Background
Methods
Study design and participants
Intervention
Usual care
Data collection and measurements
Data collection
Characteristics
Outcome measure
Definitions
Statistical analysis
Results
Characteristics | Intervention
N = 32 | Usual care
N = 132 |
P-value |
---|---|---|---|
Patient characteristics | |||
Age, mean ± SD | 83.8 ± 6.2 | 85.1 ± 6.7 | 0.28 |
Men, n (%) | 7 (21.9) | 28 (21.2) | 1.00 |
Institutional resident, n (%) | 7 (21.9) | 47 (35.6) | 0.15 |
CCI, mean ± SD | 2.7 ± 1.6 | 2.0 ± 1.8 | 0.04 |
Number of medications at admission | |||
Total, mean ± SD | 9.2 ± 2.5 | 7.8 ± 2.5 | 0.01 |
5–8 medications, n (%) | 15 (46.9) | 88 (66.7) | 0.04 |
9–12 medications, n (%) | 13 (40.6) | 38 (28.8) | 0.21 |
13 or more medications, n (%) | 4 (12.5) | 6 (4.5) | 0.11 |
Number of medications at discharge | |||
Total, mean ± SD | 4.5 ± 2.6 | 6.8 ± 2.4 | < 0.001 |
0–4 medications, n (%) | 18 (56.3) | 21 (15.9) | < 0.001 |
5–8 medications, n (%) | 13 (40.6) | 85 (64.4) | 0.02 |
9–12 medications, n (%) | 0 (0.0) | 23 (17.4) | 0.02 |
13 or more medications, n (%) | 1 (3.1) | 3 (2.3) | 1.00 |
Fall-risk-increasing drugsa at admission | |||
Total number, mean ± SD | 2.9 ± 1.3 | 2.6 ± 1.4 | 0.22 |
0–2 medications, n (%) | 13 (40.6) | 62 (47.0) | 0.56 |
3–5 medications, n (%) | 16 (50.0) | 65 (49.2) | 1.00 |
6 or more medications, n (%) | 1 (3.1) | 5 (3.8) | 1.00 |
Fall-risk-increasing drugsa at discharge | |||
Total number, mean ± SD | 1.4 ± 1.2 | 2.1 ± 1.4 | 0.01 |
0–2 medications, n (%) | 27 (84.4) | 80 (60.6) | 0.01 |
3–5 medications, n (%) | 5 (15.6) | 50 (37.9) | 0.02 |
6 or more medications, n (%) | 0 (0.0) | 2 (1.5) | 1.00 |
PIMsb at admission | |||
Total number, mean ± SD | 1.5 ± 0.8 | 1.3 ± 1.1 | 0.19 |
0–1 medication, n (%) | 17 (53.1) | 83 (62.9) | 0.32 |
2–3 medications, n (%) | 15 (46.9) | 44 (33.3) | 0.22 |
4 or more medications, n (%) | 0 (0.0) | 5 (3.8) | 0.58 |
PIMsb at discharge | |||
Total number, mean ± SD | 0.8 ± 0.8 | 1.1 ± 1.0 | 0.03 |
0–1 medication, n (%) | 27 (84.4) | 89 (67.4) | 0.08 |
2–3 medications, n (%) | 5 (15.6) | 41 (31.1) | 0.12 |
4 or more medications, n (%) | 0 (0.0) | 2 (1.5) | 1.00 |
Past medical history, n (%) | |||
Dementia | 14 (43.8) | 55 (41.7) | 0.84 |
Heart diseasec
| 5 (15.6) | 28 (21.2) | 0.63 |
Stroke | 11 (34.4) | 28 (21.2) | 0.16 |
Diabetes mellitus | 6 (18.6) | 35 (26.5) | 0.50 |
Hip fracture | 2 (6.3) | 19 (14.4) | 0.37 |
Any fracture | 14 (43.8) | 44 (33.3) | 0.31 |
Current smoker, n (%) | 1 (3.1) | 11 (8.3) | 0.46 |
Current drinker, n (%) | 3 (9.4) | 10 (7.6) | 0.72 |
Type of hip fracture, n (%) | |||
Intracapsular fracture | 17 (53.1) | 60 (45.5) | 0.55 |
Intertrochanteric fracture | 11 (36.7) | 67 (50.8) | 0.12 |
Subtrochanteric fracture | 4 (12.5) | 4 (3.0) | 0.05 |
Others | 0 (0.0) | 1 (0.8) | 1.00 |
Management during admission | |||
Surgery, n (%) | 31 (96.9) | 129 (97.7) | 0.58 |
VTE prophylaxis, n (%) | 32 (100) | 130 (98.5) | 1.00 |
Perioperative antibiotics, n (%) | 31 (100) | 129 (100) | 1.00 |
Medical consultationd, n (%) | 7 (21.9) | 41 (31.7) | 0.39 |
Osteoporosis treatment, n (%) | |||
PTH analogue | 2 (6.3) | 2 (1.5) | 0.17 |
Bisphosphonate | 3 (9.4) | 6 (4.5) | 0.38 |
Vitamin D | 3 (9.4) | 21 (15.9) | 0.42 |
Category | Intervention
n = 31 | Usual care
n = 127 | ||||
---|---|---|---|---|---|---|
At admission | At discharge |
p-value | At admission | At discharge |
p-value | |
Any PIMs,a n (%) | 29 (93.5) | 16 (51.6) | < 0.001 | 95 (74.8) | 87 (68.5) | 0.33 |
Benzodiazepines, n (%) | 11 (35.5) | 7 (22.6) | 43 (33.9) | 37 (29.1) | ||
PPIs, n (%) | 10 (32.3) | 4 (12.9) | 33 (26.0) | 31 (24.4) | ||
Hypnoticsb, n (%) | 5 (16.1) | 2 (6.5) | 17 (13.4) | 13 (10.2) | ||
Antipsychotics, n (%) | 4 (12.9) | 2 (9.8) | 12 (9.4) | 9 (7.1) | ||
Anticholinergics, n (%) | 2 (6.5) | 1 (3.2) | 13 (10.2) | 12 (9.4) | ||
H2-receptor antagonistsc, n (%) | 1 (3.2) | 0 (0.0) | 9 (7.1) | 8 (6.3) | ||
Anticonvulsants, n (%) | 2 (6.5) | 2 (6.5) | 6 (4.7) | 8 (6.3) | ||
Opioids, n (%) | 2 (6.5) | 2 (6.5) | 5 (3.9) | 3 (2.4) | ||
SSRIs, n (%) | 1 (3.2) | 1 (3.2) | 4 (3.1) | 4 (3.1) | ||
Others, n (%) | 5 (16.1) | 1 (3.2) | 12 (9.4) | 11 (8.7) |
Outcome | Intervention n = 32 | Usual care
n = 132 | Odds ratio (95% CI) |
p-value |
---|---|---|---|---|
Primary composite outcome | ||||
Death or any new fracture, n (%) | 7 (21.9) | 28 (21.2) | 1.04 (0.41–2.65) | 1.00 |
Secondary outcomes | ||||
Death, n (%) | 4 (12.5) | 13 (9.8) | 1.31 (0.40–4.32) | 0.75 |
Any new fracture, n (%) | 3 (9.4) | 15 (11.4) | 0.81 (0.22–2.97) | 1.00 |
Cardiovascular eventa, n (%) | 0 (0.0) | 12 (9.1) | Not applicable | 0.13 |
Unplanned hospital admission, n (%) | 7 (21.9) | 25 (18.9) | 1.20 (0.47–3.08) | 0.80 |
Adverse events during hospital stay | ||||
Delirium, n (%) | 12 (37.5) | 63 (47.7) | 0.66 (0.30–1.45) | 0.33 |
In-hospital infectionb, n (%) | 6 (18.8) | 17 (12.9) | 1.56 (0.56–4.34) | 0.38 |
Adverse drug eventc, n (%) | 1 (3.1) | 18 (13.6) | 0.20 (0.03–1.59) | 0.30 |
Cardiovascular event, n (%) | 0 (0.0) | 7 (5.3) | 0.26 (0.01–4.63) | 0.36 |
In-hospital death, n (%) | 1 (3.1) | 5 (3.8) | 0.82 (0.09–7.27) | 1.00 |