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Risk of Hospitalized Falls and Hip Fractures in 22,103 Older Adults Receiving Mental Health Care vs 161,603 Controls: A Large Cohort Study

Research output: Contribution to journalArticle

Brendon Stubbs, Gayan Perera, Fiona Gaughran, Ai Koyanagi, Nicola Veronese, Davy VanCampfort, Joseph Firth, Katie Sheehan, Robert Stewart, Christoph Mueller

Original languageEnglish
JournalJournal Of The American Medical Directors Association
Early online date19 Apr 2020
DOIs
Accepted/In press9 Mar 2020
E-pub ahead of print19 Apr 2020

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Abstract

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 (7.22-20.52)], 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.

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