Loss of health related quality of life following low-trauma fractures in the elderly

BMC Geriatrics

Research Article

Louisa Pericleous¹  Alexandra Papaioannou²  Jacques P. Brown³  Louis Bessette³  Suzanne N. Morin⁴  Jonathan D. Adachi⁵  William D. Leslie⁶  Robert B. Hopkins⁷  Natasha Burke⁷  Jean-Eric Tarride⁷  Sergei Muratov⁷ 

[1] Amgen Canada Inc., Mississauga, Ontario, Canada;Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada;Department of Medicine, McMaster University, Hamilton, Ontario, Canada;Department of Medicine, Laval University, Quebec City, Quebec, Canada;Department of Medicine, McGill University, Montréal, Quebec, Canada;Department of Medicine, McMaster University, Hamilton, Ontario, Canada;Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada;Programs for Assessment of Technology in Health (PATH), St. Joseph’s Healthcare Hamilton, 25 Main Street West, Suite 2000, L8P 1H1, Hamilton, ON, Canada;Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada;

关键词: Frail elderly;    Fractures;    Health-related quality of life;   

DOI  :  10.1186/s12877-016-0259-5

 received in 2015-11-17, accepted in 2016-04-13,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundTo estimate the long-term change in health related quality of life (HRQoL) following low-trauma fractures among individuals receiving home care (HC) services or living in long-term care (LTC) facilities using linked healthcare administrative data from Ontario, Canada.MethodsHRQoL was estimated using the Health Utility Index (HUI-2) with the InterRai Minimum Data Set (MDS), a mandatory questionnaire for LTC and HC in the province of Ontario (population 14 million). The HUI-2, a validated HRQoL instrument, allows the calculation of health utility where 0 represents death and 1 the best imaginable health state. For reference, the HUI-2 utility value for Canadians aged 80–84 years is 0.61 and the minimal clinically important difference is 0.03. The MDS was linked to Ontario acute care databases for fiscal years 2007–2011 to identify low-trauma fractures using ICD-10-CA codes. Regression models were used to identify predictors of change in HRQoL from pre-fracture levels to 3 years post fracture for several populations. Low-trauma fractures included hip, humerus, vertebral, wrist, multiple and other.ResultsTwenty-three thousand six-hundred fifty-five unique patients with low-trauma fractures were identified with pre- and post-fracture HRQoL assessments, of which 5057 individuals had at least 3 years of follow-up. Compared to patients receiving HC services (N = 3303), individuals residing in LTC (N = 1754) were older, taking more medications, and had more comorbidities. LTC patients had more hip fractures (49 % of total versus 29 %). For all fracture types, HRQoL decreased immediately following fracture. Although levels rebounded after the first month, HRQoL up to 36 months never returned to pre-fracture levels even for non-hip fracture. For both HC and LTC cohorts, clinically important and statistically significant decreases in HUI-2 utility scores were observed 36 months post fracture. Of the 6 HUI-2 domains, mobility had the largest impact on change in HRQoL. Regression analysis indicated that living with a musculoskeletal disorder or a neurological condition and living in LTC were associated with greater decrements in utility following a fracture.ConclusionsBased on the analysis of one of the largest studies on HRQoL to date, among individuals living in LTC facilities or receiving HC services, fractures have a significant permanent impact on HRQoL up to 3 years following fracture.

【 授权许可】

CC BY   
© Tarride et al. 2016