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Osteoporosis management among residents living in long-term care

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Osteoporosis management among residents living in long-term care. L.M. Giangregorio M. Jantzi Papaioannou J. Hirdes C.J. Maxwell J.W. Poss Osteoporos Int 2009, 20:1471-1478. Background. Fractures in long-term care (LTC) residents have substantial economic and human costs.

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slide1

Osteoporosis management among residents living in long-term care

  • L.M. Giangregorio
  • M. Jantzi
  • Papaioannou
  • J. Hirdes
  • C.J. Maxwell
  • J.W. Poss
  • Osteoporos Int 2009, 20:1471-1478.
background
Background

Fractures in long-term care (LTC) residents

have substantial economic and human costs.

Giangregorio LM et al: OsteoporosInt 2009, 20:1471-1478.

slide3

What are the objectives?

Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.

  • Describe the prevalence and predictors of osteoporosis management among long-term care facilities.
  • Identify sociodemographic, clinical and functional characteristics associated with osteoporosis management.
what methods were used
What methods were used?
  • Retrospective study of 17 LTC facilities
      • 13 in Ontario, 4 in Manitoba
  • Used Resident Assessment Instrument
      • RAI 2.0 data
  • Residents were 65+ years
  • Inclusion criteria for osteoporosis group:
      • History of hip fracture
      • Any fracture within past 180 days
      • Diagnosis of osteoporosis
      • Prescribed osteoporosis medication

Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.

description of osteoporosis group
Description of Osteoporosis Group

Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.

what percentage of residents n 525 received osteoporosis treatment
What percentage of residents (n=525) received osteoporosis treatment?

Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.

what are predictors of osteoporosis management in ltc
What are predictors of osteoporosis management in LTC?
  • MORE likely to receive treatment if:
    • Taking 10 or more medications
  • LESS likely to receive treatment if:
    • Have 6+ co-morbid conditions
    • Use a wheelchair
    • Have cognitive impairment
    • Have swallowing difficulties
    • Depression
    • From facility in Manitoba

Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.

what are the issues in ltc osteoporosis management
What are the issues in LTCosteoporosis management?

Important considerations:

  • 10% of residents were taking a bisphosphonate but were not taking vitamin D or a multivitamin
  • Possible reasons for suboptimal osteoporosis management:
    • nonadherence
    • tolerability
    • length of treatment versus life expectancy or prognosis
    • prevention of polypharmacy or less focus on preventative health than on “presenting” conditions

(Duque et al. J Am Med Dir Assoc 2007, 8, e67-e73)

Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.

what did we conclude
What did we conclude?

Giangregorio LM et al: OsteoporosInt 2009, 20:1471-1478.

Osteoporosis Management:

Is not optimal among residents at risk for future fracture

Needs to identify at-risk subgroups of residents that are not receiving therapy in order to close the osteoporosis care gap

acknowledgments
Acknowledgments

This study was an environmental scan

conducted in association with

the Ontario Osteoporosis Strategy

and received funding from

the Ontario Ministry of Health and Long-Term Care and McMaster University

Giangregorio LM et al: Osteoporos Int 2009, 20:1471-1478.

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