1
|
Dams J, Gottschalk S, Schwenk M, Nerz C, Becker C, Klenk J, Jansen CP, König HH. Budget impact analysis of a Lifestyle-integrated Functional Exercise (LiFE) program for older people in Germany: a Markov model based on data from the LiFE-is-LiFE trial. BMC Geriatr 2024; 24:186. [PMID: 38395743 PMCID: PMC10893703 DOI: 10.1186/s12877-024-04802-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Fall prevention is important for healthy ageing, but the economic impact of fall prevention are scarcely investigated. A recent cost-effectiveness analysis compared a group-delivered Lifestyle-integrated Functional Exercise Program (gLiFE) with an individually-delivered program (LiFE) in community-dwelling people (aged ≥ 70 years) at risk of falling. In addition, the current study aimed to analyze the budget impact of LiFE and gLiFE, compared with standard care in Germany. METHODS A Markov model was developed to reflect falls and associated care needs for community-dwelling persons over 5 years. The intervention effects of LiFE and gLiFE were shown to be equivalent in a non-inferiority trial, although the costs differed. Outpatient, inpatient, and intervention costs were assessed from a payer's perspective. The effect of parameter uncertainty was assessed in sensitivity analyses. RESULTS The budget impact due to intervention costs was €510 million for LiFE and €186 million for gLiFE. Over five years, health care expenditures were €35,008 million for those receiving standard care, €35,416 million for those receiving LiFE, and €35,091 million for persons receiving gLiFE. Thereby, LiFE and gLiFE could prevent 2700 deaths and 648,000 falls over 5 years. Parameter uncertainties in the risk of falling, uptake of an intervention offer, and in the intervention effects had a major influence; thus cost savings for LiFE and gLiFE compared with standard care could be achieved for individuals with a high risk of falling. CONCLUSIONS The results revealed that cost savings for LiFE and gLiFE compared with standard care could only be achieved for individuals at high risk of falling, with gLiFE being superior to LiFE. Future research should consider benefits and aspects of fall prevention beyond falls (e.g., physical activity, social aspects, and personal preferences of participants). TRIAL REGISTRATION The study was preregistered under underclinicaltrials.gov (identifier: NCT03462654) on 12th March 2018; https://clinicaltrials.gov/ct2/show/NCT03462654 .
Collapse
Affiliation(s)
- Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg- Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany.
| | - Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg- Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | - Michael Schwenk
- Department of Sport Science, Human Performance Research Centre, University of Konstanz, Constance, Germany
| | - Corinna Nerz
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Jochen Klenk
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- IB University of Applied Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Carl-Philipp Jansen
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
- Center for Geriatric Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg- Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| |
Collapse
|
2
|
Becker N, Hafner T, Pishnamaz M, Hildebrand F, Kobbe P. Patient-specific risk factors for adverse outcomes following geriatric proximal femur fractures. Eur J Trauma Emerg Surg 2022; 48:753-761. [PMID: 35325262 PMCID: PMC9001566 DOI: 10.1007/s00068-022-01953-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Proximal femur fractures (PFFs) occur frequently among geriatric patients due to diverse risk factors, such as a lower bone mineral density and the increased risk of falls. METHODS In this review, we focus on recent literature of patient-specific risk factors and their impact on common complications and outcome parameters in patients with PFF. RESULTS Patient- and treatment related factors have a significant impact on outcome and are associated with an increased risk of mortality, impairments in functional rehabilitation and complicative courses. CONCLUSION Geriatric patients at high risk for complications are nursing home inhabitants suffering from severe osteoporosis, dementia and sarcopenia. The early and ongoing assessment for these individual risk factors is crucial. Strategies including interdisciplinary approaches, addressing comorbidities and facilitating an optimal risk factor evaluation result in a beneficial outcome. The ongoing ambulant assessment and therapy of complicating factors (e.g., malnutrition, sarcopenia, frailty or osteoporosis) have to be improved.
Collapse
Affiliation(s)
- Nils Becker
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany.
| | - Tobias Hafner
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Miguel Pishnamaz
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Philipp Kobbe
- Department of Orthopedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Aachen, Germany
| |
Collapse
|
3
|
Scheckel B, Stock S, Müller D. Cost-effectiveness of group-based exercise to prevent falls in elderly community-dwelling people. BMC Geriatr 2021; 21:440. [PMID: 34311698 PMCID: PMC8314607 DOI: 10.1186/s12877-021-02329-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical studies indicate that strength-balance training for active fall prevention can prevent fractures in older people. The present modelling study evaluates the cost-effectiveness of fall prevention exercise (FPE) provided to independently living older people compared to no intervention in Germany. METHOD We designed a Markov model to evaluate the cost-effectiveness of a group-based FPE-program provided to independently living people ≥75 years from the perspective of the German statutory health insurance (SHI). Input data was obtained from public databases, clinical trials and official statistics. The incremental cost-effectiveness ratio (ICER) was presented as costs per avoided hip fracture. Additionally, we performed deterministic and probabilistic sensitivity analyses and, estimated monetary consequences for the SHI in a budget impact analysis (BIA). RESULTS For women, the costs per hip fracture avoided amounted to €52,864 (men: €169,805). Results of deterministic and probabilistic sensitivity analyses confirmed the robustness of the results. According to the BIA, for the reimbursement of FPE additional costs of €3.0 million (women) and €7.8 million (men) are expected for the SHI. CONCLUSIONS Group-based FPE appears to be no cost-effective option to prevent fall-related hip fractures in independently living elderly. To allow a more comprehensive statement on the cost effectiveness of FPE fracture types other than hip should be increasingly evaluated in clinical trials.
Collapse
Affiliation(s)
- Benjamin Scheckel
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany.
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany
| | - Dirk Müller
- Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Str. 176-178, 50935, Cologne, Germany
| |
Collapse
|
4
|
Büchele G, Rapp K, Bauer J, Jaensch A, Becker C, Benzinger P. Risk of traumatic intracranial haemorrhage is increased in older people exposed to oral anticoagulation with phenprocoumon. Aging Clin Exp Res 2020; 32:441-447. [PMID: 31102254 DOI: 10.1007/s40520-019-01215-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hospital admissions resulting from traumatic intracranial haemorrhages (TIH) in older people are increasing. There are concerns regarding an increased risk of a TIH in people taking oral anticoagulants (OAC) like phenprocoumon. AIMS The aim of this study was to estimate the incremental risk of a TIH associated with OAC in older people. Furthermore, this study explored differences in risk according to functional status. METHODS The study took data from a large German health insurance provider and combined hospital diagnoses with data regarding drug dispensing to estimate rates of a TIH in people with and without exposure to phenprocoumon. Analyses were stratified by sex and by severe functional impairment as disclosed by the long-term care insurance provider. RESULTS Overall, exposure to OAC resulted in 2.7 times higher rates of TIH. People with severe functional impairment had a higher baseline risk of TIH than people without severe functional impairment. However, the incremental risk in those exposed to OAC was similar among people with and without severe functional impairment (standardised incidence rate difference 15.73 (95% CI 7.84; 23.61) and 12.10 (95% CI 9.63; 14.57) per 10,000 person-years, respectively). CONCLUSIONS OAC increases the risk of TIH considerably. The incremental risk of TIH in those exposed to OAC is comparable between people with and without severe functional impairment. The presence of severe functional impairment per se should not exclude such patients from the potential benefits of OAC. For now, the prescription should be personalized based on individual fall risk factors and risk-taking behaviour.
Collapse
|
5
|
Rapp K, Büchele G, Dreinhöfer K, Bücking B, Becker C, Benzinger P. Epidemiology of hip fractures : Systematic literature review of German data and an overview of the international literature. Z Gerontol Geriatr 2019; 52:10-16. [PMID: 29594444 PMCID: PMC6353815 DOI: 10.1007/s00391-018-1382-z] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/23/2018] [Accepted: 03/02/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hip fractures are regarded as a worldwide epidemic and a major public health concern. Changing risk factors, local differences and temporal trends contribute to the particular epidemiology of hip fractures. This overview gives a comprehensive insight into the epidemiology of hip fractures and reviews where German data have contributed to the literature. METHODS The review of the epidemiology of hip fractures in Germany is based on a systematic literature search in PubMed. Information about the global epidemiology of hip fractures was provided by a selective literature review focusing on specific aspects of the epidemiology of hip fractures. RESULTS Hip fracture rates vary more than 100-fold between different countries. In most high-income countries, a rise in age-standardized hip fracture rates was observed until the 1980s and 1990s and a decrease thereafter. Such a decrease has not been observed for Germany so far. Many factors, diseases and drugs have been found to be associated with hip fractures and there is some evidence that fracture risk in later life is already programmed during fetal life and early childhood. Of the hip fracture burden 50% occur in people with disability and in need of care. In nursing homes approximately 4 fractures can be expected in 100 women per year. In people with intellectual or developmental disabilities comparable risks of hip fracture occur 10-40 years earlier than in the general population. Incidence of disability, institutionalization and death are frequent consequences of hip fractures. CONCLUSION The epidemiology of hip fractures is characterized by a high burden of disease, local differences, temporal trends, well-defined high-risk populations and many established risk factors.
Collapse
Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany.
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Karsten Dreinhöfer
- Department of Musculoskeletal Rehabilitation, Prevention and Health Service Research, Center for Sport Science and Sport Medicine (CSSB), Center for Musculoskeletal Surgery (CMSC), Charité Universitätsmedizin, Berlin, Germany
- Department of Orthopedics and Traumatology, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Benjamin Bücking
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg GmbH, Baldingerstraße, 35043, Marburg, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Petra Benzinger
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| |
Collapse
|
6
|
Becker C, Heppner HJ. [Mobility in older people]. Z Gerontol Geriatr 2019; 52:1-2. [PMID: 30701296 DOI: 10.1007/s00391-018-01490-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Clemens Becker
- Geriatrie und Geriatrische Rehabilitation, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Deutschland.
| | - Hans Jürgen Heppner
- Geriatrische Klinik & Geriatrische Tagesklinik, Heliosklinikum Schwelm, Schwelm, Deutschland
| |
Collapse
|
7
|
Gustavsson J, Jernbro C, Nilson F. There is more to life than risk avoidance - elderly people's experiences of falls, fall-injuries and compliant flooring. Int J Qual Stud Health Well-being 2018; 13:1479586. [PMID: 29869973 PMCID: PMC5990953 DOI: 10.1080/17482631.2018.1479586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Falls are the most common cause of injury in all ages and are especially difficult to prevent among residential care residents. Compliant flooring that absorbs energy generated within the fall, has been proposed as a measure to prevent fall-injury, however little is known regarding the implementation aspects in clinical settings. The aim of this study is to explore the experiences of falls, the risk of fall-injury, prevention in general and specifically compliant flooring as an injury preventative measure amongst frail elderly people living in a residential care facility with compliant flooring. Through this, generate a theory that further explains the underlying barriers of active prevention amongst elderly people. METHOD We used the grounded theory method and conducted semi-structured in-depth interviews with eight elderly people in residential care (data collected between February and December 2017). RESULTS The identified categories were Falling as a part of life, Fearing the consequences and A wish to prevent falls and injuries. Through the results it was clear that There is more to life than risk avoidance, permeated the interviews, therefore forming the grounded theory. The interviewees viewed falls as something common and normal, and were uninterested in focusing on the risk of falls. Although they wanted to prevent falls, it was often difficult to integrate preventative measures into their everyday life. They embraced the idea of an injury-reducing compliant flooring, however their main interests lay elsewhere, preferring to focus on social interaction and issues concerning daily activities. CONCLUSIONS The theory generated in this paper proposes explanations on the obstacles of implementing fall prevention measures in an elderly frail population. The findings give insights as to why interest and compliance for active fall prevention measures are low. We conclude that complaint flooring, from the perspective of the residents, can work well in residential care.
Collapse
Affiliation(s)
- Johanna Gustavsson
- Centre for Public Safety, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Carolina Jernbro
- Centre for Public Safety, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Finn Nilson
- Centre for Public Safety, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| |
Collapse
|
8
|
Cost-effectiveness of a home safety intervention to prevent falls in impaired elderly people living in the community. Arch Osteoporos 2018; 13:122. [PMID: 30413893 DOI: 10.1007/s11657-018-0535-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/22/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Among others, the German National Prevention Conference recently recommended the provision of preventive options for elderly to maintain their independent living. Because a home safety assessment and modification program (HSM) has shown to be effective in avoiding falls and risk of falling in elderly, the aim of this analysis was to evaluate the cost-effectiveness of HSM in patients aged ≥ 80 years who receive non-institutionalized long-term care. METHODS In order to reflect quality-adjusted life years (QALYs) and costs resulting from HSM, a Markov-model with a time horizon of 20 years was performed from the perspective of the German statutory health insurance (SHI) and statutory long-term care insurance (LCI). The model assumed that HSM reduces fall-related hip fractures in accordance with the reduction of the rate of falls. Data was obtained from public databases and from various literature searches. The robustness of the results was assessed in deterministic and probabilistic sensitivity analyses. RESULTS In women, the incremental cost-effectiveness ratio of HSM compared to no prevention was €9580 per QALY, while in men, it was €57,589. For the German SHI/LCI, in total, the provision of HSM to patients ≥ 80 years who receive non-institutionalized long-term care would result in annual costs of €7.7 million. The results were robust in several sensitivity analyses. CONCLUSIONS Provided that the rate of falls is a valid surrogate endpoint for the rate of fall-related hip fractures, HSM could be a promising approach for investments in preventive options targeting the reduction of fall-related fractures in elderly women.
Collapse
|
9
|
Roigk P, Becker C, Schulz C, König HH, Rapp K. Long-term evaluation of the implementation of a large fall and fracture prevention program in long-term care facilities. BMC Geriatr 2018; 18:233. [PMID: 30285637 PMCID: PMC6167865 DOI: 10.1186/s12877-018-0924-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Falls and fractures are extremely frequent in long-term care facilities (LTCFs). Therefore, a fall and fracture prevention program was started in nearly 1000 LTCFs in Bavaria/Germany between 2007 and 2010. The components of the program were exercise classes, the documentation of falls, environmental adaptations, medication reviews, the recommendation to use hip protectors and education of staff. The present study aimed to provide a comprehensive evaluation of the implementation process of the program regarding results of the implementation phase and the follow-up of 3–9 years after start of implementation. Methods Data from numerous sources were used, including data from published studies, statistical data, health insurance claims data and unpublished data from an online questionnaire. To incorporate different aspects, time periods and results, the RE-AIM framework was applied. Results The program was adopted by 942 of the 1150 eligible LTCFs and reached about 62,000 residents. During the implementation phase exercise classes and recommendation about environmental adaptations were offered in nearly all LTCFs. 13.5% of the residents participated in exercise classes. Hip protectors were available for 9.2% of all residents. In the first implementation wave, femoral fracture rate was significantly reduced by 18% in the first year. At follow-up nearly 90% of all LTCFs still offered exercise classes, which were attended by about 11% of residents. However, only 10% of the exercise classes completely fulfilled the requirements of an effective strength and balance training. Individual advice about environmental adaptations was provided in 74.3% of the LTCFs and nearly all LTCFs claimed to offer hip protectors to their residents. A long-term effect of the program on femoral fractures could not be detected. Conclusions The program did not affect the femoral fracture rate in the long run. Possible reasons could be a high turn-over of the staff, a reduced fidelity of training components or a shift in daily priorities among the staff.
Collapse
Affiliation(s)
- Patrick Roigk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany.
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Claudia Schulz
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstrasse 110, 70376, Stuttgart, Germany
| |
Collapse
|
10
|
A quasi-experimental evaluation of compliant flooring in a residential care setting. PLoS One 2018; 13:e0201290. [PMID: 30048517 PMCID: PMC6062098 DOI: 10.1371/journal.pone.0201290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/12/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Fall injuries affect the lives of older people to a substantial degree. This quasi-experimental observational study investigates the potential fall injury reducing effect of a compliant flooring in a residential care setting. METHODS The allocation of the compliant flooring was non-random. Data on fall-events and individual characteristics were collected in a residential care unit during a period of 68 months. The primary outcome was the fall injury rate per fall, and a logistic regression analysis was used to test for the effect of complaint flooring. Falls per 1000 bed days was the secondary outcome, used to measure the difference in fall risk on compliant flooring versus regular flooring. RESULTS The event dataset is an unbalanced panel with repeated observations on 114 individuals, with 70% women. The mean age was 84.9 years of age, the average Body Mass Index (BMI) was 24.7, and there was a mean of 6.57 (SD: 15.28) falls per individual. The unadjusted effect estimate showed a non-significant relative risk injury reduction of 29% per fall (RR 0.71 [95% CI: 0.46-1.09]) compared to regular flooring. Re-estimating, excluding identified outliers, showed an injury risk reduction of 63% (RR 0.37 [95% CI: 0.25-0.54]). Falls per 1000 bed days showed that individuals living in apartments with compliant flooring had a fall rate of 5.3 per 1000 bed days compared to a fall rate of 8.4 per 1000 bed days among individuals living in regular apartments. This corresponds to an incidence rate ratio (IRR) of 0.63 (95% exact Poisson CI: 0.50-0.80). CONCLUSION The results of this non-randomized study indicate that compliant flooring has the potential to reduce the risk of fall injury without increasing the fall risk among older people in a Swedish residential care setting.
Collapse
|
11
|
Reber KC, König HH, Becker C, Rapp K, Büchele G, Mächler S, Lindlbauer I. Development of a risk assessment tool for osteoporotic fracture prevention: A claims data approach. Bone 2018; 110:170-176. [PMID: 29421456 DOI: 10.1016/j.bone.2018.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 01/30/2018] [Accepted: 02/03/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND In aging societies osteoporotic fractures are a major health problem with high economic costs. Targeting prevention at individuals at high risk is important to reduce the future burden of fractures. Available risk assessment tools (e.g., FRAX®, QFracture, the algorithm provided by the German Osteology Society (DVO-Tool)) rely on self-reported patient information to predict fracture risk. Time and resource constraints, limited access to clinical data, and (un)willingness to participate may hamper the use of these tools. To overcome such obstacles, the aim is to develop a fracture risk assessment tool based on claims data that may be directly used on an institutional level. METHODS Administrative claims data of an elderly (≥65years) population (N=298,530) for the period from 2006 through 2014 was used. Major osteoporotic fractures (MOF) were identified based on hospital diagnoses. We applied Cox proportional hazard regression to determine the association of individual risk factors and fracture risk. Hazard ratios were used to construct a risk score. The discriminative ability of the score was evaluated using C-statistics. RESULTS We identified 7864 MOF during follow-up. The median time to first fracture during follow-up was 371.5days. Individuals with a MOF during follow-up had a higher mean and median risk score (mean: 4.53; median: 4) than individuals without MOF (mean: 3.07; median: 3). Adding drug-related risk factors slightly improved discrimination compared to a simple model with age, gender, and prior fracture. CONCLUSION We developed a fracture risk score model based on in-hospital treated subjects to predict MOF that can be used on an institutional level. The score included age, sex and prior fracture as risk factors. Adding other risk factors involved very small improvement in discrimination.
Collapse
Affiliation(s)
- Katrin C Reber
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital Stuttgart, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Germany
| | - Sarah Mächler
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Germany
| | - Ivonne Lindlbauer
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany
| |
Collapse
|
12
|
Incidence Rates of and Mortality after Hip Fracture among German Nursing Home Residents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020289. [PMID: 29414914 PMCID: PMC5858358 DOI: 10.3390/ijerph15020289] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 11/17/2022]
Abstract
Little is known about hip fracture rates and post-fracture mortality among nursing home residents. This retrospective cohort study examined incidence rates (IR) of and mortality after hip fracture in this population focusing on sex differences. A cohort of >127,000 residents ≥65 years, newly admitted to German nursing homes between 2010 and 2014 were used to calculate age-, sex-, care-need- and time after admission-specific IR. To determine mortality, the Kaplan-Meier-method was applied. Using Cox regression, we studied mortality and estimated time-dependent hazard ratios (HRs). For this purpose, to each person with a hip fracture, one resident without a hip fracture was matched by sex, age and care-need using risk-set sampling. 75% were women (mean age: 84.0 years). During 168,588 person-years (PY), 8537 residents with at least one hip fracture were observed. The IR for women and men were 52.9 and 42.5/1000 PY. For both sexes, IR increased with rising age and decreased with increasing care-level. IR were highest in the first months after admission and subsequently declined afterwards. The impact of hip fractures on mortality was time-dependent. Mortality of residents with hip fracture was highest in the first two months after fracture compared to those without (HR): 2.82; 95% CI 2.57–3.11) and after six months, no differences were found (HR: 1.10; 95% CI 0.98–1.22) Further research should always include analyses stratified by sex, age and time period after admission.
Collapse
|
13
|
Gustavsson J, Rahm G, Jernbro C, Nilson F. Effects of Impact-Absorbing Flooring in Residential Care from the Perspectives of Enrolled Nurses. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/02763893.2017.1335670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Johanna Gustavsson
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - GullBritt Rahm
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Carolina Jernbro
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Finn Nilson
- Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| |
Collapse
|
14
|
Sandmann A, Amling M, Barvencik F, König HH, Bleibler F. Economic evaluation of vitamin D and calcium food fortification for fracture prevention in Germany. Public Health Nutr 2017; 20:1874-1883. [PMID: 26568196 PMCID: PMC10261623 DOI: 10.1017/s1368980015003171] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/07/2015] [Accepted: 10/13/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The study evaluates the economic benefit of population-wide vitamin D and Ca food fortification in Germany. DESIGN Based on a spreadsheet model, we compared the cost of a population-wide vitamin D and Ca food-fortification programme with the potential cost savings from prevented fractures in the German female population aged 65 years and older. SETTING The annual burden of disease and the intervention cost were assessed for two scenarios: (i) no food fortification; and (ii) voluntary food fortification with 20 µg (800 IU) of cholecalciferol (vitamin D3) and 200 mg of Ca. The analysis considered six types of fractures: hip, clinical vertebral, humerus, wrist, other femur and pelvis. SUBJECTS Subgroups of the German population defined by age and sex. RESULTS The implementation of a vitamin D and Ca food-fortification programme in Germany would lead to annual net cost savings of €315 million and prevention of 36 705 fractures in the target population. CONCLUSIONS Vitamin D and Ca food fortification is an economically beneficial preventive health strategy that has the potential to reduce the future health burden of osteoporotic fractures in Germany. The implementation of a vitamin D and Ca food-fortification programme should be a high priority for German health policy makers because it offers substantial cost-saving potential for the German health and social care systems.
Collapse
Affiliation(s)
- Arne Sandmann
- Department of Osteology and Biomechanics, University Medical Center Hamburg–Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg–Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany
| | - Florian Barvencik
- Department of Osteology and Biomechanics, University Medical Center Hamburg–Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg–Eppendorf, Hamburg, Germany
| | - Florian Bleibler
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg–Eppendorf, Hamburg, Germany
| |
Collapse
|
15
|
Bluhmki T, Peter RS, Rapp K, König HH, Becker C, Lindlbauer I, Rothenbacher D, Beyersmann J, Büchele G. Understanding Mortality of Femoral Fractures Following Low-Impact Trauma in Persons With and Without Care Need. J Am Med Dir Assoc 2016; 18:221-226. [PMID: 27776984 DOI: 10.1016/j.jamda.2016.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Persons with osteoporotic fracture history are subject to an increased risk for subsequent fractures and mortality. The aim of this retrospective study was to investigate the impact of a previous osteoporotic low-impact (fragility) index fracture (eg, forearm, lower leg) on mortality of a subsequent femoral fracture. DESIGN Retrospective cohort study. PARTICIPANTS/MEASUREMENTS Claims data of a German health insurance agency including >1.2 million insurants aged 65 years or older and observed between 2004 and 2009. METHODS A multistate model was developed handling index fractures and care need as time-dependent exposures, while age was chosen as the underlying time scale. Excess risks were expressed as differences in cause-specific hazards. Nelson-Aalen estimates were used for their nonparametric estimation. Time-simultaneous statistical inference was based on confidence bands provided by wild bootstrap resampling. RESULTS Excess femoral fracture risk increased with progressive age and was highest in persons with care need. It was observed starting from an age of 79 years in women and 85 years in men onward. A prior index fracture increased mortality after a femoral fracture by increasing femoral fracture risk, while leaving the hazard of death after a subsequent femoral fracture unchanged. CONCLUSIONS The results indicated that increased mortality of a subsequent femoral fracture is not triggered by an intrinsically increased mortality hazard but an increased femoral fracture incidence.
Collapse
Affiliation(s)
- Tobias Bluhmki
- Department of Mathematics and Economics, Institute of Statistics, Ulm University, Ulm, Germany
| | - Raphael Simon Peter
- Department of Medicine, Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kilian Rapp
- Department for Geriatric Rehabilitation, Robert Bosch Krankenhaus, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center, Hamburg, Germany
| | - Clemens Becker
- Department for Geriatric Rehabilitation, Robert Bosch Krankenhaus, Stuttgart, Germany
| | - Ivonne Lindlbauer
- Department of Health Economics and Health Services Research, University Medical Center, Hamburg, Germany
| | - Dietrich Rothenbacher
- Department of Medicine, Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Jan Beyersmann
- Department of Mathematics and Economics, Institute of Statistics, Ulm University, Ulm, Germany
| | - Gisela Büchele
- Department of Medicine, Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
| |
Collapse
|
16
|
Lachance CC, Korall AMB, Russell CM, Feldman F, Robinovitch SN, Mackey DC. External Hand Forces Exerted by Long-Term Care Staff to Push Floor-Based Lifts: Effects of Flooring System and Resident Weight. HUMAN FACTORS 2016; 58:927-943. [PMID: 27098263 DOI: 10.1177/0018720816644083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 03/17/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of flooring type and resident weight on external hand forces required to push floor-based lifts in long-term care (LTC). BACKGROUND Novel compliant flooring is designed to reduce fall-related injuries among LTC residents but may increase forces required for staff to perform pushing tasks. A motorized lift may offset the effect of flooring on push forces. METHOD Fourteen female LTC staff performed straight-line pushes with two floor-based lifts (conventional, motor driven) loaded with passengers of average and 90th-percentile resident weights over four flooring systems (concrete+vinyl, compliant+vinyl, concrete+carpet, compliant+carpet). Initial and sustained push forces were measured by a handlebar-mounted triaxial load cell and compared to participant-specific tolerance limits. Participants rated pushing difficulty. RESULTS Novel compliant flooring increased initial and sustained push forces and subjective ratings compared to concrete flooring. Compared to the conventional lift, the motor-driven lift substantially reduced initial and sustained push forces and perceived difficulty of pushing for all four floors and both resident weights. Participants exerted forces above published tolerance limits only when using the conventional lift on the carpet conditions (concrete+carpet, compliant+carpet). With the motor-driven lift only, resident weight did not affect push forces. CONCLUSION Novel compliant flooring increased linear push forces generated by LTC staff using floor-based lifts, but forces did not exceed tolerance limits when pushing over compliant+vinyl. The motor-driven lift substantially reduced push forces compared to the conventional lift. APPLICATION Results may help to address risk of work-related musculoskeletal injury, especially in locations with novel compliant flooring.
Collapse
Affiliation(s)
- Chantelle C Lachance
- Simon Fraser University, Burnaby, CanadaOlder Adult Program, Fraser Health Authority, Surrey, CanadaSimon Fraser University, Burnaby Canada
| | - Alexandra M B Korall
- Simon Fraser University, Burnaby, CanadaOlder Adult Program, Fraser Health Authority, Surrey, CanadaSimon Fraser University, Burnaby Canada
| | | | - Fabio Feldman
- Older Adult Program, Fraser Health Authority, Surrey, Canada
| | - Stephen N Robinovitch
- Simon Fraser University, Burnaby, CanadaOlder Adult Program, Fraser Health Authority, Surrey, CanadaSimon Fraser University, Burnaby Canada
| | | |
Collapse
|
17
|
Büchele G, Rapp K, König HH, Jaensch A, Rothenbacher D, Becker C, Benzinger P. The Risk of Hospital Admission Due to Traumatic Brain Injury Is Increased in Older Persons With Severe Functional Limitations. J Am Med Dir Assoc 2016; 17:609-12. [PMID: 27073040 DOI: 10.1016/j.jamda.2016.02.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hospital admissions due to traumatic brain injuries (TBIs) in older persons are increasing. Falls are the leading mechanism of injury in this age group. TBIs are associated with unfavorable outcomes such as mortality and institutionalization. OBJECTIVES To estimate rates of TBIs in older persons with severe functional limitations, expressed as "care need," living in the community, and in older persons with care need living in nursing homes compared with older persons without care need. PARTICIPANTS More than 1.2 million persons aged 65 years and older living in Bavaria, Germany, and insured with one of the largest German health insurances (health care and long-term care insurance). METHODS Age-standardized rates were calculated based on hospital claims data and claims data of the long-term care insurance and were compared between groups. The 3 groups were defined by claims data of the long-term care insurance. RESULTS TBI in older persons account for 4.8 hospital admissions per 1000 person-years. Overall TBI rates do not differ significantly between men and women. TBI rates are lowest in persons without care need and are highest for older persons living in nursing homes. Their contribution to the overall burden of TBI is lower than their contribution to the burden of fragility fractures. CONCLUSION TBIs in older persons are common. Those with severe functional limitations are at increased risk for TBI. Nursing home residents have the highest rates of TBI. Fall prevention programs should seek to prevent not only fragility fractures but also head impact.
Collapse
Affiliation(s)
- Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kilian Rapp
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Clemens Becker
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Stuttgart, Germany
| | - Petra Benzinger
- Department of Clinical Gerontology, Robert Bosch Krankenhaus Stuttgart, Stuttgart, Germany.
| |
Collapse
|
18
|
Benzinger P, Becker C, Todd C, Bleibler F, Rothenbacher D, König HH, Rapp K. The impact of preventive measures on the burden of femoral fractures - a modelling approach to estimating the impact of fall prevention exercises and oral bisphosphonate treatment for the years 2014 and 2025. BMC Geriatr 2016; 16:75. [PMID: 27038629 PMCID: PMC4818493 DOI: 10.1186/s12877-016-0247-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 03/23/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Due to the demographic transition with a growing number of old and oldest-old persons the absolute number of fragility fractures is expected to increase in industrialized countries unless effective preventive efforts are intensified. The main causes leading to fractures are osteoporosis and falls. The aim of this study is to develop population based models of the potential impact of fall-prevention exercise and oral bisphosphonates over the coming decade. METHODS The German federal state of Bavaria served as the model population. Model interventions were limited to community-dwelling persons aged 65 years and older. Models are based on fall-prevention exercise being offered to all persons aged 70 to 89 years and oral bisphosphonate treatment offered to all persons with osteoporosis as defined by a T-score of ≤ - 2.5. Treatment effect sizes are estimated from meta-analyses. Reduction in all femoral fractures in the population of community-dwelling persons aged 65 years and older is the outcome of interest. A spreadsheet-based modelling approach was used for prediction. RESULTS In 2014, reduction of femoral fractures by 10 % required 21 % of all community-dwelling persons aged 70-89 to participate in fall-prevention exercise, or 37 % of those with osteoporosis to receive oral bisphosphonates. Without intervention, demographic changes will result in a 24 % increase in femoral fractures by 2025. To lower the increase of fractures between 2014 and 2025 to 10 %, fall-prevention-exercise participation rate needs to be 25 % and bisphosphonate treatment rates 41 %, whereas to hold the 2025 rates flat at 2014 rates require 43 % fall-prevention-exercises participation, and is not achievable using oral bisphosphonates. CONCLUSIONS Unrealistic high treatment and participation rates of the two analysed measures are needed to achieve substantial effects on the expected burden of femoral fractures at present and in the future.
Collapse
Affiliation(s)
- Petra Benzinger
- Department of Clinical Gerontology, Robert Bosch Krankenhaus, Auerbachstrasse 110, 70376, Stuttgart, Germany.
| | - Clemens Becker
- Department of Clinical Gerontology, Robert Bosch Krankenhaus, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Chris Todd
- School of Nursing, Midwifery & Social Work and Manchester Academic Health Science Centre, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Florian Bleibler
- Department of Health Economics and Health Services Research, Hamburg Centre for Health Economics, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholzstrasse 22, 89081, Ulm, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Centre for Health Economics, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert Bosch Krankenhaus, Auerbachstrasse 110, 70376, Stuttgart, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Helmholzstrasse 22, 89081, Ulm, Germany
| |
Collapse
|
19
|
Berry SD, Lee Y, Zullo AR, Kiel DP, Dosa D, Mor V. Incidence of Hip Fracture in U.S. Nursing Homes. J Gerontol A Biol Sci Med Sci 2016; 71:1230-4. [PMID: 26980299 DOI: 10.1093/gerona/glw034] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/11/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hip fractures are associated with significant morbidity and mortality in the nursing home. Our objective was to describe the incidence rate (IR) of hip fracture according to age, sex, and race in a nationwide sample of long-stay nursing home residents. METHODS Using 2007-2010 Medicare claims data linked with the Minimum Data Set, we identified 892,837 long-stay residents (≥100 days in the same nursing facility) between May 1, 2007 and April 30, 2008. Hip fractures were defined using Part A diagnostic codes (ICD-9). Residents were followed from the date they became a long-stay resident until the first event of death, discharge, hip fracture, or 2 years of follow-up. RESULTS Mean age was 84 years (range 65-113 years), and 74.5% were women. 83.9% were white and 12.0% were black. The overall IR of hip fracture was 2.3/100 person years. The IR was similar in men and women across age groups. The IR of hip fracture was highest in Native Americans aged 85 years or older (3.7/100 person years), in whites (2.6/100 person years), and during the first 100 days of institutionalization (2.7/100 person years). IRs of hip fracture were lowest in blacks (1.3/100 person years). CONCLUSIONS In nursing home residents surviving 100 days or more in a facility, the incidence of hip fracture is high, particularly among older white, Native American, and newly admitted residents. This is the first nationwide study to provide sex- and age-specific estimates among U.S. nursing home residents, and it underscores the magnitude of the problem.
Collapse
Affiliation(s)
- Sarah D Berry
- Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice & Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice & Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island
| | - Doug P Kiel
- Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - David Dosa
- Department of Health Services, Policy, and Practice & Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island
| | - Vincent Mor
- Department of Health Services, Policy, and Practice & Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island
| |
Collapse
|
20
|
Chen PH, Chen CY, Lin YC, Chen MY. Low bone mineral density among adults with disabilities in Taiwan: A cross-sectional descriptive study. Disabil Health J 2015; 8:635-41. [PMID: 26049786 DOI: 10.1016/j.dhjo.2015.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/06/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Low bone mineral density (BMD) is a silent disease that can lead to osteoporosis and is a serious health problem worldwide. People with disabilities are especially at risk for fall-related death. OBJECTIVES To examine the prevalence of low bone mineral density and associated risk factors among adults with disabilities in Taiwan. METHODS We conducted a population-based, cross-sectional study in 2013; the participants were 572 community adults with disabilities over the age of 20 years. Statistical analyses used to evaluate the association included chi-squared tests, ANOVA, and logistic regression. RESULTS Over one-third of the participants had an intellectual disability, 26% physical disability, and the remainder had a combination of disabilities. Of the participants, 62.5% had abnormal bone mineral density, and 21.8% met the criteria for osteoporosis. After adjusting for potential confounding variables, the determinant risk factors for low bone mineral density were age (β = -.14, p = 0.002), gender (β = -.12, p = 0.004), and level of physical activity (β = .1, p = 0.024). The majority of participants with low BMD were not aware of abnormal bone density, and only 2.4% had received treatment. CONCLUSIONS This study identified a high prevalence of low bone mineral density among adults with disabilities; few of the participants possessed awareness of bone health, and very few received early treatment or information on prevention of osteoporosis. The enhancement of osteoporosis interventions and health promotion programs to prevent osteoporosis and related problems are necessary for this population.
Collapse
Affiliation(s)
- Po-Han Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Chu-Yeh Chen
- College of Nursing, Chang Gung University of Science and Technology, Taiwan
| | - Yu-Chen Lin
- Department of Health Promotion, Chiayi Bureau of Health, Taiwan
| | - Mei-Yen Chen
- College of Nursing, Chang Gung University of Science and Technology, No. 2, Chiapu Rd., West Sec., Puzi City, Chiayi County 61363, Taiwan.
| |
Collapse
|
21
|
Benzinger P, Rapp K, König HH, Bleibler F, Globas C, Beyersmann J, Jaensch A, Becker C, Büchele G. Risk of osteoporotic fractures following stroke in older persons. Osteoporos Int 2015; 26:1341-9. [PMID: 25572044 DOI: 10.1007/s00198-014-3005-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 12/11/2014] [Indexed: 01/28/2023]
Abstract
UNLABELLED The aim of this study was to explore the increased risk of stroke survivors to different sustained osteoporotic fractures. We used hospital data and data on functional impairment. We found a higher risk in stroke survivors without functional impairment with the risk higher for lower than for upper extremity fractures. INTRODUCTION Stroke survivors are at high risk of osteoporotic fractures due to frequent falls and an increased risk to develop osteoporosis. Data on their relative risk to sustain other than hip fractures is limited. Furthermore, the role of severe functional impairment on their fracture risk has not been considered yet. The aim of this study was to determine the relative risk of stroke survivors to sustain different osteoporotic fractures with regard to the presence of severe functional impairment. METHODS Data from 2004 to 2009 of more than 1.2 million individuals aged 65 years or older and insured at a large German health insurance company were used for the analyses. Incident stroke and fractures were obtained from hospital diagnoses. Analyses were stratified by gender and information on severe functional impairment. Persons without preceding incident stroke were used as the reference group. Multistate models were used to estimate hazard ratios. RESULTS Stroke survivors had a higher risk for fractures. However, a strong effect modification by functional impairment was apparent. Stroke survivors with functional impairment had no significantly increased risk for any fractures site compared to the corresponding reference group with functional impairment. In contrast, stroke survivors without functional impairment had a clearly and significantly increased fracture risk for most fracture sites. In these persons, the relative fracture risk for fractures of the lower extremities was higher than for fractures of the upper extremities. CONCLUSION To evaluate the relative risk of stroke survivors for osteoporotic fractures, functional status appears to be a relevant parameter.
Collapse
Affiliation(s)
- P Benzinger
- Robert Bosch Krankenhaus Stuttgart, Auerbachstraße 110, 70376, Stuttgart, Germany,
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Gustavsson J, Bonander C, Andersson R, Nilson F. Investigating the fall-injury reducing effect of impact absorbing flooring among female nursing home residents: initial results. Inj Prev 2015; 21:320-4. [DOI: 10.1136/injuryprev-2014-041468] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/08/2015] [Indexed: 11/03/2022]
|
23
|
Rapp K, Freiberger E, Todd C, Klenk J, Becker C, Denkinger M, Scheidt-Nave C, Fuchs J. Fall incidence in Germany: results of two population-based studies, and comparison of retrospective and prospective falls data collection methods. BMC Geriatr 2014; 14:105. [PMID: 25241278 PMCID: PMC4179843 DOI: 10.1186/1471-2318-14-105] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Fall incidence differs considerably between studies and countries. Reasons may be differences between study samples or different assessment methods. The aim was to derive estimates of fall incidence from two population-based studies among older community-living people in Germany and compare retrospective and prospective falls data collection methods. Methods Data were derived from the 2008–11 wave of the German health interview and examination survey for adults (DEGS1), and the Activity and Function of the Elderly in Ulm study (ActiFE-Ulm). Data collection took place in community facilities (DEGS1) or participants’ homes (ActiFE-Ulm). Participation rates were 42% (newly recruited) and 64% (panel component) in DEGS1 and 19.8% in ActiFE-Ulm. Self-report retrospective fall data covering the previous 12 month period in DEGS1 and ActiFE-Ulm were collected, but only ActiFE-Ulm used prospective 12 month fall calendars. The incidence of ‘any fall’ and ‘recurrent falls’ were calculated for both methods. Results Fall rates increased with age in men but not women. The ActiFE-Ulm prospectively assessed incidence (95% confidence interval) in women and men aged 65- < 90 years were 38.7 (36.9-40.5) and 29.7 (28.1-31.3) fallers/year and 13.7 (12.5-14.9) and 10.9 (9.9-12.0) recurrent fallers/year, respectively. Retrospective and prospective fall incidence in ActiFE-Ulm did not differ.The retrospectively assessed incidence of ‘any fall’ among persons 65- < 80 years were significantly lower in DEGS1 than ActiFE-Ulm (women: 25.7% (22.4-29.2) versus 37.4% (34.8-39.9); men: 16.3% (13.6-19.3) versus 28.9% (26.6-31.1). Retrospective incidence estimates of recurrent falls were similar in both studies for women (10.4% (8.3-12.9) versus 10.2% (8.5-11.8)) and men (6.1% (4.3-8.5) versus 8.4% (7.1-9.8)). Conclusion Both studies were population-based, but retrospective self-reported fall incidence differed between studies. Study design influences retrospective reported fall incidence considerably. Costly collection of prospective data gives similar rates to the cheaper retrospective report method.
Collapse
Affiliation(s)
- Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Büchele G, Becker C, Cameron ID, König HH, Robinovitch S, Rapp K. Predictors of Serious Consequences of Falls in Residential Aged Care: Analysis of More Than 70,000 Falls From Residents of Bavarian Nursing Homes. J Am Med Dir Assoc 2014; 15:559-63. [DOI: 10.1016/j.jamda.2014.03.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
|
25
|
Bleibler F, Rapp K, Jaensch A, Becker C, König HH. Expected lifetime numbers and costs of fractures in postmenopausal women with and without osteoporosis in Germany: a discrete event simulation model. BMC Health Serv Res 2014; 14:284. [PMID: 24981316 PMCID: PMC4118314 DOI: 10.1186/1472-6963-14-284] [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: 10/22/2013] [Accepted: 05/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoporotic fractures cause a large health burden and substantial costs. This study estimated the expected fracture numbers and costs for the remaining lifetime of postmenopausal women in Germany. METHODS A discrete event simulation (DES) model which tracks changes in fracture risk due to osteoporosis, a previous fracture or institutionalization in a nursing home was developed. Expected lifetime fracture numbers and costs per capita were estimated for postmenopausal women (aged 50 and older) at average osteoporosis risk (AOR) and for those never suffering from osteoporosis. Direct and indirect costs were modeled. Deterministic univariate and probabilistic sensitivity analyses were conducted. RESULTS The expected fracture numbers over the remaining lifetime of a 50 year old woman with AOR for each fracture type (% attributable to osteoporosis) were: hip 0.282 (57.9%), wrist 0.229 (18.2%), clinical vertebral 0.206 (39.2%), humerus 0.147 (43.5%), pelvis 0.105 (47.5%), and other femur 0.033 (52.1%). Expected discounted fracture lifetime costs (excess cost attributable to osteoporosis) per 50 year old woman with AOR amounted to € 4,479 (€ 1,995). Most costs were accrued in the hospital € 1,743 (€ 751) and long-term care sectors € 1,210 (€ 620). Univariate sensitivity analysis resulted in percentage changes between -48.4% (if fracture rates decreased by 2% per year) and +83.5% (if fracture rates increased by 2% per year) compared to base case excess costs. Costs for women with osteoporosis were about 3.3 times of those never getting osteoporosis (€ 7,463 vs. € 2,247), and were markedly increased for women with a previous fracture. CONCLUSION The results of this study indicate that osteoporosis causes a substantial share of fracture costs in postmenopausal women, which strongly increase with age and previous fractures.
Collapse
Affiliation(s)
- Florian Bleibler
- Department for Health Economics and Health Service Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr, 52, D-20246 Hamburg, Germany.
| | | | | | | | | |
Collapse
|
26
|
Lahmann NA, Heinze C, Rommel A. Stürze in deutschen Krankenhäusern und Pflegeheimen 2006–2013. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57:650-9. [DOI: 10.1007/s00103-014-1966-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
Risk for femoral fractures in Parkinson's disease patients with and without severe functional impairment. PLoS One 2014; 9:e97073. [PMID: 24853110 PMCID: PMC4031076 DOI: 10.1371/journal.pone.0097073] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 04/15/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Impaired balance is a major problem in patients with idiopathic Parkinson's disease (PD) resulting in an increased risk of falls and fall-related fractures. Most studies which analyzed the risk of femoral fractures in patients with idiopathic PD were performed either in specialized centers or excluded very frail patients. The current study used a large population-based dataset in order to analyze the risk of femoral fractures in patients with idiopathic PD. METHODS Data from more than 880.000 individuals aged 65 years or older and insured between 2004 and 2009 at a large German health insurance company were used for the analyses. Persons with idiopathic PD were identified by the dispensing of Parkinson-specific medication and by hospital diagnoses, if available. People without PD served as the reference group. Incident femoral fractures were obtained from hospital diagnoses. Analyses were stratified by gender and information on severe functional impairment (care need) as provided by reimbursement claims. RESULTS Compared with the reference group, persons with idiopathic PD had a more than doubled risk to sustain a femoral fracture. The risk was higher in men (HR = 2.61; 95%-CI: 2.28-2.98) than in women (HR = 1.79; 95%-CI: 1.66-1.94). The increased risk was only observed in people without severe functional impairment. The sensitivity analysis using a refined definition of idiopathic PD patients yielded similar results. CONCLUSION The findings confirm the increased risk of femoral fractures in patients with idiopathic PD. The relative risk is particularly high in male PD patients and in patients without severe functional impairment.
Collapse
|
28
|
Seitz DP, Anderson GM, Austin PC, Gruneir A, Gill SS, Bell CM, Rochon PA. Effects of impairment in activities of daily living on predicting mortality following hip fracture surgery in studies using administrative healthcare databases. BMC Geriatr 2014; 14:9. [PMID: 24472282 PMCID: PMC3922692 DOI: 10.1186/1471-2318-14-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 01/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impairment in activities of daily living (ADL) is an important predictor of outcomes although many administrative databases lack information on ADL function. We evaluated the impact of ADL function on predicting postoperative mortality among older adults with hip fractures in Ontario, Canada. METHODS Sociodemographic and medical correlates of ADL impairment were first identified in a population of older adults with hip fractures who had ADL information available prior to hip fracture. A logistic regression model was developed to predict 360-day postoperative mortality and the predictive ability of this model were compared when ADL impairment was included or omitted from the model. RESULTS The study sample (N = 1,329) had a mean age of 85.2 years, were 72.8% female and the majority resided in long-term care (78.5%). Overall, 36.4% of individuals died within 360 days of surgery. After controlling for age, sex, medical comorbidity and medical conditions correlated with ADL impairment, addition of ADL measures improved the logistic regression model for predicting 360 day mortality (AIC = 1706.9 vs. 1695.0; c -statistic = 0.65 vs 0.67; difference in - 2 log likelihood ratios: χ(2) = 16.9, p = 0.002). CONCLUSIONS Direct measures of ADL impairment provides additional prognostic information on mortality for older adults with hip fractures even after controlling for medical comorbidity. Observational studies using administrative databases without measures of ADLs may be potentially prone to confounding and bias and case-mix adjustment for hip fracture outcomes should include ADL measures where these are available.
Collapse
Affiliation(s)
- Dallas P Seitz
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
| | | | | | | | | | | | | |
Collapse
|
29
|
Klein D, Nagel G, Kleiner A, Ulmer H, Rehberger B, Concin H, Rapp K. Blood pressure and falls in community-dwelling people aged 60 years and older in the VHM&PP cohort. BMC Geriatr 2013; 13:50. [PMID: 23692779 PMCID: PMC3663706 DOI: 10.1186/1471-2318-13-50] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 05/10/2013] [Indexed: 01/14/2023] Open
Abstract
Background Falls are one of the major health problems in old people. Different risk factors were identified but only few epidemiological studies analysed the influence of conventionally measured blood pressure on falls. The objective of our study was to investigate the relationship between systolic and diastolic blood pressure and falls. Methods In 3,544 community-dwelling Austrian women and men aged 60 years and older, data on falls within the previous three months were collected by questionnaire. Blood pressure was measured by general practitioners within the Vorarlberg Health Monitoring and Prevention Programme (VHM&PP) 90 to 1095 days before the fall assessment. A multiple logistic regression analysis was conducted. The models were stratified by gender and adjusted by age, number of medical conditions and subjective feeling of illness. Results In total, 257 falls in 3,544 persons were reported. In women, high systolic and diastolic blood pressure was associated with a decreased risk of falls. An increase of systolic blood pressure by 10 mmHg and of diastolic blood pressure by 5 mmHg reduced the risk of falling by 9% (OR 0.91, 95% Cl 0.84-0.98) and 8% (OR 0.92, 95% Cl 0.85-0.99), respectively. In men, an increased risk of falls was observed in participants with low systolic or low diastolic blood pressure. Conclusions Blood pressure was associated with the risk of falls. Hypertensive values decreased the risk in women and low blood pressure increased the risk in men.
Collapse
Affiliation(s)
- Diana Klein
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany.
| | | | | | | | | | | | | |
Collapse
|
30
|
Benzinger P, Becker C, Kerse N, Bleibler F, Büchele G, Icks A, Rapp K. Pelvic fracture rates in community-living people with and without disability and in residents of nursing homes. J Am Med Dir Assoc 2013; 14:673-8. [PMID: 23680402 DOI: 10.1016/j.jamda.2013.03.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/12/2013] [Accepted: 03/12/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES There are limited data on the epidemiology of pelvic fractures. The purpose of this study was to calculate incidence rates of pelvic fractures leading to hospital admission and to compare incidence rates between residents of nursing homes and community-dwelling persons with and without care need. METHODS Data were retrieved from a database of the largest health insurance company in Bavaria, Germany. Between 2004 and 2009, 10,170 pelvic fractures were observed in 751,101 women and 491,098 men. Age- and gender-specific incidence rates were calculated. Incidence rates were further stratified by setting (nursing home versus community) and functional status (no care need versus care need for those in the community). In addition, the average cumulative risk for a pelvic fracture at different ages was calculated. RESULTS The incidence rate increased from 0.54 and 0.38 per 1000 person-years in women and men aged 65 to 69 years to 9.35 and 4.45 per 1000 person-years in women and men aged 90 years and older, respectively. Persons living in a nursing home or living at home with care need had considerably higher incidence rates than community-dwelling older persons without care need. The average cumulative risk at the age of 65 years for an incident pelvic fracture until the age of 90 years was 6.9% in women and 2.8% in men. CONCLUSION The incidence of pelvic fractures leading to hospital admission is higher in women than in men and rises dramatically with increasing age. Persons with care need have a particularly high risk for pelvic fracture.
Collapse
Affiliation(s)
- Petra Benzinger
- Department for Geriatric Rehabilitation, Robert Bosch Krankenhaus, Stuttgart, Germany.
| | | | | | | | | | | | | |
Collapse
|
31
|
Becker C, Schwickert L, Mellone S, Bagalà F, Chiari L, Helbostad JL, Zijlstra W, Aminian K, Bourke A, Todd C, Bandinelli S, Kerse N, Klenk J. Proposal for a multiphase fall model based on real-world fall recordings with body-fixed sensors. Z Gerontol Geriatr 2013. [PMID: 23184296 DOI: 10.1007/s00391-012-0403-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Falls are by far the leading cause of fractures and accidents in the home environment. The current Cochrane reviews and other systematic reviews report on more than 200 intervention studies about fall prevention. A recent meta-analysis has summarized the most important risk factors of accidental falls. However, falls and fall-related injuries remain a major challenge. One novel approach to recognize, analyze, and work better toward preventing falls could be the differentiation of the fall event into separate phases. This might aid in reconsidering ways to design preventive efforts and diagnostic approaches. From a conceptual point of view, falls can be separated into a pre-fall phase, a falling phase, an impact phase, a resting phase, and a recovery phase. Patient and external observers are often unable to give detailed comments concerning these phases. With new technological developments, it is now at least partly possible to examine the phases of falls separately and to generate new hypotheses.The article describes the practicality and the limitations of this approach using body-fixed sensor technology. The features of the different phases are outlined with selected real-world fall signals.
Collapse
Affiliation(s)
- C Becker
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
|