A large number of frail older adults living in long term care homes are at high risk for hip fracture

Objectives: To determine the percent distribution of LTC residents among the 8 individual risk levels of our hip fracture prediction outcome scale and to examine if the distribution would be beneficial for the potential transformation of our instrument to a Clinical Assessment Protocol (CAP). Material(s) and Method(s): Our outcome scale was developed using the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI-MDS) for all residents with a LTC admission assessment from Ontario, Canada from April, 1, 2006 to March, 31, 2010 (N=29,848). The scale was created using decision tree analysis and includes traditional risk factors for fracture such as prior fractures and fall, age, gender, height and weight, and LTC specific risk factors for the frail elderly such as cognitive function, falls, wandering and, transfer status. The outcome scale is capable of both discriminating and predicting residents at risk for hip fracture over a one year time period. The scale will be implemented within the RAI-MDS and potentially converted into a CAP. CAP's are used to assist health care providers to interpret systematically information that is recorded within the RAI-MDS and to provide recommendations for care planning of frail older adults. For the current analysis, the distribution of LTC residents among the 8 individual risk levels of our scale will be examined. Result(s): Approximately 45% of LTC residents were 85 years and older, 2/3 were women, 1/3 had a prior fall within the past 180 days, and 3% had a prior hip fracture within the past 180 days. A total of 1553 (5. 2%) new fractures (including hip, spine humerus, forearm, and pelvis) and 959 hip fractures (3. 2%) were reported over the one year time period. The outcome scale has 8 risk levels of absolute hip fracture risk, which range from 0.6 to 12.6%. The distribution of residents within each risk level decreased as the risk level for hip fracture increased (Table). The distribution property of the scale allocates 56% of the assessed residents into the lowest three risk levels, 36% for risk levels 4 to 6, and 8% for the two highest risk levels. Conclusion(s): The large population of lower risk residents is important because the management of too many high risk individuals may quickly overwhelm LTC resources that are needed for clinical care. The scale's properties are beneficial for the potential transformation of our tool to a CAP, which will assist clinicians in resident care planning for hip fracture.

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