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Preventing falls and fractures in long-term care

Published online by Cambridge University Press:  18 April 2011

Stephen J Wallis*
Affiliation:
Department of Medicine for the Elderly, Cambridge University Hospitals NHS Foundation Trust, UK
Gordon A Campbell
Affiliation:
Department of Medicine for the Elderly, Cambridge University Hospitals NHS Foundation Trust, UK
*
Address for correspondence: Stephen Wallis, Department of Medicine for the Elderly, Box 135, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ. Email: drstephenwallis@gmail.com

Summary

The prevalence of falls and associated injuries increases with age and dependency. The highest occurs among individuals living in long-term care institutions. Preventing falls results in reduced physical and psychological morbidity as well as having cost-saving implications. This review explores both uni- and multifactorial approaches to reducing fall rates and risk in individuals in long-term care, as well as highlighting the differences in this group from community-dwelling individuals.

Type
Intermediate care and rehabilitation
Copyright
Copyright © Cambridge University Press 2011

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References

1Prudham, D, Evans, JG. Factors associated with falls in the elderly: a community study. Age Ageing 1981; 10: 141–46.CrossRefGoogle ScholarPubMed
2Blake, AJ, Morgan, K, Bendall, MJ, Dallosso, H, Ebrahim, SB, Arie, TH, Fentem, PH, Bassey, EJ. Falls by elderly people at home: prevalence and associated factors. Age Ageing 1988; 17: 365–72.CrossRefGoogle ScholarPubMed
3Rubenstein, LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 2006; 35 S2: ii3741.CrossRefGoogle ScholarPubMed
4Gibson, RE, Harden, M, Byles, J, Ward, J. Incidence of falls and fall-related outcomes among people in aged-care facilities in the Lower Hunter region, NSW. NSW Public Health Bull 2008; 19: 166–69.CrossRefGoogle ScholarPubMed
5Rubenstein, LZ, Josephson, KR, Osterweil, LD. Falls and fall prevention in the nursing home. Clin Geriatr Med 1996; 12: 881902.CrossRefGoogle ScholarPubMed
6Rubenstein, LZ, Josephson, KR, Robbins, AS. Falls in the nursing home. Ann Intern Med 1994; 121: 442–51.CrossRefGoogle ScholarPubMed
7Sugarman, JR, Connell, FA, Hansen, A, Helgerson, SD, Jessup, MC, Lee, H. Hip fracture incidence in nursing home residents and community dwelling older people, Washington State, 1993–1995. J Am Geriatr Soc 2005; 50: 1638–43.CrossRefGoogle Scholar
8Butler, M, Norton, R, Lee-Joe, T, Cheng, A, Campbell, AJ. The risks of hip fracture in older people from private homes and institutions. Age Ageing 1996; 25: 381–85.CrossRefGoogle ScholarPubMed
9Bradley, C, Pointer, S. Hospitalisations due to falls by older people, Australia 2005–06. Injury research and statistics series number 50. Cat. no. INJCAT 122. Adelaide: AIHW; 2008.Google Scholar
10Peel, NM, Kassulke, DJ, McClure, RJ. Population based study of hospitalised fall related injuries in older people. Inj Prev 2002; 8: 280–83.CrossRefGoogle ScholarPubMed
11Delbaere, K, Close, JCT, Brodaty, H, Sachdev, P, Lord, SR. Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study. BMJ 2010; 341: c4165.CrossRefGoogle ScholarPubMed
12Cumming, RG, Salkeld, G, Thomas, M, Szonyi, G. Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. J Gerontol A Biol Sci Med Sci 2000; 55: 299305.CrossRefGoogle ScholarPubMed
13Chung, MC, Mc Kee, KJ, Austin, D et al. Post-traumatic stress disorder in older people after a fall. Int J Geriatr Psychiatry 2009; 24: 955–64.CrossRefGoogle ScholarPubMed
14Dowswell, T. Towner, E, Cryer, C, Jarvis, S, Edwards, P, Lowe, P. Accidental Falls: Fatalities and Injuries: an examination of the data sources and review of the literature in preventative strategies. University of Newcastle upon Tyne (1999).Google Scholar
15Carroll, NV, Delafuente, JC, Cox, FM, Narayan, S. Fall-related hospitalization and facility costs among residents of institutions providing long term care. Gerontologist. 2008; 48: 213–22.CrossRefGoogle ScholarPubMed
16Torgerson, DJ, Iglesias, CP, Reid, DM. ‘The economics of fracture prevention’. In The Effective Management of Osteoporosis. London: Aesculapius Medical Press, 2001; pp. 111–21.Google Scholar
17Heinrich, S, Rapp, K, Rissmann, U, Bercker, C, Konig, . Cost of falls in old age: a systematic review. Osteoporos Int 2010; 21: 891902.CrossRefGoogle ScholarPubMed
18Oliver, D, Masud, T. Preventing fall and injuries in care homes. Age Ageing 2004; 33: 532–35.CrossRefGoogle Scholar
19Oliver, D. Preventing falls and falls-injuries in hospitals and long-term facilities. Rev Clin Gerontol 2007; 17: 7591.CrossRefGoogle Scholar
20Lamb, SE, Jorstad-Stein, EC, Hauer, K, Becker, C. Prevention of Falls Network Europe and Outcomes Consensus Group. Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. JAMA 2005; 53: 1618–22.Google Scholar
21Tinetti, ME, Williams, CS. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 1997; 337: 1279–84.CrossRefGoogle ScholarPubMed
22Prevention of Falls in Older Persons. 2010 AGS/BGS Clinical Practice Guideline. Available at: http://www.medcats.com/FALLS/frameset.htm (accessed 12 February 2011).Google Scholar
23Chen, JS, Sambrook, PN, Simpson, JM, Cameron, ID, Cumming, RG, Seibel, MJ, Lord, SR, March, LM. Risk factors for hip fracture among institutionalised older people. Age Ageing 2009; 38: 429–34.CrossRefGoogle ScholarPubMed
24Lord, SR, March, LM, Cameron, ID, Cumming, RG, Schwarz, J, Zochling, J, Chen, JS, Makaroff, J, Sitoh, YY, Lau, TC, Brnabic, A, Sambrook, PN. Differing risk factors of falls in nursing home and intermediate care residents who can and cannot stand unaided. JAGS 2003; 51: 1645–50.CrossRefGoogle ScholarPubMed
25Delbaere, K, Close, JC, Menz, HB, Cumming, RG, Cameron, ID, Sambrook, PN, March, LM, Lord, SR. Development and validation of falls risk screening tools for use in residential aged care facilities. Med J Aust 2008; 189: 193–96.CrossRefGoogle ScholarPubMed
26Podsiadlo, D, Richardson, S. The timed ‘Up & Go’: a test of basic functional mobility for frail elderly persons. JAMA 1991; 39: 142–48.Google Scholar
27Nordin, E, Lindelöf, N, Rosendahl, E, Jensen, J, Lundin-Olsson, L. Prognostic validity of the Timed Up-and-Go test, a modified Get-Up-and-Go test, staff's global judgement and falls history in evaluating falls risk in residential care facilities. Age Ageing 2008; 37: 442–48.CrossRefGoogle Scholar
28Meyer, G, Kopke, S, Haastert, B, Muhlhauser, I. Comparison of a fall risk assessment tool with nurses’ judgement alone: a cluster-randomised controlled trial Age Ageing 2009; 38: 417–23.CrossRefGoogle Scholar
29Barker, AL, Nitz, JC, Low Choy, NL, Haines, T. Measuring fall risk and predicting who will fall: Clinimetric properties of four fall risk assessment tools for residential aged care. J Gerontol A Biol Sci Med Sci 2009; 8: 916–24.CrossRefGoogle Scholar
30Perell, KL, Nelson, A, Goldman, RL, Luther, SL, Prieto-Lewis, N, Rubenstein, LZ. Fall risk assessment measures: an analytic review. J Gerontol A Biol Sci Med Sci 2001; 56: M76166.CrossRefGoogle ScholarPubMed
31Tinetti, ME, Williams, TF, Mayewski, R. Fall risk index for elderly patients based on number of chronic disabilities. Am J Med 1986; 80: 429–34.CrossRefGoogle ScholarPubMed
32Berg, K. Balance and its measure in the elderly: a review. Physiother Can 1989; 41: 240–46.CrossRefGoogle Scholar
33Close, JCT. Falls in older oeople: risk factors, assessment and intervention. IBMS BoneKEy 2009; 6: 368–84.CrossRefGoogle Scholar
34Gillespie, LD, Robertson, MC, Gillespie, WJ, Lamb, SE, Gates, S, Cumming, RG, Rowe, BH. Interventions for preventing falls in older people living in the community (Review). Cochrane Database Syst Rev 2009; issue 2.CrossRefGoogle Scholar
35Leipzig, RM, Cumming, RG, Tinetti, ME. Drugs and falls in older people: A systematic review and meta-analysis: I. Psychotrophic drugs. J Am Geriatr Soc 1999; 47: 3039.CrossRefGoogle Scholar
36Lawlor, DA, Patel, R, Ebrahim, S. Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ 2003; 327: 712.CrossRefGoogle ScholarPubMed
37Woolcott, JC, Richardson, KJ, Wiens, MO, Patel, B, Marin, J, Khan, KM, Marra, CA. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med 2009; 169: 1952–60.CrossRefGoogle ScholarPubMed
38Zermansky, AG, Alldred, DP, Petty, DR, Raynor, DK, Freemantle, N, Eastaugh, J, Bowie, P. Clinical medication review by a pharmacist of elderly people living in care homes – randomised controlled trial. Age Ageing 2006; 35: 586–91.CrossRefGoogle ScholarPubMed
39Campbell, AJ, Robertson, MC, Gardner, MM, Norton, RN, Buchner, M. Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomised, controlled trial. J Am Geriatr Soc 1999; 47: 850–53.CrossRefGoogle Scholar
40Ooi, WL, Hossain, M, Lipsitz, LA. The association between orthostatic hypotension and recurrent falls in nursing home residents. Am J Med 2000; 108: 106–11.CrossRefGoogle ScholarPubMed
41Aronow, WS, Ahn, C. Postprandial hypotension in 499 elderly persons in a long-term health care facility. J Am Geriatr Soc 1994; 42: 930–32.CrossRefGoogle Scholar
42Le Couteur, DG, Fisher, AA, Davis, MW, McLean, AJ. Postprandial systolic blood pressure responses of older people in residential care: association with risk of falling. Gerontology 2003; 49: 260–64.CrossRefGoogle ScholarPubMed
43Working Group of the Australian and New Zealand Bone and Mineral Society, Endocrine Society of Australia and Osteoporosis Australia. Vitamin D and adult bone health in Australia and New Zealand: a position statement. MJA 2005; 182: 281–85.Google Scholar
44Hirani, V, Primatesta, P. Vitamin D concentrations among people aged 65 years and over living in private households and institutions in England: population survey. Age Ageing 2005; 34: 485–91.CrossRefGoogle ScholarPubMed
45Heaney, RP. Long-latency deficiency disease: insights from calcium and vitamin D. Am J Clin Nutr 2003; 78: 912–19.CrossRefGoogle ScholarPubMed
46Department of Health. Nutrition and Bone Health: with particular reference to calcium and vitamin D. Report on Health and Social Subjects 49. London: The Stationery Office, 1998.Google Scholar
47Flicker, L, Mead, K, MacInnis, RJ, Nowson, C, Scherer, S, Stein, MS, Thomasx, J, Hopper, JL, Wark, JD. Serum vitamin D and falls in older women in residential care in Australia. JAGS 2003; 51: 1533–38.CrossRefGoogle ScholarPubMed
48Prabhala, A, Garg, R, Dandona, P. Severe myopathy associated with vitamin D deficiency in western New York. Arch Intern Med 2000; 160: 1199–203.CrossRefGoogle ScholarPubMed
49Skaria, J, Katiyar, BC, Srivastava, TP, Dube, B. Myopathy and neuropathy associated with osteomalacia. Acta Neurol Scand 1975; 51: 3758.CrossRefGoogle ScholarPubMed
50Pfeifer, M, Begerow, B, Minne, HW. Vitamin D and muscle function. Osteoporos Int 2002; 13: 187–94.CrossRefGoogle ScholarPubMed
51Bischoff, HA, Stähelin, HB, Dick, W, Akos, R, Knecht, M, Salis, C, Nebiker, M, Theiler, R, Pfeifer, M, Begerow, B, Lew, RA, Conzelmann, M. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 2003; 18: 343–51.CrossRefGoogle ScholarPubMed
52Pfeifer, M, Begerow, B, Minne, HW, Abrams, C, Nachtigall, D, Hansen, C. The effects of a short-term vitamin D and calcium supplementation on body sway and secondary hyperparathyroidsm in elderly women. J Bone Miner Res 2000; 15: 1113–18.CrossRefGoogle Scholar
53Broe, KE, Chen, TC, Weinberg, J, Bischoff-Ferrari, HA, Holick, MF, Kiel, DP. A higher dose vitamin D reduces the risk of falls in nursing home residents: A randomised, multiple-dose study. JAGS 2007; 55: 234–39.CrossRefGoogle ScholarPubMed
54Kalyani, RR, Stein, B, Valiyil, R, Manno, R, Maynard, JW, Crews, DC. Vitamin D treatment for the prevention of falls in older adults: systematic review and meta-analysis. JAGS 2010; 58: 1299–310.CrossRefGoogle ScholarPubMed
55Bischoff-Ferrari, HA, Dawson-Hughes, B, Staehelin, HB, Orav, JE, Stuck, AE, Theiler, R, Wong, JB, Egli, A, Kiel, DP, Henschkowski, J. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 2009; 339: b3692.CrossRefGoogle ScholarPubMed
56Flicker, L, MacInnis, RJ, Stein, MS. Should older people in residential care receive vitamin D to prevent falls? Results of a randomized trial. JAGS 2005; 53: 1881–88.CrossRefGoogle ScholarPubMed
57Mayes, N, Walker, K, Bayly, JR. Evaluating and improving clinical standards in the management of fracture risk in older people in residential care settings. J Bone Miner Res 2009; 24 (suppl 1): SU0397.Google Scholar
58Hippisley-Cox, J, Bayly, J, Potter, J, Fenty, J, Parker, C. Evaluation of standards of care for osteoporosis and falls in primary care. 2007 QRESEARCH: Final Report to The Information Centre for health and social care. Available at: http://www.ic.nhs.uk/statistics-and-data-collections/primary-care/general-practice/evaluation-of-standards-of-care-for-osteoporosis-and-falls-in-primary-care (accessed 12 February 2011).Google Scholar
59Bolland, MJ, Avenell, A, Baron, JA, Grey, A, MacLennan, GS, Gamble, GD, Reid, IR. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ 2010; 341: c3691.CrossRefGoogle ScholarPubMed
60Hsia, J, Heiss, G, Ren, H, Allison, M, Dolan, NC, Greenland, P, Heckbert, SR, Johnson, KC, Manson, JE, Sidney, S, Trevisan, M; Women's Health Initiative Investigators. Calcium/vitamin D supplementation and cardiovascular events. Circulation 2007; 115: 846–54.CrossRefGoogle ScholarPubMed
61Autier, P, Gandini, S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med 2007; 167: 1730–37.CrossRefGoogle ScholarPubMed
62Malcolm Law, M, Withers, H, Morris, J, Anderson, F. Vitamin D supplementation and the prevention of fractures and falls: results of a randomised trial in elderly people in residential accommodation. Age Ageing 2006; 35: 482–86.Google Scholar
63Sanders, KM, Stuart, AL, Williamson, EJ. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 2010; 303: 1815–22.CrossRefGoogle ScholarPubMed
64Chiarelli, PE, Mackenzie, LA, Osmotherly, PG. Urinary incontinence is associated with an increase in falls: a systematic review. Aust J Physiother 2009; 55: 8995.CrossRefGoogle ScholarPubMed
65Hasegawa, J, Kuzuya, M, Iquchi, A. Urinary incontinence and behavioural symptoms are independent risk factors for recurrent and injurious falls, respectively, among residents in long-term care facilities. Arch Gerontol Geriatr 2010; 50: 7781.CrossRefGoogle ScholarPubMed
66Ivers, RQ, Cumming, RG, Mitchell, P, Attebo, K. Visual impairment and falls in older adults: the Blue Mountains Eye Study. JAGS 1998; 46: 5864.Google ScholarPubMed
67Harwood, RH, Foss, AJE, Osborn, F, Gregson, RM, Zaman, A, Masud, T. Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial. Br J Opthalmol 2005; 89: 5359.CrossRefGoogle ScholarPubMed
68Elliott, AF, McGwin, G, Owsley, C. Vision-enhancing interventions in nursing home residents and their short-term effect on physical and cognitive function. JAGS 57: 202–8.CrossRefGoogle Scholar
69Cumming, RG, Ivers, R, Clemson, L, Cullen, J, Hayes, MF, Tanzer, M, Mitchell, P. Improving vision to prevent falls in frail older people: A randomized trial. JAGS 2007; 55: 175–81.CrossRefGoogle ScholarPubMed
70La Grow, SJ, Robertson, MC, Campbell, AJ, Clarke, GA, Kerse, NM. Reducing hazard related falls in people 75 years and older with significant visual impairment: how did a successful program work? Inj Prev 2006; 12: 296301.CrossRefGoogle ScholarPubMed
71Healey, F, Oliver, D, Milne, A, Connelly, J. The effect of bedrails on falls and injury: a systematic review of clinical studies. Age Ageing 2008; 37: 368–78.CrossRefGoogle ScholarPubMed
72Vellas, B, Conceicao, J, Lafont, C, Fontan, B, Garry, PJ, Adoue, D, Albarede, JL. Malnutrition and falls. Lancet 1990; 336: 1447.CrossRefGoogle ScholarPubMed
73Gray-Donald, K, Payette, H, Boutier, V. Randomized clinical trial of nutritional supplementation shows little effect on functional status among free-living frail elderly. J Nutr 1995; 125: 2965–71.Google ScholarPubMed
74Kenkmann, A, Price, GM, Bolton, J, Hooper, L. Health, wellbeing and nutritional status of older people living in UK care homes: an exploratory evaluation of changes in food and drink provision. BMC Geriatrics 2010; 10: 28.CrossRefGoogle ScholarPubMed
75Drahota, A, Gal, D, Windsor, J. Flooring as an intervention to reduce injuries from falls in healthcare settings: an overview. Qual Ageing Policy Pract Res 2007; 8: 38.CrossRefGoogle Scholar
76Skelton, D, Dinan, S, Campbell, M, Rutherford, O. Tailored group exercise (Falls Management Exercise – FaME) reduces falls in community-dwelling older frequent fallers (an RCT) [letter]. Age Ageing 2005; 34: 636–39.CrossRefGoogle Scholar
77Robertson, MC, Devlin, N, Gardner, MM, Campbell, AJ. Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: Randomised controlled trial. BMJ 2001; 322: 697701.CrossRefGoogle ScholarPubMed
78Gillespie, LD, Robertson, MC, Gillespie, WJ, Lamb, SE, Gates, S, Cumming, RG, Rowe, BH. Interventions for preventing falls in older people living in the community (Review). Cochrane Database Syst Rev 2009; issue 2.CrossRefGoogle Scholar
79Cameron, ID, Murray, GR, Gillespie, LD et al. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev 2010; issue 1.CrossRefGoogle Scholar
80Sherrington, C, Whitney, JC, Lord, R, Herbert, RD, Cumming, RG, Close, JC. Effective exercise for the prevention of falls JAGS 2008; 56: 2234–43.CrossRefGoogle ScholarPubMed
81Cameron, ID, Murray, GR, Gillespie, LD, Robertson, MC, Hill, KD, Cumming, RG, Kerse, N. Interventions for preventing falls in older people living in the community (Review). Cochrane Database Syst Rev 2009; issue 2.CrossRefGoogle Scholar
82Jenson, J, Lundin-Olsson, L, Nyberg, L, Gustafson, Y. Falls and injury prevention in older people living in residential care facilities. Ann Intern Med 2002; 136: 733–41.CrossRefGoogle Scholar
83Ray, WA, Taylor, JA, Meador, KG. A randomized trial of a consultation service to reduce falls in nursing homes. JAMA 1997; 278: 557–62.CrossRefGoogle ScholarPubMed
84Becker, C, Kron, M, Lindemann, U. Effectiveness of a multifaceted intervention on falls in nursing home residents. J Am Geriatr Soc 2003; 51: 306–13.CrossRefGoogle ScholarPubMed
85Dyer, CAE, Taylor, GJ, Reed, M, Dyer, CA, Robertson, DR, Harrington, R. Falls prevention in residential care homes: a randomised controlled trial. Age Ageing 2004; 33: 596602.CrossRefGoogle Scholar
86Kerse, N, Peri, K, Robinson, E, Wilkinson, T, von Randow, M, Kiata, L, Parsons, J, Latham, N, Parsons, M, Willingale, J, Brown, P, Arroll, B. Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomised controlled trial. BMJ 2008; 337: a1445.CrossRefGoogle ScholarPubMed
87Cusimano, MD, Kwok, J, Spadafora, K. Effectiveness of multifaceted fall-prevention programs for the elderly in residential care. Inj Prev 2008; 14: 113–22.CrossRefGoogle ScholarPubMed
88Jensen, J, Nyberg, L, Gustafson, Y, Lundin-Olsson, L. Fall and injury prevention in residential care – effects in residents with higher and lower levels of cognition. J Am Geriatr Soc 2003; 51: 627–35.CrossRefGoogle ScholarPubMed
89Matthews, FE, Denning, T. Prevalence of dementia in institutional care. Lancet 2002; 360: 225–25.CrossRefGoogle ScholarPubMed
90Neyens, JC, Dijcks, BP, Twisk, J, Schols, JM, van Haastregt, JC, Van Den Heuvel, WJ, de Witte, LP. A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomised controlled trial (RCT). Age Ageing 2009; 38: 194–99.CrossRefGoogle ScholarPubMed
91Kannus, P, Parkkari, J, Niemi, S, Pasanen, M, Palvanen, M, Järvinen, M, Vuori, I. Prevention of hip fracture in elderly people with the use of a hip protector. N Eng J Med 2000; 343: 1506–13.CrossRefGoogle ScholarPubMed
92O'Halloran, PD, Cran, GW, Beringer, TR, Kernohan, G, O'Neill, C, Orr, J, Dunlop, L, Murray, LJ. A cluster randomised controlled trial to evaluate a policy of making hip protectors available to residents of nursing homes. Age Ageing 2004; 33: 582–88.CrossRefGoogle ScholarPubMed
93Parker, MJ, Gillespie, WJ, Gillespie, LD. Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev 2005; issue 3.CrossRefGoogle Scholar
94Sawka, AM, Boulos, P, Beattie, K, Thabane, L, Papaioannou, A, Gafni, A, Cranney, A, Zytaruk, N, Hanley, DA, Adachi, JD. Do hip protectors decrease the risk of hip fracture in institutional- and community-dwelling elderly? A systematic review and meta-analysis of randomized controlled trials. Osteoporos Int 2005; 16: 1461–74.CrossRefGoogle ScholarPubMed
95Koike, T, Orito, Y, Toyoda, H. External hip protectors are effective for the elderly with higher-than average risk factors for hip fractures. Osteoporosis Int 2009; 20: 1613–20.CrossRefGoogle ScholarPubMed
96Waldegger, L, Cranney, A, Man-Son-Hing, M, Coyle, D. Cost effectiveness of hip protectors in institutional dwelling elderly. Osteoporos Int 2003; 14: 243–50.CrossRefGoogle ScholarPubMed
97Koike, T, Orito, Y, Toyoda, H. External hip protectors are effective for the elderly with higher-than average risk factors for hip fractures. Osteoporosis Int 2009; 20: 1613–20.CrossRefGoogle ScholarPubMed
98Warnke, A, Meyer, G, Bender, R, Muhlhauser, I. Predictors of adherence to the use of hip protectors in nursing home residents. JAGS 2004; 52: 340–45.CrossRefGoogle Scholar
99Final Appraisal Determination. Alendronate, etidronate, risedronate, raloxifene and strontium ranelate and parathyroid hormone for the primary prevention of osteoporotic fragility fractures in postmenopausal women. Technology Appraisal Guideline 161. National Institute for Health and Clinical Excellence. October 2008. Available at: http://guidance.nice.org.uk/TA161/Guidance/pdf/English (accessed 12 February 2011).Google Scholar
100Osteoporosis. Clinical Guideline for prevention and treatment. Executive Summary National Osteoporosis Guideline Group 2008. Available at: www.shef.ac.uk/NOGG/downloads.html (accessed 12 February 2011).Google Scholar
101Dawson-Hughes, B, Heaney, RP, Holick, MF, Lips, P, Meunier, PJ, Vieth, R. Estimates of optimal vitamin D status. Osteoporosis Int 2005; 16: 713–16.CrossRefGoogle ScholarPubMed
102Chapuy, MC, Arlot, ME, Duboeuf, F, Brun, J, Crouzet, B, Arnaud, S, Delmas, PD, Meunier, PJ. Vitamin D3 and calcium to prevent hip fractures in elderly women. N Engl J Med 1992; 327: 1637–42.CrossRefGoogle ScholarPubMed
103DIPART (vitamin D Individual Patient Analysis of Randomized Trials) Group. Patient level pooled analysis of 68,500 patients from seven major vitamin D fracture trials in US and Europe. BMJ 2010; 340: b5463.CrossRefGoogle Scholar
104Bischoff-Ferrari, HA, Willett, WC, Wong, JB, Giovannucci, E, Dietrich, T, Dawson-Hughes, B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomised controlled trials. JAMA 2005; 293: 2257–64.CrossRefGoogle Scholar
105Campbell, GA. Current thoughts on osteoporosis. CME Geriatric Medicine 2009; 11: 5472.Google Scholar
106Parikh, S, Avorn, J, Solomon, DH. Pharmacological management of osteoporosis in nursing homes populations: a systematic review. JAGS 2009; 57: 327–34.CrossRefGoogle ScholarPubMed
107Boonen, S, McClung, MR, Eastell, R, El-Hajj Fuleihan, G, Barton, IP, Delmas, P. Safety and efficacy of risedronate in reducing fracture risk in osteoporotic women aged 80 and older: Implications for the use of antiresorptive agents in the old and oldest old. JAGS 2004; 52: 1832–39.CrossRefGoogle ScholarPubMed
108Seeman, E, Vellas, B, Benhamou, C, Aquino, JP, Semler, J, Kaufman, JM, Hoszowski, K, Varela, AR, Fiore, C, Brixen, K, Reginster, JY, Boonen, S. Strontium ranelate reduces the risk of vertebral and non-vertebral fractures in women eighty years of age and older. J Bone Miner Res 2006; 21: 1113–20.CrossRefGoogle Scholar
109Greenspan, SL, Schneider, DL, McClung, MR, Miller, PD, Schnitzer, TJ, Bonin, R, Smith, ME, DeLucca, P, Gormley, GJ, Melton, ME. Alendronate improves bone mineral density in elderly women with osteoporosis residing in long-term care facilities: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 2002; 136: 742–46.CrossRefGoogle ScholarPubMed
110Lyles, KW, Colón-Emeric, CS, Magaziner, JS, Adachi, JD, Pieper, CF, Mautalen, C, Hyldstrup, L, Recknor, C, Nordsletten, L, Moore, KA, Lavecchia, C, Zhang, J, Mesenbrink, P, Hodgson, PK, Abrams, K, Orloff, JJ, Horowitz, Z, Eriksen, EF, Boonen, S; HORIZON Recurrent Fracture Trial. Zolendronic acid and clinical fractures and mortality after hip fracture. N Eng J Med 2007; 357: 1799–809.CrossRefGoogle Scholar
111Black, D, Reid, I, Lyles, K et al. Reduction in the risk of clinical fractures after a single dose of zoledronic acid 5 mg. ASBMR Annual Meeting 2010. Presentation 1028.CrossRefGoogle Scholar
112Bebbington, A, Darton, R, Netten, A. In Care Homes for Older People: Volume 2: Admissions, Needs and Outcomes. The 1995/96 National Longitudinal Survey of Publicly-Funded Admissions. Personal Social Services Research Unit, University of Kent at Canterbury (ISBN 1–902671-25–2); 2001.Google Scholar
113Cummings, SR, San Martin, J, McClung, MR, Siris, ES, Eastell, R, Reid, IR, Delmas, P, Zoog, HB, Austin, M, Wang, A, Kutilek, S, Adami, S, Zanchetta, J, Libanati, C, Siddhanti, S, Christiansen, C; FREEDOM Trial. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 2009; 361: 756–65.CrossRefGoogle ScholarPubMed
114Ringe, JD, Moller, G. Differences in persistence, safety and efficacy of generic and original branded once weekly bisphosphonates in patients with postmenopausal osteoporosis: 1-year results of a retrospective patient chart review analysis. Rheumatol Int 2009; 30: 213–21.CrossRefGoogle ScholarPubMed
115Black, DM, Schwartz, AV, Ensrud, KE, Cauley, JA, Levis, S, Quandt, SA, Satterfield, S, Wallace, RB, Bauer, DC, Palermo, L, Wehren, LE, Lombardi, A, Santora, AC, Cummings, SR; FLEX Research Group. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA 2006; 296: 2927–38.CrossRefGoogle ScholarPubMed
116Corley, DA, Kubo, AI, Zhao, W, Quesenberry, C. Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients. Gastroenterology 2010; 139: 93101.CrossRefGoogle ScholarPubMed
117Habib, ZA, Havstad, SL, Wells, K, Divine, G, Pladevall, M, Williams, LK. Thiazolidinedione use and the longitudinal risk of fractures in patients with type 2 diabetes mellitus. J Clin Endocrinol Metab 2010; 95: 592600.CrossRefGoogle ScholarPubMed
118Care Quality Commission. Prevention and management of falls – older people. Available at: http://www.cqc.org.uk/_db/_documents/20081126_Clinical_Triggers_Falls_198–06_-_On_New_Template.doc (accessed 4 March 2011).Google Scholar