Hip fractures are common in nursing home (NH) residents and associated with functional dependence and elevated mortality. Multiple sclerosis (MS) is a chronic, immune-mediated and degenerative disease of the central nervous system, characterized by disability progression over time. Although hip fracture risk is high in young people with multiple sclerosis (MS), this research has not been examined in an institutionalized aging population with MS.
[Photo: Dr. Tingting Zhang]
This study, conducted by lead author Dr. Tingting Zhang, assistant professor of health services, policy, and practice at the Brown University School of Public health, sought to (1) compare the incidence of hip fracture between NH residents with and without MS; and (2) identify clinical characteristics associated with 2-year hip fracture risk in long-term NH residents with MS.
Using a retrospective cohort study design, this study used data from the national NH clinical assessment and from Medicare claims. Participants included age-, sex- and race-matched NH residents with/without MS (2007–2008). Multivariable competing risk regression was used to compare two-year hip fracture risk, and to examine risk factors. A total of 5692 NH residents with MS were matched to 28,460 without MS. Approximately 80 percent of residents with MS vs. 50 percent of those without MS required extensive assistance in walking or total dependence at baseline. The adjusted incidence rate of hip fracture was 7.1 and 18.6 per 1000 person-years in those with or without MS, respectively. Wandering and anxiolytic exposure were the main hip fracture risk factors in transfer independent residents with MS; while pneumonia and antidepressant use were the main factors in dependent residents with MS.
In contrast to prior comparisons from younger, non-NH populations, the incidence of hip fracture was lower in NH residents with MS as compared with matched controls. Residents with MS were much more functionally dependent, which likely explains these findings. Residents with MS may require different and complex healthcare needs as compared to those without MS, and warrant further investigations. Fracture prevention strategies should focus on fall prevention in independent residents; and possibly improvement of health status and facility quality of care in dependent residents.
This article was published in Disability and Health Journal.