Association of sustained integrative-care use with mortality and immobility-related complications among postfracture older adults in South Korean long-term care hospitals: a population-based, propensity score-matched, retrospective cohort study.

Abstract

To investigate whether sustained integrative care, combining traditional Korean medicine (TKM) with conventional medical care, is associated with lower mortality and reduced risk of major medical complications among older adults undergoing postfracture rehabilitation in long-term care hospitals (LTCHs). A nationwide, population-based, retrospective propensity score-matched cohort study. LTCHs in South Korea, using the National Health Insurance Service customised claims database (2014-2023). Older adults (aged ≥65 years) newly admitted to LTCHs with a fracture diagnosis were included in the cohort. Patients were matched 1:1 using propensity scores to an integrative care group (receiving acupuncture, moxibustion or cupping alongside conventional medical care) and a usual care group (receiving conventional care alone), resulting in a matched cohort of 40 720 participants (20 360 per group) with a mean follow-up of 3.0 years. The primary outcome was all-cause mortality. Secondary outcomes included the incidence of major immobility-related complications: pneumonia, deep vein thrombosis, pressure ulcers and urinary tract infections. The propensity score-matched groups were compared with multivariable Cox proportional hazards regression models. Compared with the usual care group, the integrative care group exhibited significantly lower risks of all-cause mortality (adjusted HR (aHR) 0.79 (95% CI 0.77 to 0.81)) and major complications, including pneumonia (aHR 0.72 (95% CI 0.69 to 0.76)), deep vein thrombosis (aHR 0.71 (95% CI 0.58 to 0.88)), pressure ulcers (aHR 0.76 (95% CI 0.72 to 0.80)) and urinary tract infections (aHR 0.75 (95% CI 0.70 to 0.80)). Integrative care during postfracture rehabilitation in LTCHs is associated with lower mortality and fewer immobility-related complications in older adults. These findings support integrative rehabilitation as a potential strategy for postfracture care, although confirmation in prospective studies is warranted.