Original Study
Risk of Nursing Home Admission After Femoral Fracture Compared With Stroke, Myocardial Infarction, and Pneumonia

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Abstract

Objective

To analyze the burden of institutionalizations after femoral fracture and compare it with other “catastrophic” disease entities like stroke, myocardial infarction, or pneumonia.

Design/Setting/Participants

Routine data of 414,000 hospitalized German patients aged 66 years and older were used to calculate institutionalization risks after femoral fracture, stroke, myocardial infarction, pneumonia or a combined group of “all other hospitalizations.”

Measurements

Institutionalization was defined as nursing home admission within 6 months after discharge from hospital. Age- and sex-specific incidence and incidence rates of institutionalization were calculated. To compare the risk of institutionalization between the disease entities, age-standardized rates were computed and proportional hazards models were applied. In-house mortality and mortality after discharge from hospital were also calculated.

Results

The risk of institutionalization increased exponentially with age in all disease entities. For example, the risk of institutionalization after femoral fracture increased from 3.6% in women aged 65 to 69 years to 34.8% in women aged 95 years and older. The highest institutionalization rates were observed in patients with stroke, followed by femoral fracture, pneumonia, and myocardial infarction. In men, the age-standardized risk of institutionalization was almost as high after femoral fracture as after stroke (7.5% vs 8.0%). In contrast to myocardial infarction and pneumonia, femoral fracture and stroke were more likely to be followed by institutionalization rather than death.

Conclusion

Femoral fractures result in high burden of institutionalizations. Prevention of falls, diagnosis and treatment of osteoporosis, and high-quality rehabilitation are challenges to tackle the burden of institutionalization in these patients in the future.

Section snippets

Study Population

The basic dataset consisted of all community-dwelling people aged 65 years and older insured with the Allgemeine Ortskrankenkasse Bayern (AOK Bavaria) on January 1, 2004, who were consecutively insured during the following year and still living at home on January 1, 2005. Bavaria is a federal state with 12.5 million inhabitants in the south of Germany. Health insurance is statutory in Germany. The AOK is Germany's largest statutory health insurance company. This nonprofit health insurance

Results

The study population consisted of 414,049 patients aged 66 years and older who were hospitalized for at least 7 days during the study period. The median age was 77.2 years and 62.8% of the patients were women (Figure 1). Femoral fracture was the main discharge diagnosis in 13,445 patients (3.2% of the study population). The main discharge diagnosis of stroke was more frequently and myocardial infarction and pneumonia were less frequently reported than femoral fractures. Within these disease

Discussion

The objective of the study was to compare the age- and sex-specific burden of institutionalization after femoral fracture with the burden of institutionalization after other diseases such as stroke, myocardial infarction, or pneumonia. Therefore, a large health claims database including 414,000 older people from the south of Germany was used. Institutionalization rates increased exponentially with age in all disease entities. The highest institutionalization rates were observed in patients with

Acknowledgments

We thank Regina Merk-Bäuml, Ralf Brum, Markus Gindl, and Stefanie Büttner from the Allgemeine Ortskrankenkasse (AOK) for their support of our analyses.

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    J.M. has relationships with the following, none of these has direct relationship to the work described in this article: Ammonett, LLC; Novartis; Sanofi; Regeneron; Viking. The other authors declare no conflicts of interest.

    The analysis was funded by the Bundesministerium für Bildung und Forschung (Förderkennzeichen: 01EC1007A).

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