Living alone vs. living with someone as a predictor of mortality after a bone fracture in older age

BACKGROUND: Living alone is a risk factor for health decline in old age, especially when facing adverse events increasing vulnerability. AIM: We examined whether living alone is associated with higher post-fracture mortality risk. METHODS: Participants were 190 men and 409 women aged 75 or 80 years at baseline. Subsequent fracture incidence and mortality were followed up for 15 years. Extended Cox regression analysis was used to compare the associations between living arrangements and mortality risk during the first post-fracture year and during the non-fracture time. All participants contributed to the non-fracture state until a fracture occurred or until death/end of follow-up if they did not sustain a fracture. Participants who sustained a fracture during the follow-up returned to the non-fracture state 1 year after the fracture unless they died or were censored due to end of follow-up. RESULTS: Altogether, 22% of men and 40% of women sustained a fracture. During the first post-fracture year, mortality risk was over threefold compared to non-fracture time but did not differ by living arrangement. In women, living alone was associated with lower mortality risk during non-fracture time, but the association attenuated after adjustment for self-rated health. In men, living alone was associated with increased mortality risk during non-fracture time, although not significantly. CONCLUSION: The results suggest that living alone is not associated with pronounced mortality risk after a fracture compared to living with someone. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40520-020-01511-5) contains supplementary material, which is available to authorized users.