Antipsychotic Use and the Risk of Hip Fracture Among Older Adults Afflicted With Dementia

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.

Keywords: Antipsychotics, dementia, hip fracture, nursing homes