Antipsychotic Use and the Risk of Hip Fracture Among Older Adults Afflicted With Dementia
published online 13 January 2010.
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.
aDepartment of Community Health–Epidemiology, Brown University Warren Alpert Medical School, Providence, RI
bCenter for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, RI
cDepartment of Family Medicine, Brown University Warren Alpert Medical School, Providence, RI
dCenter for Gerontology and Health Care Research, Brown University Warren Alpert Medical School, Providence, RI
eDepartment of Epidemiology and Community Health, Virginia Commonwealth University, Richmond, VA
Address correspondence to Kate L. Lapane, PhD, 1008 E. Clay Street, 3rd floor, PO Box 980212, Richmond, VA, 23298.
Jessica Jalbert is a pre-doctoral fellow at Pfizer. Charles B. Eaton, MD, has active grants with Pfizer and Forest Pharmaceuticals and is also a consultant for Pfizer. Susan C. Miller has no conflicts of interest to declare. Kate L. Lapane, PhD had a training grant to fund predoctoral fellows at Pfizer.
ABSTRACT