Fractures in the Elderly Prevalence and Effects on Quality of Life Joe Dan Metcalf II, M.D. Hospital Medicine Medical Director of Palliative Care Director of Best Practices

Objective

– State short-term and long-term effects of long bone and spinal fractures in the geriatric patient

How serious is the problem?

Falls with FracturesOutcomes • 20-30% percent of people who fall suffer moderate to severe injuries: lacerations, hip fractures, or head trauma (Sterling, O’Connor & Bonadies, 2001).

• These injuries impact the patient’s functional capacity and increase their risk of early death (Alexander, Rivara & Wolf, 1992).

Location of Falls (65 years and older)

Nursing Home 10%

Public Places 30%

Home 60%

Unintentional Fall Death Rates by Gender, Age 65 +, U.S. 1996 140

Per 100,000

120 100

Men Women

80 60 40 20 0 65-74

75-84

85+

National Center for Health Statistics, Vital Statistics

Unintentional Fall Age-Adjusted Death Rates, Age 65 +, gender and race U.S. 35

White, Men

30 25

Black, Men

20 15

White, Women

10 5

Black, Women

National Center for Health Statistics, Vital Statistics

1998

1997

1996

1995

1994

1993

1992

1991

1990

1989

1988

1987

1986

1985

1984

1983

1982

1981

0

Risk Factors

Intrinsic (Personal) factors for Falls • Aged (over 65 years) • Female • Low mobility or fragility – lower extremity weakness, and poor grip strength • Functional impairments - limited Activities of Daily living (ADL) • Poor gait and balance • Low body weight

• Cognitive impairment or dementia • Chronic illness - Parkinson disease, visual difficulties, stroke, hypertension, or urinary incontinence • Psychoactive medication - tranquilizers or antidepressants • Previous falls • Heavy drinking

Fragile Bone  Osteoporosis, or brittle bones  Fall induced fractures Normal Bone

Dempster et al., JBMR 1986

Osteoporotic Bone

Most Common Fractures in Older Adults • • • • • • • •

Spine Hip Forearm Leg Ankle Pelvis Humerus Hand

Scheffer AC, Schuurmans MJ, Van Dijk N, Van Der Hoof T. Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age and Ageing 2008;37:19–24. Bell AJ, Talbot-Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the emergency department after a fall: a retrospective analysis. Medical Journal of Australia 2000;173(4):176–7.

Falls and fractures (Colledge, 2007)

Type of fracture Wrist Proximal Humerus Hip Ankle Pelvis Face Tibia / fibula Face Vertebral

Percentage attributed to falls by older women 96 95 92 88 80 77 65 59