Risk of Hospitalized Falls and Hip Fractures in 22,103 Older Adults Receiving Mental Health Care vs 161,603 Controls: A Large Cohort Study
Por:
Stubbs B, Perara G, Koyanagi A, Veronese N, Vancampfort D, Firth J, Sheehan K, De Hert M, Stewart R and Mueller C
Publicada:
1 dic 2020
Ahead of Print:
19 abr 2020
Resumen:
Objectives: To investigate the risk of hospitalized fall or hip fracture among older adults using mental health services.
Design: Retrospective cohort study.
Setting and Participants: Residents of a South London catchment aged >60 years receiving specialist mental health care between 2008 and 2016.
Measures: Falls and/or a hip fracture leading to hospitalization were ascertained from linked national records. Incidence rates and incidence rate ratios (IRRs) were age- and gender-standardized to the catchment population. Multivariable survival analyses were applied investigating falls and/or hip fractures as outcomes.
Results: In 22,103 older adults, incidence rates were 60.1 per 1000 person-years for hospitalized falls and 13.7 per 1000 person-years for hip fractures, representing standardized IRRs of 2.17 [95% confidence interval (CI) 2.07-2.28] and 4.18 (3.79-4.60), respectively. The IRR for falls was high in those with substance-use disorder [IRR = 6.72 (5.35-8.33)], bipolar disorder [IRR = 3.62 (2.50-5.05)], depression [IRR = 2.28 (2.00-2.59)], and stress-related disorders [IRR = 2.57 (2.10-3.11)]. Hip fractures were increased in all populations (IRR > 2.5), with greatest risk in substance use disorders [IRR = 12.64 (7.2220.52)], dementia [IRR= 4.38 (3.82-5.00)], and delirium [IRR = 4.03 (3.00-5.29)]. Comparing mental disorder subgroups with each other, after the adjustment for 25 potential confounders, patients with dementia and substance use had a significantly increased risk of falls, and patients with dementia also had an increased risk of hip fractures.
Conclusion and Implications: Older people using mental health services have more than double the incidence of falls and 4 times the incidence of hip fractures compared to the general population. Although incidences differ between diagnostic subgroups, all groups have a higher incidence than the general population. Targeted interventions to prevent falls and hip fractures among older adult mental health service users are urgently needed. (C) 2020 The Author(s). Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Filiaciones:
Stubbs B:
South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom
Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
Perara G:
Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
Koyanagi A:
Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain
ICREA, Barcelona, Spain
Veronese N:
Primary Care Department, Azienda ULSS (Unità Locale Socio Sanitaria) 3 "Serenissima," Dolo, Venice, Italy
Vancampfort D:
Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
University Psychiatric Centre, KU Leuven, University of Leuven, Kortenberg, Belgium
Firth J:
NICM Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia
Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
Sheehan K:
Department of Population Health Sciences, School of Population Health & Environmental Sciences, King's College London, London, United Kingdom
De Hert M:
University Psychiatric Centre KU Leuven, Kortenberg, Belgium
Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
Stewart R:
South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom
Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
Mueller C:
South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom
Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
Green Published, Green Accepted, hybrid
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