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Background <p>The underlying general condition of older adults before proximal humerus fracture (PHF) and outcomes after PHF have not been described in detail. Furthermore, there is no consensus regarding the treatment of PHF in older adults requiring long-term care (LTC). This study assessed the LTC status and treatment in older adults with PHF and examined the changes in LTC status and death after PHF.</p> Methods <p>We conducted a retrospective cohort study using the medical and LTC insurance claims databases of a prefecture from 2014 to 2019. We included patients ≥ 65 years old with PHF and evaluated their LTC status and mortality, excluding those with an observation period of &lt; 6 months before PHF. A survival time analysis was performed using the Kaplan-Meier method.</p> Results <p>We identified 887 eligible patients, including 452 (51%) in the surgical group and 435 (49%) in the non-surgical group. The proportions of patients requiring LTC were 42% and 52% in the surgical and non-surgical groups, respectively. In patients who did not require LTC, the proportion for surgery decreased with age, whereas in patients who required LTC, the proportion for surgery was highest in the 75- to 84-year-old group. The mortality rate was lower in the surgical group than in the non-surgical group among patients 75–84 years old who required LTC (log-rank <i>p</i> = 0.001; hazard ratio 0.16, 95% CI 0.04–0.56). In contrast, there was no significant association between treatment methods and mortality in the LTC status in the other age groups. The overall 1-year mortality after PHF was 7%, and an additional 20% of patients with PHF had worsening LTC 1 year after injury.</p> Conclusions <p>Among the older adults with PHF, 47% required LTC before the injury, and 26% had a worsening LTC status or died 1 year after PHF. The prognoses after surgery for PHF differed according to age and LTC status.</p>

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Treatment and prognosis of proximal humerus fracture in older adults: a retrospective cohort study using health insurance claims database

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月5日

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  • Akihiro Saitsu,
  • Hayato Yamana,
  • Yusuke Sasabuchi,
  • Hiroki Matsui,
  • Hideyuki Sasanuma,
  • Tomohiro Matsumura,
  • Yoshimitsu Wada,
  • Takeshi Kanno,
  • Hitoaki Okazaki,
  • Takahide Kohro,
  • Katsushi Takeshita,
  • Hideo Yasunaga,
  • Kazuhiko Kotani

摘要

Background

The underlying general condition of older adults before proximal humerus fracture (PHF) and outcomes after PHF have not been described in detail. Furthermore, there is no consensus regarding the treatment of PHF in older adults requiring long-term care (LTC). This study assessed the LTC status and treatment in older adults with PHF and examined the changes in LTC status and death after PHF.

Methods

We conducted a retrospective cohort study using the medical and LTC insurance claims databases of a prefecture from 2014 to 2019. We included patients ≥ 65 years old with PHF and evaluated their LTC status and mortality, excluding those with an observation period of < 6 months before PHF. A survival time analysis was performed using the Kaplan-Meier method.

Results

We identified 887 eligible patients, including 452 (51%) in the surgical group and 435 (49%) in the non-surgical group. The proportions of patients requiring LTC were 42% and 52% in the surgical and non-surgical groups, respectively. In patients who did not require LTC, the proportion for surgery decreased with age, whereas in patients who required LTC, the proportion for surgery was highest in the 75- to 84-year-old group. The mortality rate was lower in the surgical group than in the non-surgical group among patients 75–84 years old who required LTC (log-rank p = 0.001; hazard ratio 0.16, 95% CI 0.04–0.56). In contrast, there was no significant association between treatment methods and mortality in the LTC status in the other age groups. The overall 1-year mortality after PHF was 7%, and an additional 20% of patients with PHF had worsening LTC 1 year after injury.

Conclusions

Among the older adults with PHF, 47% required LTC before the injury, and 26% had a worsening LTC status or died 1 year after PHF. The prognoses after surgery for PHF differed according to age and LTC status.