Cargando…

Validation of a one year fracture prediction tool for absolute hip fracture risk in long term care residents

BACKGROUND: Frail older adults living in long term care (LTC) homes have a high fracture risk, which can result in reduced quality of life, pain and death. The Fracture Risk Scale (FRS) was designed for fracture risk assessment in LTC, to optimize targeting of services in those at highest risk. This...

Descripción completa

Detalles Bibliográficos
Autores principales: Negm, Ahmed M., Ioannidis, George, Jantzi, Micaela, Bucek, Jenn, Giangregorio, Lora, Pickard, Laura, Hirdes, John P., Adachi, Jonathan D., Richardson, Julie, Thabane, Lehana, Papaioannou, Alexandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307179/
https://www.ncbi.nlm.nih.gov/pubmed/30587140
http://dx.doi.org/10.1186/s12877-018-1010-1
_version_ 1783382947072573440
author Negm, Ahmed M.
Ioannidis, George
Jantzi, Micaela
Bucek, Jenn
Giangregorio, Lora
Pickard, Laura
Hirdes, John P.
Adachi, Jonathan D.
Richardson, Julie
Thabane, Lehana
Papaioannou, Alexandra
author_facet Negm, Ahmed M.
Ioannidis, George
Jantzi, Micaela
Bucek, Jenn
Giangregorio, Lora
Pickard, Laura
Hirdes, John P.
Adachi, Jonathan D.
Richardson, Julie
Thabane, Lehana
Papaioannou, Alexandra
author_sort Negm, Ahmed M.
collection PubMed
description BACKGROUND: Frail older adults living in long term care (LTC) homes have a high fracture risk, which can result in reduced quality of life, pain and death. The Fracture Risk Scale (FRS) was designed for fracture risk assessment in LTC, to optimize targeting of services in those at highest risk. This study aims to examine the construct validity and discriminative properties of the FRS in three Canadian provinces at 1-year follow up. METHODS: LTC residents were included if they were: 1) Adults admitted to LTC homes in Ontario (ON), British Columbia (BC) and Manitoba (MB) Canada; and 2) Received a Resident Assessment Instrument Minimum Data Set Version 2.0. After admission to LTC, one-year hip fracture risk was evaluated for all the included residents using the FRS (an eight-level risk scale, level 8 represents the highest fracture risk). Multiple logistic regressions were used to determine the differences in incident hip or all clinical fractures across the provinces and FRS risk levels. We examined the differences in incident hip or all clinical fracture for each FRS level across the three provinces (adjusted for age, BMI, gender, fallers and previous fractures). We used the C-statistic to assess the discriminative properties of the FRS for each province. RESULTS: Descriptive statistics on the LTC populations in ON (n = 29,848), BC (n = 3129), and MB (n = 2293) are: mean (SD) age 82 (10), 83 (10), and 84 (9), gender (female %) 66, 64, and 70% respectively. The incident hip fractures and all clinical fractures for FRS risk level were similar among the three provinces and ranged from 0.5 to 19.2% and 1 to 19.2% respectively. The overall discriminative properties of the FRS were similar between ON (C-statistic = 0.673), BC (C-statistic = 0.644) and MB (C-statistic = 0.649) samples. CONCLUSION: FRS is a valid tool for identifying LTC residents at different risk levels for hip or all clinical fractures in three provinces. Having a fracture risk assessment tool that is tailored to the LTC context and embedded within the routine clinical assessment may have significant implications for policy, service delivery and care planning, and may improve care for LTC residents across Canada.
format Online
Article
Text
id pubmed-6307179
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-63071792019-01-02 Validation of a one year fracture prediction tool for absolute hip fracture risk in long term care residents Negm, Ahmed M. Ioannidis, George Jantzi, Micaela Bucek, Jenn Giangregorio, Lora Pickard, Laura Hirdes, John P. Adachi, Jonathan D. Richardson, Julie Thabane, Lehana Papaioannou, Alexandra BMC Geriatr Research Article BACKGROUND: Frail older adults living in long term care (LTC) homes have a high fracture risk, which can result in reduced quality of life, pain and death. The Fracture Risk Scale (FRS) was designed for fracture risk assessment in LTC, to optimize targeting of services in those at highest risk. This study aims to examine the construct validity and discriminative properties of the FRS in three Canadian provinces at 1-year follow up. METHODS: LTC residents were included if they were: 1) Adults admitted to LTC homes in Ontario (ON), British Columbia (BC) and Manitoba (MB) Canada; and 2) Received a Resident Assessment Instrument Minimum Data Set Version 2.0. After admission to LTC, one-year hip fracture risk was evaluated for all the included residents using the FRS (an eight-level risk scale, level 8 represents the highest fracture risk). Multiple logistic regressions were used to determine the differences in incident hip or all clinical fractures across the provinces and FRS risk levels. We examined the differences in incident hip or all clinical fracture for each FRS level across the three provinces (adjusted for age, BMI, gender, fallers and previous fractures). We used the C-statistic to assess the discriminative properties of the FRS for each province. RESULTS: Descriptive statistics on the LTC populations in ON (n = 29,848), BC (n = 3129), and MB (n = 2293) are: mean (SD) age 82 (10), 83 (10), and 84 (9), gender (female %) 66, 64, and 70% respectively. The incident hip fractures and all clinical fractures for FRS risk level were similar among the three provinces and ranged from 0.5 to 19.2% and 1 to 19.2% respectively. The overall discriminative properties of the FRS were similar between ON (C-statistic = 0.673), BC (C-statistic = 0.644) and MB (C-statistic = 0.649) samples. CONCLUSION: FRS is a valid tool for identifying LTC residents at different risk levels for hip or all clinical fractures in three provinces. Having a fracture risk assessment tool that is tailored to the LTC context and embedded within the routine clinical assessment may have significant implications for policy, service delivery and care planning, and may improve care for LTC residents across Canada. BioMed Central 2018-12-27 /pmc/articles/PMC6307179/ /pubmed/30587140 http://dx.doi.org/10.1186/s12877-018-1010-1 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Negm, Ahmed M.
Ioannidis, George
Jantzi, Micaela
Bucek, Jenn
Giangregorio, Lora
Pickard, Laura
Hirdes, John P.
Adachi, Jonathan D.
Richardson, Julie
Thabane, Lehana
Papaioannou, Alexandra
Validation of a one year fracture prediction tool for absolute hip fracture risk in long term care residents
title Validation of a one year fracture prediction tool for absolute hip fracture risk in long term care residents
title_full Validation of a one year fracture prediction tool for absolute hip fracture risk in long term care residents
title_fullStr Validation of a one year fracture prediction tool for absolute hip fracture risk in long term care residents
title_full_unstemmed Validation of a one year fracture prediction tool for absolute hip fracture risk in long term care residents
title_short Validation of a one year fracture prediction tool for absolute hip fracture risk in long term care residents
title_sort validation of a one year fracture prediction tool for absolute hip fracture risk in long term care residents
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307179/
https://www.ncbi.nlm.nih.gov/pubmed/30587140
http://dx.doi.org/10.1186/s12877-018-1010-1
work_keys_str_mv AT negmahmedm validationofaoneyearfracturepredictiontoolforabsolutehipfractureriskinlongtermcareresidents
AT ioannidisgeorge validationofaoneyearfracturepredictiontoolforabsolutehipfractureriskinlongtermcareresidents
AT jantzimicaela validationofaoneyearfracturepredictiontoolforabsolutehipfractureriskinlongtermcareresidents
AT bucekjenn validationofaoneyearfracturepredictiontoolforabsolutehipfractureriskinlongtermcareresidents
AT giangregoriolora validationofaoneyearfracturepredictiontoolforabsolutehipfractureriskinlongtermcareresidents
AT pickardlaura validationofaoneyearfracturepredictiontoolforabsolutehipfractureriskinlongtermcareresidents
AT hirdesjohnp validationofaoneyearfracturepredictiontoolforabsolutehipfractureriskinlongtermcareresidents
AT adachijonathand validationofaoneyearfracturepredictiontoolforabsolutehipfractureriskinlongtermcareresidents
AT richardsonjulie validationofaoneyearfracturepredictiontoolforabsolutehipfractureriskinlongtermcareresidents
AT thabanelehana validationofaoneyearfracturepredictiontoolforabsolutehipfractureriskinlongtermcareresidents
AT papaioannoualexandra validationofaoneyearfracturepredictiontoolforabsolutehipfractureriskinlongtermcareresidents