Fracture incidence among elderly people in institutional care: linking injury surveillance data with a postal code-based register of residential and nursing homes

Fracture prevention strategies will be most cost-effective if targeted at groups of frail elderly people who are at particularly high risk of falls and fractures. Elderly people living in residential and nursing homes are one potential target population, but fracture incidence in this setting remains poorly defined in many countries. We have used the All Wales Injury Surveillance System (AWISS) in a population-based study of people aged over 65 living in the city of Cardiff. We linked a postal code-based register of all care homes in the city with injury data from Cardiff's only Accident and Emergency department. Cardiff has 47,520 residents aged over 65, and 1,874 (3.9%) live in residential or nursing homes. Fracture incidence was 25/1,000/year overall, and 5/1,000/year for hip fracture. During 1997, the care home residents suffered 162 fractures, 82 of which were of the hip; an incidence of 86/1,000/year overall, 44/1,000/year for hip fracture. Even after adjustment for the age and sex profile of the care home population, fracture incidence remained 2.3 times higher and hip fracture incidence 3.6 times higher than in the general elderly population. Such figures support the potential cost-effectiveness of strategies that prevent fractures in care homes, and are of special interest to those planning intervention studies in this setting.