Antipsychotic Use and the Risk of Hip Fracture Among Older Adults Afflicted With Dementia
Antipsychotic Use and the Risk of Hip Fracture Among Older Adults Afflicted With Dementia
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DOI：
10.1016/j.jamda.2009.10.001
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发表时间：
2010-02-01
影响因子：
7.6
通讯作者：
Lapane, Kate L.
中科院分区：
文献类型：
--
作者：
Jalbert, Jessica J.;Eaton, Charles B.;Lapane, Kate L.
目的：量化居住在养老院（NH）并患有痴呆症的老年人使用抗精神病药物（AP）与髋部骨折风险之间的关系。设计：巢式病例对照研究。背景：2001-2002年加利福尼亚州、佛罗里达州、伊利诺伊州、纽约州和俄亥俄州的NHs （N = 586）。参与者：来源人群包括长期居住的符合医疗补助条件的居民，他们居住在至少有20张床位的NHs中，年龄在65岁或以上，诊断为痴呆，但没有接受临终关怀，没有昏迷、卧床不起、瘫痪或坐在轮椅上，没有髋部骨折的记录（N = 69,027）。共发现髋部骨折764例；从源人群（N = 3582）中随机选择最多5个对照，与NH和最小数据集（MDS）评估的病例相匹配。测量：确定髋部骨折病例，并从医疗补助索赔数据中确定药物使用情况。居民水平的特征，包括痴呆严重程度，从居民MDS评估中获得。结果：目前使用ap会增加髋部骨折的风险（校正优势比= 1.26；95%可信区间：1.05-1.52）。当单独分析时，使用常规抗精神病药物的患者髋部骨折的风险略高于使用非典型药物的患者。长期使用ap比短期使用更容易导致髋部骨折。结论：APs似乎增加了NH老年痴呆患者髋部骨折的风险。髋部骨折可能是在AP使用者中观察到的死亡率风险增加的一个促成机制。（中华医学杂志2010；11:120-127）
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. (J Am Med Dir Assoc 2010; 11: 120-127)