Incidence of hip fracture among long-term care insurance beneficiaries with dementia: comparison of home care and institutional care services

Hip fracture among older adults is not only a major health issue but also preventable by providing proper care, but there is a lack of studies on the association between type of long-term care (LTC) service and hip fracture. This study aimed to investigate the association between the type of LTC service and the incidence of hip fracture among older adults with dementia receiving long-term care insurance (LTCI), and to investigate how such association differs according to characteristics of beneficiaries and structural characteristic of institutional care. In this retrospective cohort study, data from 2008 to 2013 were collected from 7112 LTCI beneficiaries having benefit level 1 or 2 with dementia aged 60 years or over in the Korean elderly cohort data set. Type of LTC service was categorized into institutional or home care using the LTCI Claims Database, and the incidence of hip fracture was used as the outcome variable. A survival analysis using a time-dependent Cox regression analysis was performed to examine the association between time-varying LTC service type and hip fracture. Of the 7112 older adults, 115 (1.6%) had hip fracture during a total of 16,540 person-years. Compared to LTC beneficiaries with home care, those with institutional care had a higher adjusted hazards ratio of incidence of hip fracture (hazards ratio = 4.33, 95% confidence interval, 2.84-6.59). This association was particularly strong among beneficiaries who did not have a danger of hip fracture during the mandatory assessment for benefit eligibility, who were partially ambulatory, who were from rural areas, and females. Institutional care was more likely associated with a higher incidence of hip fracture than home care. The government need to watch the institutional LTC services quality and promote improvements of the institutional care quality.