Background
Hospital admissions resulting from traumatic intracranial haemorrhages (TIH) in older people are increasing. There are concerns regarding an increased risk of a TIH in people taking oral anticoagulants (OAC) like phenprocoumon.
Aims
The aim of this study was to estimate the incremental risk of a TIH associated with OAC in older people. Furthermore, this study explored differences in risk according to functional status.
Methods
The study took data from a large German health insurance provider and combined hospital diagnoses with data regarding drug dispensing to estimate rates of a TIH in people with and without exposure to phenprocoumon. Analyses were stratified by sex and by severe functional impairment as disclosed by the long-term care insurance provider.
Results
Overall, exposure to OAC resulted in 2.7 times higher rates of TIH. People with severe functional impairment had a higher baseline risk of TIH than people without severe functional impairment. However, the incremental risk in those exposed to OAC was similar among people with and without severe functional impairment (standardised incidence rate difference 15.73 (95% CI 7.84; 23.61) and 12.10 (95% CI 9.63; 14.57) per 10,000 person-years, respectively.
Conclusions
OAC increases the risk of TIH considerably. The incremental risk of TIH in those exposed to OAC is comparable between people with and without severe functional impairment. The presence of severe functional impairment per se should not exclude such patients from the potential benefits of OAC. For now, the prescription should be personalized based on individual fall risk factors and risk-taking behaviour.
Background
Hip fractures are regarded as a worldwide epidemic and a major public health concern. Changing risk factors, local differences and temporal trends contribute to the particular epidemiology of hip fractures. This overview gives a comprehensive insight into the epidemiology of hip fractures and reviews where German data have contributed to the literature.
Methods
The review of the epidemiology of hip fractures in Germany is based on a systematic literature search in PubMed.
Information about the global epidemiology of hip fractures was provided by a selective literature review focusing on specific aspects
of the epidemiology of hip fractures.
Results
Hip fracture rates vary more than 100-fold between different countries. In most high-income countries, a rise in agestandardized
hip fracture rates was observed until the 1980s and 1990s and a decrease thereafter. Such a decrease has not been observed for Germany so far. Many factors,diseases and drugs have been found to be
associated with hip fractures and there is some evidence that fracture risk in later life is already programmed during fetal life and
early childhood. Of the hip fracture burden 50% occur in people with disability and in need of care. In nursing homes approximately 4 fractures can be expected in 100 women per year. In people with intellectual or developmental disabilities comparable risks of hip fracture occur 10–40 years earlier than in the general population. Incidence of disability, institutionalization and death are frequent consequences of hip fractures.
Conclusion
The epidemiology of hip fractures is characterizedby a high burden of disease, local differences, temporal trends, well-defined high-risk populations and many established risk factors.