Hip Fractures, Musculoskeletal Health, and Dementia: Population-Based Cohort Studies and Scoping Reviews Among Older Adults

Abstract

Objectives: This study aimed to investigate the risks and impacts associated with fractures, osteoporosis, frailty, physical function, and dementia in older adults in community and LTC setting. The study aims to identify important factors influencing these health issues and identify strategies for improving management and outcomes. Methods: The research integrates data from three primary sources: Project 1 (ICES Data Repository): Healthcare utilization and administrative databases were linked using unique, encoded identifiers from the ICES Data Repository to estimate hip fractures and osteoporosis management among adults aged 66 and older from April 1, 2014, to March 31, 2018. Osteoporosis management was assessed through pharmacotherapy records. Sex-specific and age-standardized rates were compared based on pre-fracture residency and discharge location (e.g., LTC to LTC, community to LTC, or community to community). Fracture risk was determined using the Fracture Risk Scale (FRS). Project 2 (Canadian Longitudinal Study on Aging - CLSA): Participants aged 45 to 85 years who completed both the baseline and three-year follow-up assessments were included. Outcomes examined include frailty (Fried Frailty Phenotype), and physical function limitations. MSK conditions were self-reported diagnosis by a health care professional and included rheumatoid arthritis (RA), osteoarthritis (OA), low-back pain, osteoporosis, and related fractures. Project 3: The review employed Arksey and O'Malley's framework, guided by Joanna Briggs Institute methodology and PRISMA-ScR guidelines. A comprehensive search strategy was implemented across MEDLINE, EMBASE, CINAHL, and grey literature. Independent reviewers used Covidence software for study selection and data extraction. A narrative synthesis was conducted to summarize findings, identify patterns, and highlight gaps in the literature. Findings: We found increasing hip fracture rates and low osteoporosis treatment in LTC settings, highlighting to the need for improved screening and management of osteoporosis treatment in LTC. In community, hip fracture rates decreased. We found that older adults with musculoskeletal (MSK) conditions at baseline were more likely to experience frailty at the three-year follow-up compared to those without MSK conditions. However, this association was not significant in the unadjusted analysis. Individuals with cognitive decline experience worse outcomes following hip fractures, underscoring the need for integrated care addressing both physical and cognitive health. Conclusion: Hip fractures, frailty, physical function decline, and cognitive decline are prevalent and interrelated issues among older adults aged 65 and older. These findings underscore the need for improved screening and integrated care strategies to enhance management and prevention of these complex health challenges.