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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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 care

Fractures in long-term care (LTC) residents

have substantial economic and human costs.

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


What are the objectives? care

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? care

  • 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 care

    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 treatment?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 LTC treatment?osteoporosis 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? treatment?

    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 treatment?

    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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