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
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Article info
Publication history
Published online: January 13, 2010
Footnotes
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.
Identification
Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
