Predictors of uptake and adherence to the use of hip protectors among nursing-home residents.

Abstract

The aim of the present study was to identify predictors for initial uptake and adherence with the use of hip protectors when offering hip protectors free of charge to nursing-home residents. An 18months prospective follow up study was carried out in 18 Norwegian nursing homes. One thousand two hundred and thirty-six residents were included in the study of which 604 started to use a hip protector. A multivariate logistic regression model was used to identify predictors for the initial uptake. A Cox proportional hazard model was used to identify predictors for adherence. A stepwise backward strategy was used in both the logistic and in the Cox regression. The effect of nursing homes as clusters was adjusted for in the analysis. The uptake rate among all residents was 46% and the adherence was approximately 75% after 3months, and approximately 60% after 18months. Female gender [odds ratio (OR): 1.54, 95% CI: 1.06-2.24, P=0.022], previous fractures (OR: 1.67, 95% CI: 1.02-2.75, P=0.043), previous falls (OR: 2.08, 95% CI: 1.35-3.19, P<0.001) and memory (not able to memorise: OR: 3.71, 95% CI: 2.09-6.59, P<0.001, large problems with memorising: OR: 2.85, 95% CI: 1.81-4.49, P<0.001, medium problems with memorising: OR: 2.45, 95% CI: 1.39-4.33, P=0.002, some problems with memorising: OR: 1.99, 95% CI: 1.14-3.48, P=0.016) seemed to be important predictors for uptake. Among those who took up the offer male gender (HR: 1.71, 95% CI: 1.00-2.91, P=0.049), memory (not able to memorise: HR: 0.26, 95% CI: 0.14-0.50, P<0.001, large problems with memorising: HR: 0.32, 95% CI: 0.22-0.45, P<0.001, medium problems with memorising: HR: 0.46, 95% CI: 0.30-0.73, P<0.001, some problems with memorising: HR: 0.49, 95% CI: 0.32-0.73, P=0.001) and bowel incontinence (HR: 0.41, 95% CI: 0.25-0.66, P<0.001) were predictors for a lower probability of ending hip protector use. Factors related to a high risk of falling were important predictors for both uptake and adherence. The fact that neither memory impairments nor incontinence (bowel) seemed to be barriers to hip protector use is important since these characteristics are common among nursing-home residents and tertiary prevention such as the use of hip protectors is probably the most feasible intervention to prevent hip fractures in this group.