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Jay Magaziner

Publications and source records attributed to Jay Magaziner.

At least 37 records · Page 2Linked to original sources
PubMed2005

Health and functional outcomes and health care utilization of persons with dementia in residential care and assisted living facilities: comparison with nursing homes.

PURPOSE: This study compares health and functional outcomes and health care utilization of persons with dementia residing in residential care/assisted living (RC/AL) facilities and nursing homes. DESIGN AND METHODS: The study uses data from a longitudinal cohort study of 1,252 residents with dementia in 106 RC/AL facilities and 40 nursing homes in four states. RESULTS: Rates of mortality; new or worsening morbidity; and change in activities of daily living, cognition, behavioral problems, depressive symptoms, social function, and withdrawal did not differ between the two settings. However, because of death or transfer, only about one half of the persons with mild dementia and one third of those with moderate to severe dementia remained in RC/AL facilities 1 year after enrollment. In addition, hospitalization rates were greater among individuals with mild dementia in RC/AL facilities, largely because of a medically unstable subgroup with high nursing-home-transfer rates. IMPLICATIONS: Many persons with dementia can be served equally well in either setting; however, those with major medical care needs may benefit from nursing home residence.

Aged, 80 and over↗
PubMed2005

Proxies and other external raters: methodological considerations.

OBJECTIVE: The purpose of this paper is to introduce researchers to the measurement and subsequent analysis considerations involved when using externally rated data. We will define and describe two categories of externally rated data, recommend methodological approaches for analyzing and interpreting data in these two categories, and explore factors affecting agreement between self-rated and externally rated reports. We conclude with a discussion of needs for future research. DATA SOURCES/STUDY SETTING: Data sources for this paper are previous published studies and reviews comparing self-rated with externally rated data. STUDY DESIGN/DATA COLLECTION/EXTRACTION METHODS: This is a psychometric conceptual paper. PRINCIPAL FINDINGS: We define two types of externally rated data: proxy data and other-rated data. Proxy data refer to those collected from someone who speaks for a patient who cannot, will not, or is unavailable to speak for him or herself, whereas we use the term other-rater data to refer to situations in which the researcher collects ratings from a person other than the patient to gain multiple perspectives on the assessed construct. These two types of data differ in the way the measurement model is defined, the definition of the gold standard against which the measurements are validated, the analysis strategies appropriately used, and how the analyses are interpreted. There are many factors affecting the discrepancies between self- and external ratings, including characteristics of the patient, the proxy, and of the rated construct. Several psychological theories can be helpful in predicting such discrepancies. CONCLUSIONS: Externally rated data have an important place in health services research, but use of such data requires careful consideration of the nature of the data and how it will be analyzed and interpreted.

Data Collection↗
PubMed2005

Outcomes of infection in nursing home residents with and without early hospital transfer.

OBJECTIVES: To compare outcomes of infection in nursing home residents with and without early hospital transfer. DESIGN: Observational cohort study. SETTING: Fifty-nine nursing homes in Maryland. PARTICIPANTS: Two thousand one hundred fifty-three individuals admitted to nursing homes between 1992 and 1995. MEASUREMENTS: Incident infection was recorded when a new infectious diagnosis was documented in the medical record or nonprophylactic antibiotic therapy was prescribed. Early hospital transfer was defined as transfer to the emergency department or admission to the hospital within 3 days of infection onset. Infection, resident, and facility characteristics were entered into a multivariate model to create a propensity score for early hospital transfer. Association between early hospital transfer and outcomes of infection, namely pressure ulcers and death between Days 4 and 34 after infection onset, were examined, controlling for propensity score. RESULTS: Four thousand nine hundred ninety infections occurred in 1,301 residents. Genitourinary (28%), skin (19%), upper respiratory (13%), and lower respiratory (12%) were the most common types. Three hundred seventy-five episodes in which residents survived 3 days (7.6%) resulted in early hospital transfer. In multivariate regression, individuals with early hospital transfer had higher mortality (odds ratio (OR) 1.44, 95% confidence interval (CI)=1.04-1.99) and, in 1-month survivors, a greater occurrence of pressure ulcers (OR 1.61, 95% CI=1.17-2.20) than those without, after adjusting for propensity score. CONCLUSION: Using observational data and propensity score methods, outcomes were worse in nursing home residents transferred to the hospital within 3 days of infection onset than in those who remained in the nursing home.

Aged↗
PubMed2005

Mortality and adverse health events in newly admitted nursing home residents with and without dementia.

OBJECTIVES: To evaluate the association between dementia and mortality, adverse health events, and discharge disposition of newly admitted nursing home residents. It was hypothesized that residents with dementia would die at a higher rate and develop more adverse health events (e.g., infections, fevers, pressure ulcers, falls) than residents without dementia because of communication and self-care difficulties. DESIGN: An expert clinician panel diagnosed an admission cohort from a stratified random sample of 59 Maryland nursing homes, between 1992 and 1995. The cohort was followed for up to 2 years or until discharge. SETTING: Fifty-nine Maryland nursing homes. PARTICIPANTS: Two thousand one hundred fifty-three newly admitted residents aged 65 and older not having resided in a nursing home for 8 or more days in the previous year. MEASUREMENTS: Mortality, infection, fever, pressure ulcers, fractures, and discharge home. RESULTS: Residents with dementia had significantly lower overall rates of infection (relative risk (RR)=0.77, 95% confidence interval (CI)=0.70-0.85) and mortality (RR=0.61, 95% CI=0.53-0.71) than those without dementia, whereas rates of fever, pressure ulcers, and fractures were similar for the two groups. These results persisted when rates were adjusted for demographic characteristics, comorbid conditions, and functional status. During the first 90 days of the nursing home stay, residents with dementia had significantly lower rates of mortality if not admitted for rehabilitative care under a Medicare qualifying stay (RR=0.25, 95% CI=0.14-0.45), were less often discharged home (RR=0.33, 95% CI=0.28-0.38), and tended to have lower fever rates (RR=0.78, 95% CI=0.63-0.96) than residents without dementia. CONCLUSION: Newly admitted nursing home residents with dementia have a profile of health events that is distinct from that of residents without dementia, indicating that the two groups have different long-term care needs. Results suggest that further investigation of whether residents with dementia can be well managed in alternative residential settings would be valuable.

Accidental Falls↗
PubMed2004

Medication undertreatment in assisted living settings.

BACKGROUND: Residential care/assisted living (RC/AL) is a rapidly growing, long-term care setting, where medication use has not been carefully examined. We sought to determine the prevalence and predictors of nonprescribing of selected medications whose value in decreasing morbidity has been established in clinical trials. METHODS: As part of a survey of a stratified random sample of 193 RC/AL facilities in Florida, Maryland, New Jersey, and North Carolina, data were gathered on 2014 residents 65 years and older. Patient characteristics and diagnoses were recorded based on medical record reviews and in-person patient assessments; all medications administered at least 4 of the previous 7 days were recorded. Data on facility characteristics were obtained by interviewing facility administrators. Bivariate and multivariate logistic regression was performed to identify associations between medication nonprescribing and facility characteristics, physician visitation, and patient age, sex, race, comorbidity, functional dependency, and cognition. RESULTS: Of 328 subjects with congestive heart failure, 204 (62.2%) were not receiving an angiotensin-converting enzyme inhibitor; of 172 subjects with prior myocardial infarction, 60.5% were not receiving aspirin and 76.2% were not receiving beta-blockers; of 435 patients with history of stroke, 37.5% were not receiving an anticoagulant or antiplatelet agent; and of 315 patients with osteoporosis, 61.0% were not receiving calcium supplementation and 51.1% were not receiving any treatment for the condition. Resident age, race, sex, comorbidity, cognitive status, and dependency in activities of daily living were rarely associated with nonprescribing; in contrast, facility factors-particularly facility type and the frequency of physician visits-were somewhat more frequently associated with nonprescribing. CONCLUSIONS: Undertreatment appears to be prevalent in RC/AL facilities. Since preserving independence is often a primary goal of care in these settings, more attention may need to be paid to the use of treatments that have been shown to reduce long-term morbidity.

Aged↗
PubMed2004

Association of timing of surgery for hip fracture and patient outcomes.

CONTEXT: Previous studies of surgical timing in patients with hip fracture have yielded conflicting findings on mortality and have not focused on functional outcomes. OBJECTIVE: To examine the association of timing of surgical repair of hip fracture with function and other outcomes. DESIGN: Prospective cohort study including analyses matching cases of early (< or =24 hours) and late (>24 hours) surgery with propensity scores and excluding patients who might not be candidates for early surgery. SETTING: Four hospitals in the New York City metropolitan area. PARTICIPANTS: A total of 1206 patients aged 50 years or older admitted with hip fracture over 29 months, ending December 1999. MAIN OUTCOME MEASURES: Function (using the Functional Independence Measure), survival, pain, and length of stay (LOS). RESULTS: Of the patients treated with surgery (n = 1178), 33.8% had surgery within 24 hours. Earlier surgery was not associated with improved mortality (hazard ratio, 0.75; 95% confidence interval [CI], 0.52-1.08) or improved locomotion (difference of -0.04 points; 95% CI, -0.49 to 0.39). Earlier surgery was associated with fewer days of severe and very severe pain (difference of -0.22 days; 95% CI, -0.41 to -0.03) and shorter LOS by 1.94 days (P<.001), but postoperative pain and LOS after surgery did not differ. Analyses with propensity scores yielded similar results. When the cohort included only patients who were medically stable at admission and therefore eligible for early surgery, the results were unchanged except that early surgery was associated with fewer major complications (odds ratio, 0.26; 95% CI, 0.07-0.95). CONCLUSIONS: Early surgery was not associated with improved function or mortality, but it was associated with reduced pain and LOS and probably major complications among patients medically stable at admission. Additional research is needed on whether functional outcomes may be improved. In the meantime, patients with hip fracture who are medically stable should receive early surgery when possible.

Aged↗
PubMed2004

The effect of perioperative anemia on clinical and functional outcomes in patients with hip fracture.

OBJECTIVES: To describe the epidemiology of perioperative anemia in patients with hip fracture and assess the relationship between the hemoglobin measurements and clinical outcomes. DESIGN: Prospective observational cohort study. SETTING: Four university and community teaching hospitals. PATIENTS: A consecutive cohort of 550 patients who underwent surgery for hip fracture and survived to discharge from August 1997 and August 1998 were evaluated and followed prospectively. MAIN OUTCOME MEASURES: Deaths, readmissions and Functional Independence Motor mobility scores within 60 days of discharge. RESULTS: Anemia (defined as hemoglobin <12.0 g/dL) was present in 40.4% of patients on admission, 45.6% at the presurgery nadir, 93.0% at the postsurgery nadir, and 84.6% near discharge. The mean drop in hemoglobin after surgery was 2.8 +/- 1.6 g/dL. In multivariate analyses, higher hemoglobin levels on admission were associated with shorter lengths of hospital stay and lower odds of death and readmission even after controlling for a broad range of prefracture patient characteristics, clinical status on discharge, and use of blood transfusion. Admission and preoperative anemia was not associated with risk-adjusted Functional Independence Motor mobility scores. In multivariable analyses, higher postoperative hemoglobin was associated with shorter length of stay and lower readmission rates, but did not effect rates of death or Functional Independence Motor mobility scores. CONCLUSIONS: Substantial declines in hemoglobin were common in patients with hip fracture. Higher preoperative hemoglobin was associated with shorter length of stay and lower odds of death and readmission within 60 days of discharge. Postoperative hemoglobin was also related to length of stay and readmission rates.

Aged↗
PubMed2004

Physical therapy and mobility 2 and 6 months after hip fracture.

OBJECTIVES: To examine the relationship between early physical therapy (PT), later therapy, and mobility 2 and 6 months after hip fracture. DESIGN: Prospective, multisite observational study. SETTING: Four hospitals in the New York City area. PARTICIPANTS: Four hundred forty-three hospitalized older patients discharged after surgery for hip fracture in 1997-98. MEASUREMENTS: Patient demographics, fracture type, comorbidities, dementia, number of new impairments at discharge, amount of PT between day of surgery and postoperative day (POD) 3, amount of therapy between POD4 and 8 weeks later, and prefracture, 2-, and 6-month mobility measured using the Functional Independence Measure. RESULTS: More PT immediately after hip fracture surgery was associated with significantly better locomotion 2 months later. Each additional session from the day of surgery through POD3 was associated with an increase of 0.4 points (P=.032) on the 14-point locomotion scale, but the positive relationship between early PT and mobility was attenuated by 6 months postfracture. There was no association between later therapy and 2- or 6-month mobility. CONCLUSION: PT immediately after hip fracture surgery is beneficial. The effects of later therapy on mobility were difficult to assess because of limitations of the data. Well-designed randomized, controlled trials of the effect of varying schedules and amounts of therapy on functional status after hip fracture would be informative.

Activities of Daily Living↗
PubMed2004

Concordance of proxy-perceived change and measured change in multiple domains of function in older persons.

OBJECTIVES: To compare proxy perceptions about change over 6 months in physical, instrumental, affective, and cognitive functioning of older persons with computed change in patient self-report and performance and patient's own perceptions about change. DESIGN: Prospective study. SETTING: Recovery from hip fracture that occurred in community-dwelling persons in Baltimore, Maryland, in 1990-91. The recovery from the sixth to the 12th month postfracture was observed. PARTICIPANTS: One hundred forty-one hip fracture patients aged 65 and older and a self-designated proxy for each. MEASUREMENTS: For specific tasks of physical and instrumental functioning, proxy perception of change over the previous 6 months asked in the 12th month postfracture was compared with change in criterion measures (subject self-report and observed performance) from the sixth to the 12th month postfracture. For global change over the previous 6 months in each area of functioning, proxy perception was compared with the subject's own perception in the 12th month postfracture. RESULTS: Agreement between proxy perceptions of change and change in criterion measures was poor. There was a general pattern for proxies to overstate improvement and understate deterioration in comparison with change observed in criterion measures for specific tasks of physical and instrumental functioning. Proxies' global perceptions reported subjects improving less and deteriorating more than patients' own perceptions. CONCLUSION: Proxy perceptions about task-specific and global changes in subjects' functional health over a short period of time are systematically different from patient report and observed performance.

Activities of Daily Living↗
PubMed2004

Black/White differences in pressure ulcer incidence in nursing home residents.

OBJECTIVES: To compare black and white nursing home residents with respect to the incidence of nursing home (NH)-acquired pressure ulcers (PUs) and to examine the role of resident characteristics and facility characteristics in explaining differences between the racial groups. DESIGN: Prospective cohort study conducted between 1992 and 1995. SETTING: Fifty-nine Maryland NHs. PARTICIPANTS: A total of 1,938 residents (301 black, 1,637 white) aged 65 and older newly admitted to participating NHs. MEASUREMENTS: The outcome variable was the first occurrence of a Stage 2, 3, or 4 PU as determined based on medical record review. The predictor variable was race (black, white). Eight resident characteristics (age, sex, number of activity of daily living dependencies, bedfast, PU on admission to facility, incontinence, dementia, and whether the resident was on Medicaid) and three facility characteristics (number of beds, for-profit ownership status, and urban/nonurban location) were considered as possible confounding variables. RESULTS: The incidence of PUs was 0.38 per person-year in the NH. The rate for blacks was significantly higher than for whites (0.56 vs 0.35 per person-year) (P<.001). In multivariate analysis, controlling for eight resident characteristics and three facility characteristics, race was significantly associated with PU incidence (hazard ratio comparing blacks with whites=1.31, 95% confidence interval=1.02-1.66). CONCLUSION: Blacks have a higher incidence of NH-acquired PUs than whites; resident characteristics appear to mediate the higher risk. Future research should aim to identify modifiable factors that explain differences between racial groups in PU risk and to develop solutions to prevent the suffering and cost associated with PUs.

Activities of Daily Living↗
PubMed2004

Patient relocation in the 6 months after hip fracture: risk factors for fragmented care.

OBJECTIVES: To describe the incidence and patterns of patient relocation after hip fracture, identify factors associated with relocation, and examine effect of relocation on outcomes. DESIGN: Prospective cohort study. SETTING: Four hospitals in the New York metropolitan area. PARTICIPANTS: A total of 562 patients hospitalized for hip fracture discharged alive in 1997 to 1998. MEASUREMENTS: Patient characteristics and hospital course were ascertained using patient or surrogate interview, research nurse assessment, and medical record review. Patient location was ascertained at five time points using patient or surrogate interview, and hospital readmissions were identified using New York state and hospital admission databases. Mobility was measured using patient or surrogate report using the Functional Independence Measure. RESULTS: During 6 months of follow-up, the mean number of relocations per patient+/-standard deviation was 3.5+/-1.5 (range 2-10). Forty-one percent of relocations were between home and hospital, 36% between rehabilitation or nursing facility and hospital, 17% between rehabilitation or nursing facility and home, and 4% between two rehabilitation/nursing facilities. In a Poisson regression model that controlled for patient characteristics, hospital course, and length of follow-up, factors associated with relocation (P<.05) were absence of dementia, in-hospital delirium, one or more new impairments at hospital discharge, hospital discharge other than to home, and not living at home alone prefracture. Relocation was not significantly associated with immobility or mortality at 6 months (odds ratio=1.14, 95% confidence interval=0.97-1.35). CONCLUSION: Subgroups of patients with elevated risk of relocation after hip fracture may be target groups for intensive care coordination and care planning interventions.

Aged↗
PubMed2004

The HORIZON Recurrent Fracture Trial: design of a clinical trial in the prevention of subsequent fractures after low trauma hip fracture repair.

OBJECTIVE: To present the novel design of a trial testing the safety and efficacy of a yearly bisphosponate, zoledronic acid, in preventing new clinical fractures in patients with recent low trauma hip fracture repair. RESEARCH DESIGN AND METHODS: Randomized, placebo-controlled, triple-blind study. One hundred and fifteen clinical centers worldwide are recruiting approximately 1714 subjects aged 50 years and over (no upper age limit, median age of enrolled subjects to date 79 years) who have undergone surgical repair of a low trauma hip fracture in the preceding 90 days. Patients will be assigned at random to an intervention group (5 mg zoledronic acid intravenously yearly) or a control group (placebo infusion yearly). Both groups receive a loading dose of Vitamin D2 or D3 IM or orally, followed by 800-1200 IU Vitamin D and 1000-1500 mg elemental calcium orally on a daily basis. Concomitant therapy with calcitonin, hormone replacement therapy, selective estrogen receptor modulators, tibolone, and external hip protectors are allowed. MAIN OUTCOME MEASURES: The primary endpoint is subsequent skeletal fractures as adjudicated by a clinical endpoints committee blinded to intervention status. Secondary outcomes include delayed hip fracture healing, changes in bone mineral density, and health resource utilization. Subjects will be recruited over a 3-4 year period and will be followed until 211 primary endpoints are accrued and adjudicated. CONCLUSIONS: This randomized clinical trial is novel among osteoporosis therapies as it (1). targets hip fracture patients, a previously understudied group, and (2). uses only clinically evident fractures as the primary outcome. Ethical and practical considerations in studying this frail population are discussed.

Bone Density↗
PubMed2003

Predictors of bone loss after hip fracture.

Although accelerated bone mineral density (BMD) loss follows hip fracture, little is known about factors associated with this loss. We examined potential predictors of BMD loss in a cohort of community-dwelling women who had sustained hip fracture and who were followed for 1 year after fracture. BMD was measured at the femoral neck, intertrochanteric region, and total body, during hospitalization and 2, 6, and 12 months later. Demographic, health, lifestyle, clinical, surgical, and functional characteristics at baseline, and postfracture activity were evaluated for associations with baseline BMD and BMD 1 year later. To examine possible BMD-dependent effects, high and low baseline BMD groups were defined. None of the studied factors consistently predicted either baseline BMD or BMD at 1 year after fracture, among women with either high or low baseline BMD. Baseline BMD was the only factor that substantially and consistently predicted change, explaining 70% to 90% of variation. These results suggest that BMD will not be preserved by general rehabilitative measures and that prompt, specific intervention to minimize bone loss after hip fracture is an essential element of clinical management of the hip fracture patient.

Absorptiometry, Photon↗
PubMed2003

The contribution of hip fracture to risk of subsequent fractures: data from two longitudinal studies.

BACKGROUND: The contribution of hip fracture to the risk of subsequent fractures is unclear. METHODS: Data from the Baltimore Hip Studies and the Established Populations for Epidemiologic Studies of the Elderly (EPESE) were used. Baltimore subjects enrolled at the time of hip fracture ( n=549) and EPESE subjects without previous fractures at baseline ( n=10,680) were followed for 2-10 years. Self-reported nonhip skeletal fracture was the outcome, and hip fracture was a time-varying covariate in a survival analysis stratified by study site. The model was adjusted for race, sex, age, BMI, stroke, cancer, difficulty walking across a room, dependence in grooming, dependence in transferring, and cognitive impairment. RESULTS: The rate of all subsequent self-reported fractures after hip fracture was 10.4 fractures/100 person-years. The unadjusted hazard of nonhip skeletal fracture was 2.52 (95% confidence interval 2.05 to 3.12) for subjects with hip fracture compared with subjects without; when adjusted for other known fracture risk factors the hazard ratio was 1.62 (1.30 to 2.02). Men and women had a similar relative risk increase. The increased risk of secondary fracture after hip fracture persisted over time. CONCLUSIONS: A hip fracture is associated with a 2.5-fold increased risk of subsequent fracture, which is not entirely explained by prefracture risk factors. Careful attention to secondary prevention is warranted in these patients.

Aged↗
PubMed2003

Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged.

Disability attributable to hip fracture regarding activities of daily living was evaluated by comparing 594 hip fracture patients entering eight hospitals in Baltimore, Maryland, in 1990-1991 with community-dwelling aged from the Established Populations for Epidemiologic Studies of the Elderly (EPESE) cohort matched on age, sex, and walking ability. Subjects were assessed at baseline (prefracture report for patients), 12 months, and 24 months. At baseline, 26% of both groups had walking disability, 12-14% had transferring disability, and 6-8% evidenced grooming disability. At 12 and 24 months, about 50% of hip fracture patients were walking disabled compared with 21-29% of EPESE respondents after the authors controlled for age, sex, comorbidities, and functional status (excess disability attributable to hip fracture, i.e., attributable disability, of 26 additional cases of disability per 100 persons in the hip fracture cohort during follow-up). Likewise, hip fracture patients experienced more disability regarding transferring (38-39% vs. 10-18%; attributable disability, approximately 22 cases per 100 persons) and grooming (17-19% vs. 7-15%; attributable disability, approximately six cases per 100 persons). Thus, results showed that hip fracture patients had substantially more activities of daily living disability than that explained by aging over 24 months.

Activities of Daily Living↗
PubMed2003

Frequency and impact of active clinical issues and new impairments on hospital discharge in patients with hip fracture.

BACKGROUND: Hip fracture is associated with significant mortality and disability. Patients who are discharged from the hospital with active clinical problems may have worse outcomes than those patients without active clinical problems. OBJECTIVE: To assess the frequency and impact of clinical problems at discharge on clinical and functional hip fracture outcomes. METHODS: Detailed clinical data were collected from 559 patients in a prospective, multicenter observational cohort study. Active clinical issues (ACIs) on discharge included the following: temperature of 38.3 degrees C or higher, heart rate of more than 100/min or less than 60/min, systolic blood pressure higher than 180 mm Hg or lower than 90 mm Hg, diastolic blood pressure higher than 110 mm Hg or lower than 60 mm Hg, respiratory rate of more than 24/min, oxygen saturation of less than 90%, altered mental status, no oral intake, shortness of breath, chest pain, arrhythmias, or wound infection. New impairments (NIs) included bowel and bladder incontinence, inability to get out of bed, and decubitus ulcer. Outcomes were deaths, readmissions, and functional mobility 60 days after discharge. RESULTS: Overall, 94 patients (16.8%) had 1 or more ACIs, and 229 (41.0%) had 1 or more NIs on discharge. Both ACIs and NIs on discharge were associated with increased risk-adjusted rates of death (odds ratio, 1.8; 95% confidence interval, 1.2-2.8) or readmission (odds ratio, 1.7; 95% confidence interval, 1.2-2.3). The NIs on discharge were also associated with worse functional mobility (P<.004). These relationships persisted in multivariate analyses that controlled for a previously validated, hip fracture-specific risk adjustment measure. CONCLUSIONS: Clinicians should consider information about ACIs and NIs when deciding readiness for discharge and planning post-acute care.

APACHE↗
PubMed2003

Hip fracture: risk factors and outcomes.

Hip fracture is an important public health and personal burden, and this burden is anticipated to increase over the next several decades. Although white women experience the greatest lifetime risk of hip fracture, risk extends to men and to nonwhite populations. Bone strength, risk of falling, and individual clinical characteristics combine to affect the risk of hip fracture. Nearly $9 billion were expended in 1995 in the United States for the management of hip fractures. Hip fracture has important sequelae, including loss of bone and muscle mass. Mortality is significantly increased after hip fracture, and functional recovery is limited to less than 50% of those who fracture. About 25% of patients reside in long-term care facilities for a year or more after fracture, and the impact of hip fracture on health-related quality of life is considerable and long lasting.

Accidental Falls↗