for the majority of patients, with few patients in our study requiring further intervention for persisting complaints. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrew D Duckworth
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Neil R Wickramasinghe
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Nicholas D Clement
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Charles M Court-Brown
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
| | - Margaret M McQueen
- Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SU, Scotland. E-mail address for A.D. Duckworth:
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18
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An individually-tailored multifactorial intervention program for older fallers in a middle-income developing country: Malaysian Falls Assessment and Intervention Trial (MyFAIT). BMC Geriatr 2014; 14:78. [PMID: 24951180 PMCID: PMC4080753 DOI: 10.1186/1471-2318-14-78] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/06/2014] [Indexed: 11/10/2022] Open
Abstract
Background In line with a rapidly ageing global population, the rise in the frequency of falls will lead to increased healthcare and social care costs. This study will be one of the few randomized controlled trials evaluating a multifaceted falls intervention in a low-middle income, culturally-diverse older Asian community. The primary objective of our paper is to evaluate whether individually tailored multifactorial interventions will successfully reduce the number of falls among older adults. Methods Three hundred community-dwelling older Malaysian adults with a history of (i) two or more falls, or (ii) one injurious fall in the past 12 months will be recruited. Baseline assessment will include cardiovascular, frailty, fracture risk, psychological factors, gait and balance, activities of daily living and visual assessments. Fallers will be randomized into 2 groups: to receive tailored multifactorial interventions (intervention group); or given lifestyle advice with continued conventional care (control group). Multifactorial interventions will target 6 specific risk factors. All participants will be re-assessed after 12 months. The primary outcome measure will be fall recurrence, measured with monthly falls diaries. Secondary outcomes include falls risk factors; and psychological measures including fear of falling, and quality of life. Discussion Previous studies evaluating multifactorial interventions in falls have reported variable outcomes. Given likely cultural, personal, lifestyle and health service differences in Asian countries, it is vital that individually-tailored multifaceted interventions are evaluated in an Asian population to determine applicability of these interventions in our setting. If successful, these approaches have the potential for widespread application in geriatric healthcare services, will reduce the projected escalation of falls and fall-related injuries, and improve the quality of life of our older community. Trial registration ISRCTN11674947
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19
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Court-Brown CM, Biant L, Bugler KE, McQueen MM. Changing epidemiology of adult fractures in Scotland. Scott Med J 2014; 59:30-4. [DOI: 10.1177/0036933013518148] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Fracture epidemiology in adults is changing but there is very little information about the rate of change or whether the change affects males and females equally. Methods We have compared fracture incidence in two similar populations 50–60 years apart. A study of fractures in Dundee, Scotland and Oxford, England, in 1954–1958, was compared with a similar cohort of fractures in Edinburgh, Scotland, in 2010–2011. Fracture incidence in patients >35 years was recorded in both time periods. Results The incidence of fractures increased by 50% between the two time periods, although the increase in males was only 5% compared with 85% in females. The spectrum of fractures has changed considerably, and there has been an increase in the incidence of both fragility and non-fragility fractures. Analysis showed an increased incidence of fall-related fractures in all age groups in both males and females. Interpretation There has been a substantial change in the incidence of fractures in the last 50–60 years. These have been caused by greater longevity and by considerable social and economic changes.
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Affiliation(s)
| | - Leela Biant
- Consultant Orthopaedic Surgeon, Royal Infirmary of Edinburgh, UK
| | - Kate E Bugler
- Specialty Orthopaedic Trainee, Royal Infirmary of Edinburgh, UK
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20
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Clement ND, McQueen MM, Court-Brown CM. Social deprivation influences the epidemiology and outcome of proximal humeral fractures in adults for a defined urban population of Scotland. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:1039-46. [DOI: 10.1007/s00590-013-1301-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/17/2013] [Indexed: 11/28/2022]
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21
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Court-Brown CM, Aitken SA, Duckworth AD, Clement ND, McQueen MM. The relationship between social deprivation and the incidence of adult fractures. J Bone Joint Surg Am 2013; 95:e321-7. [PMID: 23515993 DOI: 10.2106/jbjs.k.00631] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Social deprivation is associated with many diseases. To our knowledge, there has been no previous investigation of its role in the epidemiology and incidence of fractures in adults. METHODS We analyzed 6872 consecutive fractures in patients fifteen years of age or older over a one-year period. Social deprivation was analyzed using the Carstairs score, which is derived from patients' postal codes and accurately defines social deprivation in our population. RESULTS Social deprivation is associated with an increasing fracture incidence. The effect is not linear, and the most deprived 10% of society are affected. The odds ratios of the most deprived 10% of society having an increased incidence of fractures are 3.7 in males and 3.1 in females. CONCLUSIONS Social deprivation is associated with a significant increase in the incidence of fractures in the most deprived 10% of the population. Most fracture types are affected.
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Affiliation(s)
- Charles M Court-Brown
- Royal Infirmary of Edinburgh, Little France, Old Dalkeith Road, Edinburgh EH16 4SU, Scotland.
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22
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Dickson G, Chesser A, Woods NK, Dong F, Kellerman R. Time Required for Screening for Visual Impairment in Primary Care. J Prim Care Community Health 2012; 3:174-9. [DOI: 10.1177/2150131911429824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To determine the time required for adults older than 50 years to complete 1 of 3 vision impairment assessment tools in a family medicine residency office. Methods: Patients older than 50 years with no known cognitive or physical deficits that impaired ability to follow directions or complete screening tasks were invited to participate in this trial. Participants were randomized to complete 1 of 3 screening modalities, namely, the Functional Vision Screening Questionnaire (questionnaire), mixed contrast sensitivity reading card (card), or Snellen eye chart (Snellen). The time required to complete the vision assessment was obtained and recorded. Results: Sixty-nine patients, with a mean age of 63 years (SD, 10), participated in the study. The card required 94 less seconds to administer than did the questionnaire (95% confidence interval, 61.24 to 127.11 seconds). Similarly, the card required 67 less seconds to administer than did the Snellen (95% confidence interval, 34.20 to 100.06 seconds). No significant difference existed between time to administer the questionnaire and the Snellen (mean difference, 27 seconds; 95% confidence interval, –5.89 to 59.97 seconds). Conclusions: Primary care–based vision screening may detect patients with impairment who would otherwise not have vision assessment. However, a time-intensive screen will not likely be successfully implemented in a primary care office. The card required statistically significantly less time to administer than did the questionnaire or Snellen. With all modalities requiring at least 1 minute, perhaps none are suitable for use for universal, primary care–based vision screening programs. Further work is needed to characterize the reliability and ease of use of each tool.
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Affiliation(s)
- Gretchen Dickson
- Department of Family and Community Medicine, University of Kansas School of Medicine- Wichita, Wichita KS, USA
| | - Amy Chesser
- Department of Family and Community Medicine, University of Kansas School of Medicine- Wichita, Wichita KS, USA
| | - Nicole Keene Woods
- Department of Family and Community Medicine, University of Kansas School of Medicine- Wichita, Wichita KS, USA
| | - Frank Dong
- University of Kansas School of Medicine, Wichita, KS, USA
| | - Rick Kellerman
- Department of Family and Community Medicine, University of Kansas School of Medicine- Wichita, Wichita KS, USA
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23
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Syddall HE, Evandrou M, Dennison EM, Cooper C, Sayer AA. Social inequalities in osteoporosis and fracture among community-dwelling older men and women: findings from the Hertfordshire Cohort Study. Arch Osteoporos 2012; 7:37-48. [PMID: 23225280 PMCID: PMC3636494 DOI: 10.1007/s11657-012-0069-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 01/25/2012] [Indexed: 02/03/2023]
Abstract
UNLABELLED It is unknown whether osteoporosis is socially patterned. Using data from the Hertfordshire Cohort Study we found no consistent evidence for social inequalities in prevalent or incident fracture, bone mineral density or loss rates, or bone strength. Public health strategies for prevention of osteoporosis should focus on the whole population. INTRODUCTION Osteoporosis and osteoporotic fracture are major public health issues for society; the burden for the affected individual is also high. It is unclear whether osteoporosis and osteoporotic fracture are socially patterned. OBJECTIVE This study aims to analyse social inequalities in osteoporosis and osteoporotic fracture among the 3,225 community-dwelling men and women, aged 59-73 years, who participated in the Hertfordshire Cohort Study (HCS), UK. METHODS A panel of markers of bone health (fracture since 45 years of age; DXA bone mineral density and loss rate at the total femur; pQCT strength strain indices for the radius and tibia; and incident fracture) were analysed in relation to the social circumstances of the HCS participants (characterised at the individual level by: age left full time education; current social class; housing tenure and car availability). RESULTS We found little strong or consistent evidence among men, or women, for social inequalities in prevalent or incident fracture, DXA bone mineral density, bone loss rates, or pQCT bone strength, with or without adjustment for age, anthropometry, lifestyle and clinical characteristics. Reduced car availability at baseline was associated with lower pQCT radius and tibia strength strain indices at follow-up among men only (p = 0.02 radius and p < 0.01 tibia unadjusted; p = 0.05 radius and p = 0.01 tibia, adjusted for age, anthropometry, lifestyle and clinical characteristics). CONCLUSIONS Our results suggest that fracture and osteoporosis do not have a strong direct social gradient and that public health strategies for prevention and treatment of osteoporosis should continue to focus on the whole population.
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Affiliation(s)
- Holly E Syddall
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, UK.
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24
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Clement ND, Aitken S, Duckworth AD, McQueen MM, Court-Brown CM. Multiple fractures in the elderly. ACTA ACUST UNITED AC 2012; 94:231-6. [DOI: 10.1302/0301-620x.94b2.27381] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present the prevalence of multiple fractures in the elderly in a single catchment population of 780 000 treated over a 12-month period and describe the mechanisms of injury, common patterns of occurrence, management, and the associated mortality rate. A total of 2335 patients, aged ≥ 65 years of age, were prospectively assessed and of these 119 patients (5.1%) presented with multiple fractures. Distal radial (odds ratio (OR) 5.1, p < 0.0001), proximal humeral (OR 2.2, p < 0.0001) and pelvic (OR 4.9, p < 0.0001) fractures were associated with an increased risk of sustaining associated fractures. Only 4.5% of patients sustained multiple fractures after a simple fall, but due to the frequency of falls in the elderly this mechanism resulted in 80.7% of all multiple fractures. Most patients required admission (> 80%), of whom 42% did not need an operation but more than half needed an increased level of care before discharge (54%). The standardised mortality rate at one year was significantly greater after sustaining multiple fractures that included fractures of the pelvis, proximal humerus or proximal femur (p < 0.001). This mortality risk increased further if patients were < 80 years of age, indicating that the existence of multiple fractures after low-energy trauma is a marker of mortality.
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Affiliation(s)
- N. D. Clement
- Royal Infirmary of Edinburgh, 51
Little France Crescent, Old Dalkeith Road, Edinburgh EH16
4SA, UK
| | - S. Aitken
- Royal Infirmary of Edinburgh, 51
Little France Crescent, Old Dalkeith Road, Edinburgh EH16
4SA, UK
| | - A. D. Duckworth
- Royal Infirmary of Edinburgh, 51
Little France Crescent, Old Dalkeith Road, Edinburgh EH16
4SA, UK
| | - M. M. McQueen
- Royal Infirmary of Edinburgh, 51
Little France Crescent, Old Dalkeith Road, Edinburgh EH16
4SA, UK
| | - C. M. Court-Brown
- Royal Infirmary of Edinburgh, 51
Little France Crescent, Old Dalkeith Road, Edinburgh EH16
4SA, UK
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