Preliminary Data From a Geriatrician-Led Program for Orthopedic Co-Managed Hip Fracture Patients Using Zoledronic Acid.

Background: Hip fractures are increasing as the U.S. population ages and result in significant morbidity, mortality, and cost.

Real-world differences in denosumab persistence, reinitiation, and switching among cohorts of older adults in Canada and the United States.

Denosumab is an injectable osteoporosis medication administered twice per year. Discontinuation of denosumab can result in rapid rebound fractures, but the evidence is limited on real-world persistence with denosumab. We conducted 2 parallel, population-based cohort studies leveraging (1) healthcare administrative data from Ontario, Canada (ON; 100% population) and (2) a 20% random sample of US Medicare beneficiaries (US).

Combining Exercise Training and Testosterone Therapy in Older Women After Hip Fracture: The STEP-HI Randomized Clinical Trial.

Importance: Despite receiving postacute rehabilitation services, many older women with a recent hip fracture repair are unable to return to their prefracture level of function. Whether testosterone therapy can enhance recovery after hip fracture in older women with persistent mobility impairments has not been fully examined.

Objective: To evaluate the effects of a supervised exercise program combined with topical testosterone therapy on functional outcomes in older women with a recent hip fracture.

Economic modelling of fall prevention interventions delivered by community emergency medical services: a decision-tree analysis.

Background: Fall prevention interventions delivered by specially trained emergency medical services (EMS) clinicians in the homes of patients at high risk for falls have been shown to prevent recurrent falls. However, the cost of implementing this 'community EMS' approach to fall prevention is a barrier to widespread adoption. The objective of this study was to assess whether a community EMS fall prevention intervention results in overall cost savings for the healthcare system.

Osteoporosis medication use over time in the United States and Canada.

Unlabelled: Over 12 years in the US and 26 years in Ontario, Canada, we found major differences in osteoporosis medications used. In both countries, osteoporosis medication initiation has not returned to pre-2008 levels; however, denosumab use is increasing. Future work should determine whether targeted screening or undertreatment drives these trends.

High Anticholinergic Burden of Patients Hospitalized for Hip Fracture Reveals a Target for Deprescribing.

Objectives: Anticholinergic medications can produce harmful side effects, such as ataxia and delirium, in older adults. Older adults with hip fractures are particularly vulnerable, yet they are often prescribed these medications. This study aimed to evaluate the anticholinergic burden (ACB) before and after hospitalization for hip fracture, to identify potential targets for deprescribing.

Opioid Use After Hip Fracture and Subsequent Fracture Outcomes: A Self-Controlled Case Series Design.

Purpose: Hip fractures in older adults cause severe pain that often necessitates opioid use. However, opioids may trigger falls that result in subsequent fractures. Studies examining the effects of opioids on subsequent fractures are often limited by unmeasured confounding between opioid-treated and untreated persons.

Better Mental Health and Fewer Depressive Symptoms Are Associated With Greater Psychological Resilience After Hip Fracture.

Background: High psychological resilience is associated with improved functional outcomes for older adults recovering from hip fractures. The objective of this study was to identify factors associated with increased psychological resilience in older women after hip fracture.

Methods: In total, 129 women aged ≥65 years with recent surgically repaired hip fractures were enrolled in a trial of exercise and testosterone therapy.

Enabling osteoporosis treatment in post-acute care: An algorithm for providers.

Approximately 60 % of older adults with a hospitalized fracture receive post-acute care in a skilled nursing facility (SNF), yet fewer than 10-20 % receive osteoporosis treatment following a fracture. This study sought to understand SNF providers' perspectives on osteoporosis treatment and to receive feedback on a pocketcard to guide osteoporosis treatment in the post-acute care setting. We interviewed 17 SNF providers with 2+ years of post-acute care experience from 13 states.

Analgesic regimens administered to older adults receiving skilled nursing facility care following hip fracture: a proof-of-concept federated analysis.

Background: Although a majority of patients in the U.S. receive post-acute care in skilled nursing facilities (SNFs) following hip fracture, large-sample observational studies of analgesic prescribing and use in SNFs have not been possible due to limitations in available data sources.

Cholinesterase Inhibitor Initiation Does Not Increase the Risk of Fall-Related Injury in Older Adults Treated With Beta-Blockers: A Self-Controlled Case Series Design.

Background: Prescribing cholinesterase inhibitors (ChEIs) concurrently with beta-blockers might cause syncope that increases the risk of fall-related injuries (FRIs). This self-controlled case series study assesses the risk of FRIs associated with initiating ChEIs while receiving beta-blockers among Medicare fee-for-service-insured nursing home (NH) residents in the United States.

Methods: We identified individuals at their first dispensing of a beta-blocker between 2016 and 2019 after at least 45 days of long-stay NH residency.

Pre-procedural nursing home length of stay and outcomes of transcatheter aortic valve replacement.

Background: Older adults with severe aortic stenosis (AS) may receive care in a nursing home (NH) prior to undergoing transcatheter aortic valve replacement (TAVR). NH level of care can be used to stabilize medical conditions, to provide rehabilitation services, or for long-term care services. Our primary objective is to determine whether NH utilization pre-TAVR can be used to stratify patients at risk for higher mortality and poor disposition outcomes at 30 and 365 days post-TAVR.

Comparative safety and cardiovascular effectiveness of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in nursing homes.

Aim: Studies examining the safety and effectiveness of sodium-glucose cotransporter-2 inhibitors (SGLT2is) versus glucagon-like peptide-1 receptor agonists (GLP-1RAs) among community-dwelling adults may not generalize to nursing home (NH) residents, who are typically older and more multimorbid. We compared the safety and cardiovascular effectiveness of SGLT2is and GLP-1RAs among US NH residents.

Materials And Methods: Eligible individuals were aged ≥66 years with type 2 diabetes mellitus and initiated an SGLT2i or GLP-1RA in an NH between 2013 and 2018.

Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults: A Review.

Importance: Falls are reported by more than 14 million US adults aged 65 years or older annually and can result in substantial morbidity, mortality, and health care expenditures.

Observations: Falls result from age-related physiologic changes compounded by multiple intrinsic and extrinsic risk factors. Major modifiable risk factors among community-dwelling older adults include gait and balance disorders, orthostatic hypotension, sensory impairment, medications, and environmental hazards.

Short-term outcomes of prehospital opioid pain management for older adults with fall-related injury.

Background: Opioids are recommended for pain management in patients being cared for and transported by emergency medical services, but no specific guidelines exist for older adults with fall-related injury. Prior research suggests prehospital opioid administration can effectively manage pain in older adults, but less is known about safety in this population. We compared short-term safety outcomes, including delirium, disposition, and length of stay, among older adults with fall-related injury according to whether they received prehospital opioid analgesia.

Nursing Home PRevention of Injury in DEmentia (NH PRIDE): A pilot study of a remote injury prevention service for NH residents.

Background: Medication optimization, including prescription of osteoporosis medications and deprescribing medications associated with falls, may reduce injurious falls. Our objective was to describe a remote, injury prevention service (NH PRIDE) designed to optimize medication use in nursing homes (NHs), and to describe its implementation outcomes in a pilot study.

Methods: This was a non-randomized trial (pilot study) including NH staff and residents from five facilities.