Death, debility, and destitution following hip fracture

• Published in: The journals of gerontology. Series A, Biological sciences and medical sciences Vol. 69; no. 3; p. 346
• Main Authors: Tajeu, Gabriel S, Delzell, Elizabeth, Smith, Wilson, Arora, Tarun, Curtis, Jeffrey R, Saag, Kenneth G, Morrisey, Michael A, Yun, Huifeng, Kilgore, Meredith L
• Format: Journal Article
• Language: English
• Published: United States 01.03.2014
• Subjects: Age Factors; Aged; Aged, 80 and over; Case-Control Studies; Cohort Studies; Disabled Persons - statistics & numerical data; Female; Health Expenditures - statistics & numerical data; Hip Fractures - mortality; Hospitalization - statistics & numerical data; Humans; Income - statistics & numerical data; Institutionalization - statistics & numerical data; Long-Term Care - statistics & numerical data; Male; Medicaid - statistics & numerical data; Nursing Homes - statistics & numerical data; Poverty - statistics & numerical data; Retrospective Studies; Social Class; United States - epidemiology; United States; Osteoporosis; Hip fracture; Mortality; High-dimensional propensity score
• DOI: 10.1093/gerona/glt105

We examined the effects of hip fracture on mortality, entry into long-term institutional care, and new evidence of poverty. We estimate of the proportion of hip fracture patients who require not just short-term rehabilitation but who become dependent on long-term institutional care, and the risk of becoming newly dependent on Medicaid or eligible for low-income subsidies following hip fracture. We used data from 2005 through 2010 for a random 5% sample of Medicare beneficiaries (N = 3.1 million) to conduct a retrospective matched cohort study. We used high-dimensional propensity score matching to compare outcomes for patients who experienced a hip fracture with subjects who did not, but had similar propensity for suffering a hip fracture. We then compared the 1-year risk of death, debility, and destitution between groups. We matched 43,210 hip fracture patients to comparators without a hip fracture. Hip fractures were associated with more than a twofold increase in likelihood of mortality (incidence proportion ratio [IPR] of 2.27, 95% CI, 2.20-2.34), a fourfold increase in likelihood of requiring long-term nursing facility care (IPR, 3.96; 95% CI, 3.77-4.16), and a twofold increase in the probability of entering into low-income status (IPR, 2.14; 95% CI 1.99-2.31) within 1 year following hip fracture compared with subjects without a hip fracture. Hip fracture in elderly patients resulted in increased death, debility, and destitution. Initiatives that lead to improved treatment of osteoporosis could result in a decrease in incidence of fractures, subsequent death, debility, and destitution for older adults.