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Risk Factors Associated with the Occurrence of Fractures in U.S. Nursing Homes: Resident and Facility Characteristics and Prescription Medications
Author(s) -
Spector William,
Shaffer Thomas,
Potter D. E. B.,
CorreadeAraujo Rosaly,
Rhona Limcangco M.
Publication year - 2007
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2007.01081.x
Subject(s) - medicine , medical prescription , medical record , veterans affairs , medical expenditure panel survey , emergency medicine , family medicine , polypharmacy , health care , nursing , intensive care medicine , health insurance , economics , economic growth
OBJECTIVES: To determine whether resident and facility characteristics and prescription medications influence the occurrence of fractures in nursing homes (NHs). DESIGN: Panel study with 1‐year follow‐up. SETTING: A nationally representative sample of NHs from the Medical Expenditure Panel Survey (MEPS). PARTICIPANTS: Residents aged 65 and older who were in sample NHs on January 1, 1996. MEASUREMENTS: Health status measures were collected from facility records and abstracted using a computer‐assisted personal interview instrument. Fracture and drug data were updated every 4 months to provide a full year of information. Drug data were obtained from monthly medication administration records. The occurrences of fractures were obtained from medical records. Administered medications were classified using the Department of Veterans Affairs medication classification system. Facility characteristics were based on MEPS survey data collected from NH sources. RESULTS: In 1996, 6% of residents in a NH at the beginning of the year experienced a fracture during their NH stay(s). Resident risk factors included aged 85 and older, admitted from the community, exhibited agitated behaviors, and used both wheelchair and cane or walker. Use of anticonvulsants, antidepressants, opioid analgesics, iron supplements, bisphosphonates, thiazides, and laxatives were associated with fractures. A high certified nurse aide ratio was negatively associated with fractures. CONCLUSION: The findings indicate that fractures are associated with resident and facility characteristics and prescribing practices. It reaffirms the importance of medication review with special attention on opioid analgesics, antidepressants, and anticonvulsants to reduce the risk of fractures.