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An epidemiologic study of fall-related fractures among institutionalized older people
1Hebrew Rehabilitation Center for the Aged Research and Training Institute, Harvard Medical School Division on Aging, Boston, Massachusetts 02131, USA.
Objectives:
The purpose of this study was to assess the incidence of fall-related fractures, and the circumstances surrounding these events, during a 5-year period among all residents of a long-term care facility.
Participants:
The study group was composed of residents with radiologically confirmed fractures that were the direct result of a fall occurring between the years 1988 and 1992. This group was 82% female and had a mean age of 89 +/- 6 years.
Design:
The study was designed as a 5-year retrospective cohort study in a long-term care institution where annual incidence rates of fracture were assessed.
Results:
There were 296 fall-related fractures during the 5-year period. Annual incidence rates remained fairly constant (72, 86, 84, 70, and 94 per 1000 person-years, respectively) despite a 54% decline in the use of physical restraints during the 5-year period. Hip fractures comprised almost 50% of all fractures. Based on incident reports of these fractures, 42% occurred during the day, 55% took place in the bedroom or adjoining bathroom. 67% occurred while the resident was ambulating, and a wet floor was in evidence in 16% of the incidents.
Conclusion:
Fracture incidence in this long-term care facility has remained stable despite reduced restraint use. The incident reporting system may contribute valuable information to the identification of factors that should receive further attention in studies of risk factors for fracture in the long-term care setting.