Broken bones in later life are a leading cause of disability, recurrent fracture, nursing home placement, and death.
Prior studies have shown that health care providers can prevent poor outcomes, including death, by treating patients with bone-strengthening medications and by stopping risky medications that cause falls. However, few patients receive this high-quality care because it is time consuming and requires specialized knowledge that primary care providers may not have.
Researchers from Hebrew SeniorLife and Duke University will undertake a 5.5-year study that will compare two care models that have previously been shown to improve care in skilled nursing facilities. The Patient-Centered Outcomes Research Institute (PCORI) has approved $10.5 million in funding to support the study, entitled “Models of Post-Acute Care in Complex Older Adults with Fracture.”
Forty-two skilled nursing facilities will be enrolled in this study, which will compare two care models: a fracture liaison service in which recommendations are given to start medications to strengthen bones; and a deprescribing care model, which helps patients reduce medications that cause falls.
Both models are led by a remote nurse who will engage patients and providers in the decision making process.
“The study is exciting because it will help provide patients who have recently experienced a fracture and their families to make personalized choices about starting medications to prevent more broken bones and stopping risky medications that cause falls,” said Sarah Berry, MD, MPH, clinical researcher at the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, and Associate Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center.
“The study will prepare us to spread the care models to health systems so that all patients can receive high-quality care after having a broken bone,” said Cathleen S. Colon-Emeric, MD, FACP, MHS, Professor of Medicine; Chief, Division of Geriatrics in the Department of Medicine, Duke University School of Medicine.
About The Study
In random order, our study team will provide the fracture liaison service care model for 6 months, the deprescribing care model for 6 months, or both models simultaneously for 6 months. All patients who are admitted to a participating facility after a broken bone will receive the model that facility is being offered at that time. Patients will be followed for about 2 years using information that is already in their electronic health record and from Medicare to see if they have fewer injuries from falls compared to similar patients in facilities that don’t offer these care models. Patients or their caregivers will be asked to complete a survey 90 days after admission. We will compare whether important symptoms like pain, anxiety, sleep, and medication side effects are different in patients treated with the different care models.
About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 3,000 seniors a day across six campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; and Jack Satter House, Revere. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $85 million, making it one of the largest gerontological research facilities in the U.S. in a clinical setting. It also trains more than 1,000 geriatric care providers each year. For more information about Hebrew SeniorLife, visit our website or follow us on our blog, Facebook, Instagram, Twitter, and LinkedIn.
About the Hinda and Arthur Marcus Institute for Aging Research
Scientists at the Marcus Institute seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity, and productivity into advanced age. The Marcus Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment, and cure of disease; advance the standard of care for older people; and inform public decision-making.
Duke Center for the Study of Aging and Human Development
The Aging Center is a multi-disciplinary hub for the promotion of healthy aging across the lifespan and management of social and medical complexities in late life. With more than 150 affiliated faculty members from across the University and Medical Center, and millions of dollars annually in aging-related research funding, the Center is a vital national resource for the study of aging