Association between fractures and health status among independent older adults: insights from a suburban cohort in Japan

Abstract

Background: Fractures are a significant health concern for older adults, affecting their activities of daily living (ADL), physical function, and mental well-being, and contributing to the need for long-term care. However, the factors associated with fractures among independent older adults remain unclear. This study aimed to examine the association between fractures and the health status of independent older adults in a representative suburban city in Japan using data from a survey of community-dwelling residents and to identify factors associated with fractures.

Methods: A total of 15,853 survey questionnaires were mailed, and 11,346 valid responses were received, resulting in a response rate of 71.6%. The survey included questions on ADL, physical function, mental health, memory, medical conditions, and subjective complaints. For fractures, participants were asked the following question: "How many times have you experienced fractures since the age of 65?". Data were analyzed using Poisson regression models adjusted for age, sex, body mass index, family structure, and smoking history.

Results: Among the respondents, 15% reported fractures after age of 65 years. A decline in ADL, physical function, mental health, and memory were significantly associated with increased fracture frequency. Under medical conditions, the prevalence of depression (p for trend = 0.042), respiratory diseases (p for trend = 0.001), and ophthalmologic conditions (p for trend = 0.002) increased significantly with fracture number. Most subjective complaints were significantly associated with fracture number, with dysphagia demonstrating the strongest association.

Conclusions: This study utilized a relatively large and highly representative sample of community-dwelling residents to identify factors associated with fractures in independent older adults. Even in independent older adults who were not certified as requiring long-term care, fractures were significantly associated with a decline in multiple health domains. These findings provide valuable insights that can inform efforts to promote healthy aging and reduce care dependency.

Clinical trial: Not applicable.

Keywords: Community dwelling; Dysphagia; Fracture; Older well-aging adult; Subjective geriatric complaint.

Fig. 1

Survey of community-dwelling residents in the city of Toyoake. (A) Response flowchart to the survey questionnaire for residents aged ≥ 65 years. (B) Fracture number since the age of 65