It is well known that frail older adults are highly vulnerable to fractures. In long-term care settings, the rate of fracture for older adults is more than double that of older adults living in community settings. Moreover, one third of older adults experience a hip fracture while living in long-term care. Not only are hip fractures one of the most critical consequences of osteoporosis, they are also one of the primary causes of hospital admissions. Residents who are returned to long-term care after hospitalization are in need of more specialized care.
Frail older adults who are prone to fracture in long-term care are at risk of other challenges, as well. More than 40% suffer from dementia, a similar percentage have problems with swallowing, and over 20% experience renal insufficiency. It is the long-term care facility’s responsibility to use effective fracture risk assessment tools to identify residents at high risk of fracture.
A recent article published by the Canada Medical Association Journal (CMAJ) provided guidance for long-term care providers pertaining to strategies for the prevention of fractures for frail older adults. Dietary interventions were one of the main recommendations provided by the article, specifically, calcium and vitamin D supplementation. For residents highly vulnerable to fractures who are unable to meet the dietary recommendation for calcium through dietary intake, giving 500 mg of daily supplements of calcium is strongly recommended. The benefits that result from calcium supplementation are associated with sufficient vitamin D intake. For residents vulnerable to fractures, the article recommends daily vitamin D supplements of 800 IU to 2000 IU. These dietary recommendations are based on research that which suggested that taking vitamin D with calcium reduced hip fractures and mortality more than vitamin D alone or calcium alone for frail older adults.
As for exercise interventions, the article recommends that older adults at high risk of fracture participate in balance, strength, and functional training exercises only when incorporated in a multifactorial intervention to prevent falls.
Long-term care providers should make it a goal to use fracture prevention in order to protect their residents from pain, loss of mobility, critical injury and hospitalizations and ultimately to enhance quality living among long-term care residents.