A new guideline that aims to prevent fractures in residents of long-term care facilities is targeted at frail seniors and their families as well as health care workers. The guideline, published in CMAJ (Canadian Medical Association Journal), was developed with input from residents of long-term care facilities and their families, as well as researchers and health care professionals.
Seniors living in long-term care homes have a two- to four-fold risk of sustaining a fracture such as a hip or spinal fracture, compared with adults of similar age living in the community. Fractures can impact quality of life, render people immobile and lead to early death. It is difficult to determine which frail seniors are at risk because many have multiple conditions, such as dementia or poor kidney function, that hinder risk assessment.
“Our goal is to reduce the number of fractures and associated pain as well as to avoid transfers to hospitals to treat these injuries,” states Dr. Alexandra Papaioannou, Professor of Medicine, McMaster University, and a geriatrician with Hamilton Health Sciences, Hamilton, Ontario. “Fractures reduce quality of life for people and can result in early death.”
The 2015 guideline, based on current evidence, builds on the 2010 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada, which focused on people living in the community and did not include this frail group of seniors.
“What is different about these guidelines is that we involved long-term care facility residents and family members in developing the recommendations,” states Dr. Papaioannou. “It is important that residents are involved in decision making around fracture management, and that these decisions consider a person’s health conditions and life expectancy.”
For family members of residents, managing pain and maintaining mobility were the top priorities for their loved ones.
The guideline weighs the benefits and risks of each recommendation for frail seniors, accounting for various health conditions such as kidney function and ability to swallow.
Top 5 tips for preventing fractures in older adults:
1. Maintain adequate calcium and vitamin D intake
2. Take osteoporosis medications as prescribed
3. Wear hip protectors if indicated
4. Exercise regularly
5. Individually tailored interventions may reduce falls
For seniors and their caregivers:
Risk factors
Talk to your health care provider if you are concerned about becoming frail, or are caring for someone who may be frail. It is important to determine if you or a loved one is at risk of falls and fractures. A prior fracture means that the risk of another fracture is much higher.
Nutrition and vitamin supplementation
To prevent fractures, consider taking calcium and vitamin D supplements. Osteoporosis Canada recommends 1200 mg calcium intake through diet; if this requirement is not met through food, consider 500 mg of a calcium supplement per day. Vitamin D intake should be between 800 and 2000 international units (IU) a day in older adults.
Exercise
Regular strength and balance exercises can greatly reduce your risk of a debilitating fall. For example, weight-bearing exercise, resistance training and Tai Chi are all effective ways to maintain strength and keep you more balanced. It is important to talk to your health care provider to identify safe ways to exercise.
Hip protectors
Hip protectors are a specialized form of clothing that contain pads around the hip and leg area. They are designed to prevent hip fractures following a fall.
Safety
Ensure that your living environment is as safe as possible to prevent falls. For example, anti-slip shoes and walk bars can make a big difference in keeping you safe.
For some people at high risk of fracture, osteoporosis medications may be prescribed.
This new Canadian guideline is consistent with recommendations to prevent fractures in Australian residential aged care facilities and from the American Medical Directors Association, although osteoporosis medications differ between countries.
“The goals of fracture prevention are to prevent pain, loss of mobility, serious injury and transfers to acute care and ultimately to maximize opportunities for quality living among long-term care residents,” conclude the guideline authors.
