OBJECTIVE: To quantify the association between use of antipsychotic (AP) medications and the risk of hip fracture among older adults residing in a nursing home (NH) and afflicted with dementia. DESIGN: Nested case-control study. SETTING: NHs in California, Florida, Illinois, New York, and Ohio in 2001-2002 (N=586). PARTICIPANTS: The source population consisted of long-stay Medicaid-eligible residents living in NHs with at least 20 beds, who were 65 years of age or older and had a diagnosis of dementia but were not receiving hospice care, were not comatose, bedfast, paralyzed, or in a wheelchair, and had no record of a previous hip fracture (N=69,027). There were 764 cases of hip fracture identified; up to 5 controls, matched to cases on NH and quarter of Minimum Data Set (MDS) assessment, were randomly selected from the source population (N=3582). MEASUREMENTS: Cases of hip fracture were identified and medication use was ascertained from Medicaid claims data. Resident-level characteristics, including dementia severity, were obtained from resident MDS assessments. RESULTS: Current use of APs conveyed a small increased risk of hip fracture (adjusted odds ratio=1.26; 95% confidence interval: 1.05 -1.52). When analyzed separately, users of conventional antipsychotics had a slightly higher risk of hip fracture than residents on atypical agents. Long-term use of APs conferred a greater risk of hip fracture than short-term use. CONCLUSION: APs appear to increase the risk of hip fracture among older adults with dementia residing in an NH. Hip fractures may be a contributory mechanism to the increased risk mortality observed among AP users. Copyright 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
OBJECTIVE: To quantify the association between use of antipsychotic (AP) medications and the risk of hip fracture among older adults residing in a nursing home (NH) and afflicted with dementia. DESIGN: Nested case-control study. SETTING: NHs in California, Florida, Illinois, New York, and Ohio in 2001-2002 (N=586). PARTICIPANTS: The source population consisted of long-stay Medicaid-eligible residents living in NHs with at least 20 beds, who were 65 years of age or older and had a diagnosis of dementia but were not receiving hospice care, were not comatose, bedfast, paralyzed, or in a wheelchair, and had no record of a previous hip fracture (N=69,027). There were 764 cases of hip fracture identified; up to 5 controls, matched to cases on NH and quarter of Minimum Data Set (MDS) assessment, were randomly selected from the source population (N=3582). MEASUREMENTS: Cases of hip fracture were identified and medication use was ascertained from Medicaid claims data. Resident-level characteristics, including dementia severity, were obtained from resident MDS assessments. RESULTS: Current use of APs conveyed a small increased risk of hip fracture (adjusted odds ratio=1.26; 95% confidence interval: 1.05 -1.52). When analyzed separately, users of conventional antipsychotics had a slightly higher risk of hip fracture than residents on atypical agents. Long-term use of APs conferred a greater risk of hip fracture than short-term use. CONCLUSION:APs appear to increase the risk of hip fracture among older adults with dementia residing in an NH. Hip fractures may be a contributory mechanism to the increased risk mortality observed among AP users. Copyright 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
Authors: Paul D Foster; Ximena Camacho; Simone Vigod; Zhan Yao; David N Juurlink; J Michael Paterson; Muhammad M Mamdani; Diana Martins; Tara Gomes Journal: CMAJ Open Date: 2016-06-10
Authors: Sally K Rigler; Theresa I Shireman; Galen J Cook-Wiens; Edward F Ellerbeck; Jeffrey C Whittle; David R Mehr; Jonathan D Mahnken Journal: J Am Geriatr Soc Date: 2013-04-16 Impact factor: 5.562