Effectiveness of a fall and fracture prevention pathway on hip fracture risk, need of permanent care and mortality: a controlled before-and-after study

Abstract

BACKGROUND: The high rates of hip fracture in Oslo inspired a new fall prevention pathway based on well-established fall prevention strategies, but specifically focusing on care coordination, osteoporosis treatment and targeting high-risk patients. OBJECTIVE: To evaluate the effectiveness of the fall prevention pathway. METHODS: We performed a controlled before-and-after study in the home-dwelling population aged 65+ years in Oslo, Norway. The intervention consisted of identifying older adults with a fall-related injury, offering them risk assessment and tailored interventions. Using registry data, we compared registered fallers in the two intervention boroughs with the remaining 13 boroughs as controls, with registered fall injuries as time-dependent exposure in Cox regression. Hazard ratios (HRs) for later hip fracture, long-term care and all-cause mortality were estimated, adjusting for the pre-intervention period. RESULTS: The risk of hip fracture for the Oslo population aged 65+ years declined by 23% from 2012-19. HR for hip fracture amongst registered fallers in the intervention boroughs compared to the controls was 0.95 (95% CI 0.64-1.41). The difference was significant in men only [HR 0.45 (95% CI 0.21-0.95)]. The risk of admittance to long-term care was reduced [HR 0.76 (95% CI 0.62-0.93)]. No significant difference was seen in mortality. CONCLUSIONS: Overall, the risk of later hip fracture was not significantly reduced in all registered fallers in the intervention boroughs, only in men. There was a significant decline in risk of admission to nursing homes in the intervention boroughs. These results suggest that the prevention pathway might have slowed down functional decline in the older Oslo population.

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