PAM22: STUDYING PREDICTORS OF FRACTURES AMONG OMNICARE NURSING HOME RESIDENTS

Abstract

Upon admission to a skilled nursing home facility, information is recorded on a Minimum Data Set (MDS), a 400 item instrument used as the basis of 1) reimbursement for Medicare eligible nursing home stays and 2) care planning, survey and certification for all nursing home stays. OBJECTIVE: To predict and evaluate variables related to hip fractures in the nursing home setting. METHODS: Electronic MDS data was available from 200 homes for variable evaluation times. The first available Assessment Reference Date (A3A), was the baseline for a regression of time to first fracture. Excluded were 1) patients with a fracture having an A3A date within the first 10 days of baseline visit, and 2) patients with <60 days of follow-up, from first to last A3A visit. Analysis included a Kaplan-Meier curve summarizing time to fracture, and a Cox Proportional Hazards regression model. RESULTS: The initial data set included 23,045 patients. 11,465 met the inclusion criteria, and 336 of these had fractures. Most important variables, based on the coefficient size, associated with increasing risk, were unsteady gait, deterioration in ADL function, a hospital stay in the last 90 days, use of full bed rails, and Alzheimer's disease. The risk was also higher among females and whites. The need for full physical help while standing had a lower risk when compared to need for less support, but this is likely due to a lowered potential for falling, and increased vigilance an the part of staff. ?Deteriorated? ADL function had almost twice the risk when compared to ?improved? ADL. CONCLUSION: Unsteady gait, deterioration in ADL, use of bed rails, presence of Alzheimer's disease, and hospital admissions were associated with an increased risk of hip fracture. A larger sample of fractures would be more likely to be successful in studying additional relationships.