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OBJECTIVE To determine the rate of hip fracture and risk factors associated with hip fractures in disabled older persons who enroll in the Program of All-Inclusive Care for the Elderly (PACE), a program providing comprehensive care to community-living nursing-home-eligible persons. METHODS Prospective cohort study between January 1990 and December 1997. METHODS The twelve PACE demonstration sites: San Francisco, California; Columbia, South Carolina; Detroit, Michigan; Denver, Colorado; East Boston, Massachusetts; El Paso, Texas; Milwaukee, Wisconsin; Oakland, California; Portland, Oregon; Rochester, New York; Sacramento, California; and the Bronx, New York. METHODS Five thousand one hundred eighty-seven individuals in PACE; mean age 79, 71% female, 49% white, 47% with dementia. METHODS Functional status, cognitive status, demographics, and comorbid conditions were recorded on all the participants, who were tracked for occurrence of a hip fracture. The goals were to determine the rate of hip fracture and identify risk factors. RESULTS Two hundred thirty-eight hip fractures (4.6%) occurred during follow-up. The rate of hip fracture was 2.2% per person-year. Four independent predictors of hip fracture were identified using Cox proportional hazard analysis: age of 75 and older (adjusted hazard ratio (HR) = 2.0, 95% confidence interval (CI) = 1.4-2.8); white ethnicity (HR = 2.1, 95% CI = 1.6-2.8); ability to transfer independently to and from bed, chair, and toilet (HR = 3.0, 95% CI = 1.2-7.2); and five or more Short Portable Mental Status Questionnaire errors (HR = 1.6, 95% CI = 1.3-2.1). The incidence of hip fracture ranged from 0.5% per person-year in persons with zero to one independent risk factors to 4.7% per person-year in those with all four independent risk factors. CONCLUSIONS The rate of hip fracture in this cohort of disabled community-living older adults was similar to that reported in nursing home cohorts. Older age, white race, ability to transfer independently, and cognitive impairment were independent predictors of hip fracture. Persons with these risk factors should be targeted for preventive interventions, which should include strategies for making transferring safer.
Louise C Walter, and
Li-Yung Lui, and
Catherine Eng, and
Kenneth E Covinsky
June 2000,
Australian and New Zealand journal of medicine,
Louise C Walter, and
Li-Yung Lui, and
Catherine Eng, and
Kenneth E Covinsky
November 1999,
Journal of the American Geriatrics Society,
Louise C Walter, and
Li-Yung Lui, and
Catherine Eng, and
Kenneth E Covinsky
July 2005,
Physical therapy,
Louise C Walter, and
Li-Yung Lui, and
Catherine Eng, and
Kenneth E Covinsky
July 1994,
Journal of gerontology,
Louise C Walter, and
Li-Yung Lui, and
Catherine Eng, and
Kenneth E Covinsky
July 2023,
European journal of orthopaedic surgery & traumatology : orthopedie traumatologie,
Louise C Walter, and
Li-Yung Lui, and
Catherine Eng, and
Kenneth E Covinsky
July 2009,
Medicine and health, Rhode Island,
Louise C Walter, and
Li-Yung Lui, and
Catherine Eng, and
Kenneth E Covinsky
October 2015,
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry,
Louise C Walter, and
Li-Yung Lui, and
Catherine Eng, and
Kenneth E Covinsky
June 2005,
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine,
Louise C Walter, and
Li-Yung Lui, and
Catherine Eng, and
Kenneth E Covinsky
April 2002,
Journal of the American Geriatrics Society,
Louise C Walter, and
Li-Yung Lui, and
Catherine Eng, and
Kenneth E Covinsky
October 2023,
Immunity & ageing : I & A,
