Skip to main content
Top
Published in:

Open Access 01-12-2024 | Research

Impact of household characteristics on patient outcomes post hip fracture: a Welsh nationwide observational cohort study

Authors: Clare MacRae, Anna Meyer, Stewart W. Mercer, Nazir Lone, Chris Dibben, Andrew D. Duckworth, Karin Modig, Bruce Guthrie

Published in: BMC Public Health | Issue 1/2024

Login to get access

Abstract

Background

Hip fracture is common in older people and has significant health and care implications. This study aimed to examine the impact of household characteristics (living alone or living with someone who is themselves ill) on adverse outcomes following hip fracture.

Methods

A cohort study of hip fracture patients aged ≥ 50 years living alone or with one co-resident using Welsh nationwide data between January 2013 and December 2018. Outcomes were emergency hospital admission within 30 days and care-home admission and mortality within one year of hospital discharge. Analysis used cause-specific Cox proportional hazards models to examine associations with living alone and with co-resident chronic disease status.

Results

Of the 12,089 hip fracture patients discharged, 56.0% lived alone. Compared to hip fracture patients living with a co-resident, those living alone were more commonly women (78.4% versus 65.2%), older (mean 83.1 versus 78.5 years), and had more long-term conditions (mean 5.7 versus 5.3). In unadjusted analyses, compared to living with a co-resident with 0–1 long-term condition and no dementia, living alone (hazard ratio [HR] 1.44, 95%CI 1.23–1.68), living with someone with dementia (HR 1.57, 95%CI 1.07–2.30), and living with someone with 4 + physical long-term conditions (HR 1.24, 95%CI 1.03–1.49) were associated with an increase in mortality, but no significant association was found in adjusted analysis. Adjusted for age, sex, socioeconomic position, and long-term condition count of the hip fracture patient, living alone (adjusted HR [aHR] 2.26, 95%CI 1.81–2.81) and living with a co-resident with dementia (aHR 2.38, 95%CI 1.59–3.57) were both associated with more than double the risk of care home admission. There were no significant associations with 30-day hospital admission.

Conclusions

Hip fracture patients who live alone have higher one-year mortality, but associations are explained by the demographic and clinical characteristics of those living alone. However, living alone or living with a co-resident with dementia was independently associated with an additional doubling of the risk of care home admission. Household-based approaches to research and health policy may help target risk groups following hip fracture community discharge and further research is needed to understand the mechanisms by which these associations act.
Appendix
Available only for authorised users
Literature
24.
Metadata
Title
Impact of household characteristics on patient outcomes post hip fracture: a Welsh nationwide observational cohort study
Authors
Clare MacRae
Anna Meyer
Stewart W. Mercer
Nazir Lone
Chris Dibben
Andrew D. Duckworth
Karin Modig
Bruce Guthrie
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-024-20766-5