Wearing Hip Protectors Research Articles

A Description of Novel Uses of Hip Protectors in an Elderly Hip Fracture Population: A Technical Report.

Hip fractures are a significant cause of morbidity and mortality in the elderly population. The number of hip fractures is set to increase significantly by 2050 as the global population ages. The costs associated with hip fracture patients are significant due to prolonged hospitalisation and rehabilitation.Hip protectors have been advocated as a strategy to reduce the risk of hip fractures in a high-risk population. Evidence suggests that hip protectors are a cost-effective method for reducing the risk of hip fractures. There have, however, been issues with adherence with wearing hip protectors amongst patients and healthcare staff.Despite prevention strategies, many patients continue to present with hip fractures. Many of these patients have cognitive impairment or experience peri-operative delirium. This can cause issues with patients' interference with the operative wound and presents a significant burden to the healthcare team with the need for increased wound monitoring and care in the post-operative period. Applying a well-fitted hip protector provides a substantial additional barrier to protect the surgical wound. Hip fracture surgical wounds can be difficult to manage in these patients and our standard post-operative protocol is to apply compression dressings in this group of patients. We have found that a well-fitted hip protector can provide adequate compression to the surgical site.We describe a brief technical report on a novel use of hip protectors in providing wound security in the agitated patient post-operatively as well as a method of providing compression to the surgical wound site.

Hip Protectors for Community-Dwelling Older Adults


 In community-dwelling older adults who wore hip protectors there was no difference in the risk of hip fractures or pelvic fractures, compared to those who did not wear hip protectors.
 Three guidelines were identified that include recommendations around the use of hip protectors in older adults. One guideline suggests that hip protectors should be considered in adults at risk for falls and hip fracture. One guideline conditionally recommends hip protectors for frail older adults in the appropriate environment. One guideline suggests that hip protectors should not be considered in older adults in community settings.

Effectiveness of Hip Protectors to Reduce Risk for Hip Fracture from Falls in Long-Term Care

ObjectiveTo generate evidence of the effectiveness of hip protectors to minimize risk of hip fracture at the time of falling among residents of long-term care (LTC) by contrasting rates of hip fractures between falls with and without hip protectors. DesignA 12-month, retrospective cohort study. We retrospectively reviewed fall incident reports recorded during the 12 months prior to baseline in participating homes. Setting and participantsA population-based sample comprising all residents from 14 LTC homes owned and operated by a single regional health authority, who experienced at least 1 recorded fall during the 12-month study. ResultsAt baseline, the pooled mean (standard deviation) age of residents in participating homes was 82.7 (11.3) years and 68% were female. Hip protectors were worn in 2108 of 3520 (60%) recorded falls. Propensity to wear hip protectors was associated with male sex, cognitive impairment, wandering behavior, cardiac dysrhythmia, use of a cane or walker, use of anti-anxiety medication, and presence of urinary and bowel incontinence. The incidence of hip fracture was 0.33 per 100 falls in falls with hip protectors compared with 0.92 per 100 falls in falls without hip protectors, representing an unadjusted relative risk (RR) of hip fracture of 0.36 (95% confidence interval 0.14–0.90, P = .029) between protected and unprotected falls. After adjusting for propensity to wear hip protectors, the RR of hip fracture was 0.38 (95% confidence interval 0.14–0.99, P = .048) during protected vs unprotected falls. Conclusions and implicationsHip protectors were worn in 60% of falls, and the risk of hip fracture was reduced by nearly 3-fold by wearing a hip protector at the time of falling. Given that most clinical trials have failed to attain a similar level of adherence, our findings support the need for future research on the benefits of dissemination and implementation strategies to maximize adherence with hip protectors in LTC.

Hip protectors for preventing hip fractures in older people.

Older people living in nursing care facilities or older adults living at home are at high risk of falling and a hip fracture may occur after a fall. Hip protectors have been advocated as a means to reduce the risk of hip fracture. Hip protectors are plastic shields (hard) or foam pads (soft), usually fitted in pockets in specially designed underwear.This is an update of a Cochrane review first published in 1999, and updated several times, most recently in 2010. To determine if the provision of external hip protectors (sometimes referred to as hip pads or hip protector pads) reduces the risk of fracturing the hip in older people. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12), MEDLINE (1950 to week 3 November 2012), MEDLINE In-Process (18 December 2012), EMBASE (1988 to 2012 Week 50), CINAHL (1982 to December 2012), BioMed Central (January 2010), trial registers and reference lists of relevant articles. All randomised or quasi-randomised controlled trials comparing an intervention group provided with hip protectors with a control group not provided with hip protectors. Two review authors independently assessed risk of bias and extracted data. We sought additional information from trialists. Data were pooled using fixed-effect or random-effects models as appropriate. This review includes 19 studies, nine of which were cluster randomised. These included approximately 17,000 people (mean age range 78 to 86 years). Most studies were overall at low risk of bias for fracture outcomes. Trials tested hard or soft hip protectors enclosed in special underwear in 18 studies.Pooling of data from 14 studies (11,808 participants) conducted in nursing or residential care settings found moderate quality evidence for a small reduction in hip fracture risk (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.67 to 1.00); the absolute effect is 11 fewer people (95% CI, from 20 fewer to 0) per 1000 having a hip fracture when provided with hip protectors.There is moderate quality evidence when pooling data from five trials in the community (5614 participants) that shows little or no effect in hip fracture risk (RR 1.15, 95% CI 0.84 to 1.58); the absolute effect is two more people (95% CI 2 fewer to 6 more) per 1000 people having a hip fracture when provided with hip protectors.There is probably little to no effect on falls (rate ratio 1.02, 95% CI 0.9 to 1.16) or fractures other than of the hip or pelvis (rate ratio 0.87, 95% CI 0.71 to 1.07). However, the risk ratio for pelvic fractures is RR 1.27 (95% CI 0.78 to 2.08); this is an absolute effect of one more person (95% CI 1 fewer to 5 more) per 1000 having a pelvic fracture when provided with hip protectors.The incidence of adverse events while wearing hip protectors, including skin irritation, ranged from 0% to 5%. Adherence, particularly in the long term, was poor. Hip protectors probably reduce the risk of hip fractures if made available to older people in nursing care or residential care settings, without increasing the frequency of falls. However, hip protectors may slightly increase the small risk of pelvic fractures. Poor acceptance and adherence by older people offered hip protectors is a barrier to their use. Better understanding is needed of the personal and design factors that may influence acceptance and adherence.

Falls in Older Adults in Acute Care Found Common but Also Preventable

SAN FRANCISCO – Dr. Edgar Pierluissi, medical director of the Acute Care for Elders Unit at San Francisco General Hospital, recently looked at falls in elders by the numbers. First, they’re the number one cause of hip fractures, he reminded his audience at a conference on osteoporosis sponsored by the University of California, San Francisco. Other numbers from Dr. Pierluissi: 75: Physicians should ask patients aged 75 years or older if they’ve had any falls in the prior year or if they have balance or gait difficulties and observe them walking and getting into and out of a chair. 3–4: A fall in the previous year increases the risk for a future fall 3to 4-fold. 50: Studies suggest that 50% of adults over age 80 years will fall in the next year. 31: Falls in adults aged 65 years or older cause injury in approximately 31% of cases. 4: Muscle weakness quadruples the risk for a fall. 3: A gait deficit, balance deficit, or use of an assistive device nearly triples the risk for falling. 2: A visual deficit, arthritis, depression, or impaired activities of daily living more than double the risk for a fall. Cognitive impairment, use of some types of medications, or age older than 80 years each nearly doubles the risk for falling. 111: A Cochrane Review of 111 randomized controlled trials with 55,303 participants identified effective interventions to reduce the risk of falling (Cochrane Database Syst. Rev. 2009 [doi:10.1002/14651858.CD007146. pub2]). A number of forms of exercise reduced falls. Group tai chi exercise or multiplecomponent group exercise was effective if it targeted at least two of the following: strength, balance, flexibility, and endurance. Conducting a multifactorial falls evaluation reduces the number of falls. In patients with visual impairment and a high risk of falling, assessing and modifying home hazards was effective. Withdrawing psychotropic medications and educating primary care physicians about the risk of falls association with drug therapy reduced the number of falls but not the number who fell. Vitamin D supplementation may reduce falls in people with low vitamin D levels, but it’s unclear whether this helps people with adequate vitamin D levels. The Cochrane Review suggested that wearing hip protectors may provide some marginally significant benefit to frail, older adults in institutional care but not to older people who remain ambulant in the community, Dr. Pierluissi said. One randomized controlled trial of 1,042 residents in 37 nursing homes found a high rate of adherence to wearing hip protectors (74%) but these did not reduce the risk for hip fracture during the 20-month study. Residents served as their own controls by wearing hip protectors with padding on one hip but not the other. Investigators stopped the study early due to lack of efficacy, with hip fractures on 3.1% of the protected hips and 2.5% of unprotected hips, a statistically nonsignificant difference (JAMA 2007;298:413-22). Dr. Pierluissi said he has no relevant conflict of interest. CfA

Wearing hip protectors does not reduce health-related quality of life in older people

Wearing hip protectors does not reduce health-related quality of life in older people

Increasing adherence with the use of hip protectors for older people living in the community

For people at high risk of hip fracture living in community settings, providing hip protectors at no cost increased adherence, but the additional effect of an educational programme was limited. Overall, the level of adherence was modest. The objective of the study was to increase adherence with hip protector use by older people at high risk of hip fracture. The study included two randomised controlled trials with 308 older people recruited from three hospital rehabilitation wards and 171 older people recruited from the community. Participants were randomised into three groups. The control group received a brochure about hip protectors. The no cost group were fitted with free hip protectors and asked to use them. The combined group received free hip protectors and education sessions about their use. Adherence with the use of hip protectors at 3 and 6 months after recruitment was measured. Secondary outcomes were falls, fractures and hospitalisations. Very few participants in the two control groups bought a hip protector. Overall adherence in the four intervention groups was modest, but higher in the community recruitment setting (49%) than in the hospital recruitment setting (36%) at 6 months. In the community recruitment group, at 3 months of follow-up, a significantly higher number of participants in the combined group (62%) were wearing hip protectors compared to the no cost group (43%, p=0.04). Five hip fractures occurred during the study, with four sustained whilst not wearing the hip protectors. Providing hip protectors at no cost to community living older people at high risk of hip fractures modestly increases initial acceptance and adherence with hip protector use. Additional education may further increase hip protector use in people living in the community in the short term.

Could martial arts fall training be safe for persons with osteoporosis?: a feasibility study

BackgroundOsteoporosis is a well-established risk factor for fall-related hip fractures. Training fall arrest strategies, such as martial arts (MA) fall techniques, might be useful to prevent hip fractures in persons with osteoporosis, provided that the training itself is safe. This study was conducted to determine whether MA fall training would be safe for persons with osteoporosis extrapolated from the data of young adults and using stringent safety criteria.MethodsYoung adults performed sideways and forward MA falls from a kneeling position on both a judo mat and a mattress as well as from a standing position on a mattress. Hip impact forces and kinematic data were collected. For each condition, the highest hip impact force was compared with two safety criteria based on the femoral fracture load and the use of a hip protector.ResultsThe highest hip impact force during the various fall conditions ranged between 1426 N and 3132 N. Sideways falls from a kneeling and standing position met the safety criteria if performed on the mattress (max 1426 N and 2012 N, respectively) but not if the falls from a kneeling position were performed on the judo mat (max 2219 N). Forward falls only met the safety criteria if performed from a kneeling position on the mattress (max 2006 N). Hence, forward falls from kneeling position on a judo mat (max 2474 N) and forward falls from standing position on the mattress (max 3132 N) did not meet both safety criteria.ConclusionsBased on the data of young adults and safety criteria, the MA fall training was expected to be safe for persons with osteoporosis if appropriate safety measures are taken: during the training persons with osteoporosis should wear hip protectors that could attenuate the maximum hip impact force by at least 65%, perform the fall exercises on a thick mattress, and avoid forward fall exercises from a standing position. Hence, a modified MA fall training might be useful to reduce hip fracture risk in persons with osteoporosis.

Hüftverletzungen bei Fußballtorhütern unterschiedlicher Leistungsstufen

Soccer goalkeeper often dive to the side loading their hip. Different hip injuries might result. Within the scope of this study the hip injury rate of professional and amateur soccer goalkeepers was investigated. Most often players suffer from contusions and abrasions. Bursitis is reported from professional players, but hardly from amateur players. Generally amateur players are injured more often than professional players. For all players the injury risk during exercise is significantly higher than during a match. The exercise frequency showed a weak link to incidence rate only. For age, gender and exercise intensity no influence of the injury rate was found. Artificial playground resulted in a higher injury rate than natural grass, although the difference was not statistically significant. It was noted that team coachs and players indicated a different perception of the injury rate. The use of protective sports wear (hip protectors) did not significantly influence the injury rate.

Prevention of Falls in Nursing Homes: Subgroup Analyses of a Randomized Fall Prevention Trial

To evaluate the effectiveness of a multifactorial fall prevention program in prespecified subgroups of nursing home residents. Secondary analysis of a cluster-randomized, controlled trial. Six nursing homes in Germany. Seven hundred twenty-five long-stay residents; median age 86; 80% female. Staff and resident education on fall prevention, advice on environmental adaptations, recommendation to wear hip protectors, and progressive balance and resistance training. Time to first fall and the number of falls. Falls were assessed during the 12-month intervention period. Univariate regression analyses were performed, including a confirmatory test of interaction. The intervention was more effective in people with cognitive impairment (hazard ratio (HR)=0.49, 95% confidence interval (CI)=0.35-0.69) than in those who were cognitively intact (HR=0.91, 95% CI=0.68-1.22), in people with a prior history of falls (HR=0.47, 95% CI=0.33-0.67) than in those with no prior fall history (HR=0.77, 95% CI=0.58-1.01), in people with urinary incontinence (HR=0.59, 95% CI=0.45-0.77) than in those with no urinary incontinence (HR=0.98, 95% CI=0.68-1.42), and in people with no mood problems (incidence rate ratio (IRR)=0.41, 95% CI=0.27-0.61) than in those with mood problems (IRR=0.74, 95% CI=0.51-1.09). The effectiveness of a multifactorial fall prevention program differed between subgroups of nursing home residents. Cognitive impairment, a history of falls, urinary incontinence, and depressed mood were important in determining response.

Factors associated with hip protector adherence among older people in residential care

Background:There is evidence to suggest that hip protectors (HPs) prevent fractures among older people living in nursing homes. Studies have found HP wearing rates (adherence) to be low.Objectives:To investigate factors...

Educating nursing home staff on fracture prevention: a cluster randomised trial

to assess whether specialist osteoporosis nurses delivering training to care home staff can reduce fractures and improve the prescription of treatments to reduce fractures versus usual care. pragmatic cluster randomised controlled trial (RCT) with randomisation at the Primary Care Organisation (PCO) level. care homes (residential, nursing and EMI) across England and Wales within PCOs. all 300 PCOs in England and Wales were invited to take part. Of these, 58 agreed to participate and gained ethical approval in time to start the study: 29 clusters were randomised to the intervention group and 29 to the control. specialist osteoporosis nurses undertaking short training sessions with care home staff emphase the importance of fracture and fall prevention and train staff on how to identify those residents at high risk of fracture. Residents' risk of fracture and falls was reported to general practitioners (GPs) of patients along with treatment recommendations. primary outcome measures were total fractures over the past 12 months and total hip fractures over past the 12 months. Secondary outcome measures were total home falls, number of residents sustaining a fall, number of residents prescribed bisphosphonates, number of residents prescribed calcium and vitamin D and number of residents wearing hip protectors. All outcomes were measured at the care home level. of the 230 care homes randomised data were collected from 209 of these containing 5,637 residents. There were no differences between the groups in the incidence rate ratios (IRRs) for total fractures (IRR = 0.94 [0.71, 1.26] P = 0.70) or total hip fractures (IRR = 0.86 [0.63, 1.18] P = 0.36). No differences were found between groups for home falls or hip protector use. A significant increase in bisphosphonate prescription was seen in the intervention group over the control group (IRR = 1.50 [1.00, 2.24] P = 0.05). Calcium and vitamin D prescription was significantly increased in the intervention group over the control group (IRR = 1.64 [1.23, 2.18] P<0.01). the intervention significantly increased the prescription of bisphosphonates and calcium/vitamin D, but was not associated with a significant effect on the rate of falls or fractures.

PT Medical Director Empowers Staff, Boosts Effectiveness

DALLAS — Being a part-time medical director at a long-term care facility can be daunting at times, but there are ways to ease the burden, Dr. David A. Brechtelsbauer said at the annual symposium of the American Medical Directors Association. Physicians need to learn to build on work already being done by consultants and other staff, and take advantage of resources from AMDA, said Dr. Brechtelsbauer, who is director of geriatric training for the Sioux Falls (S.D.) Family Medicine Residency, medical adviser for this publication, and a part-time medical director. For example, pain is often an overlooked and undertreated condition in the nursing home, he said. If the medical director notices that pain is not being addressed in some patients, the best way to approach it is from a system perspective and involve staff from around the facility. “One equals zero,” Dr. Brechtelsbauer said. If the problem of pain is assigned to one person, that person can burn out quickly, he said. In many cases, the answer is to empower all employees, agreed Dr. George N. Smith, president of the Texas Medical Directors Association. Aides working in the facility see the residents most and know when someone is not acting normally, he said. Dr. Smith suggests encouraging the staff to report such changes to quickly identify unaddressed pain. And the aides know when a solution isn't practical, so their honest feedback is key, he added. “The aides really like to be involved,” Dr. Smith said. “They are our eyes and ears.” Physical therapists are another resource to help better detect and monitor pain among residents, Dr. Brechtelsbauer said. “We can engage our professional colleagues,” he said. It's okay for physicians not to have all the ideas and solutions, said Dr. Janice A. Knebl, chief of the division of geriatrics at the Texas College of Osteopathic Medicine, Fort Worth, and part-time medical director. Dr. Brechtelsbauer pointed out that consultant pharmacists can also be a resource for the medical director. One of the medical director's responsibilities is to identify clinical conditions and risks that are relevant to the facility population, from falls to influenza. One way to make that easier is to look at the facility's monthly infections by getting data from the consultant pharmacist on the antibiotics that have been prescribed. Engaging facility staff is also key to being an effective medical director, and physicians have the opportunity to do that even in routine interactions with staff. For example, in a situation where a resident falls out of a wheelchair and has no apparent injury, the medical director can open up a dialogue with the staff. Instead of instructing the staff to call if there are any changes, the medical director could ask for suggestions from the staff, such as, “Should the resident wear hip protectors?” and “Is there anything else that can be done for the resident?” This type of response leads to a more engaged employee and puts the patients on a path to a true clinical plan, Dr. Brechtelsbauer said.

Hip protectors: a pilot study of older people in Taiwan

This research explores the compliance by older people in Taiwan with wearing hip protectors and whether protectors can prevent fractures or decrease injuries after falls. The ageing process causes degeneration of nerves, joints, muscles and then the incidence of falls in the older people is higher than in the young. Therefore, fractures caused by falls, particularly hip fractures of older people, need to be studied. Hip protectors are designed to reduce hip fractures and hip injuries when falls occur, by distributing the impact load and absorbing the impact force generated during a fall. This research was designed as a longitudinal study using purposive sampling and intervention for six months. The target population were older people at high risk for falls and the study was carried out during a six-month period. Self-reported data were collected by interview and questionnaires. The expert validity of the questionnaires, including demographics, high-risk group, compliance and correct wearing of hip protectors and fall injuries, as assessed by three experts, was 0.94 and the test-retest correlation coefficient was 0.95. Individuals were excluded from the research sample if they were 24-hour bedridden, non-mobile or had an existing hip injury. Ten female subjects participated in this study. Their mean age was 76.1 years. During a six-month follow-up, there were 12 falls while wearing hip protectors, however, no fractures occurred because of the falls. This is the first research into hip protectors in Taiwan. The reasons for low compliance by older people were (1) unaccustomed to use, (2) discomfort, (3) wearing only during the daytime, (4) lack of assistance from family caregivers. Fall prevention, exercise and the use of hip protectors can significantly decrease the incidence of hip fractures. Although hip protectors are effective in reducing fall fracture risk, the compliance rate remains low. In the future, the researchers will develop a hip protector program related to teaching the correct method for wearing protectors. Helping older people learn how to overcome the discomfort of wearing hip protectors and encouraging a willingness to wear them is imperative.

Factors affecting adherence to use of hip protectors amongst residents of nursing homes—A correlation study

Background Hip protectors are protective pads designed to cover the greater trochanter and attenuate or disperse the force of a fall sufficiently to prevent a hip fracture. Promising results from randomised controlled trials in nursing homes have resulted in hip protectors being widely recommended in the health care literature and in national guidelines. Objectives The objectives of the study were to identify characteristics of individual residents, and the organisational features of the homes in which they live, which may affect adherence to wearing hip protectors. Design An observational, correlation study designed to identify factors related to adherence. Setting Forty nursing and residential homes in the UK. Participants 1346 residents of the homes who were not confined to bed and with no pressure sore on the hip. Methods The introduction of an evidence-based policy to offer Safehip ® hip protectors to residents free of charge and with support from a nurse facilitator. Adherence to wearing the hip protectors was observed over 72 weeks. Results Initial acceptance of the hip protectors was 37.2%. Continued adherence was 23.9% at 24 weeks; 23.2% at 48 weeks; and 19.9% at 72 weeks. Greater adherence was associated with the following individual resident characteristics: a greater degree of dependency (95% CI 1.39–3.78) and cognitive impairment (95% CI 1.01–2.98); being male rather than female (95% CI 1.06–2.48). Greater adherence was also associated with the following organisational characteristics of homes: fewer changes of senior manager during the study period (95% CI 1.01–8.51), and being resident in a home with a resident profile showing a greater proportion of residents with a higher degree of dependency (95% CI 1.04–1.27). There was wide a variation in the degree of success in implementation between homes (adherence of 0–100% at 24 weeks). Conclusions Those implementing a policy of introducing hip protectors into nursing and residential homes should consider targeting residents with cognitive impairment. Such residents are at greater risk of hip fracture and appear to be more likely to continue wearing hip protectors. Those charged with implementing changes in practice or policy should consider how the context for implementation can be optimised to increase the likelihood of success.

Effect of hip protectors in residential aged care settings

Objective: This study investigated the implementing of hip protectors for people considered at increased risk of fracturing their neck of femur (hip) in public sector residential aged and acute care facilities.Methods: Twelve public sector residential aged care facilities in Victoria participated in this intervention. Data were collected before and after a 6 month intervention with pre‐ and postintervention questionnaires.Results: Results show that wearing hip protectors reduces the risk of fracture to the neck of femur or pelvis in residential aged and acute care facilities.Discussion: Hip protectors are a potentially cost‐effective intervention to reduce the incidence of fractures. Further research on the effectiveness of falls risk assessment tools is required.

An in-service evaluation of hip protector use in residential homes

The establishment of a hip protector service has allowed us to study eligibility, acceptability and compliance with use, reasons for non-use, and the effect of dementia, confusion, incontinence and risk of falling. All residents in all residential homes in Poole were assessed at baseline. All eligible residents were offered 1 week's trial of protectors and those who wished to continue were given a set of protectors. Compliance was assessed at 3, 6 and 12 months. Percentages shown for compliance exclude those who died, were transferred, had lost data or in whom follow-up was not yet completed. Over 18 months, 873 residents from 47 homes were identified (mean age 88 years, female:male 4.5:1). Of these, 745 were considered eligible to wear protectors (86%) and 535 agreed to wear them after 1 week (72%). Compliance over 12 months was 78%. Most wearers wore protectors every day. At 3 months, 83% of demented compared to 73% of not demented residents (P = 0.023), 86% of always confused, 77% of sometimes confused and 72% of never confused (P < 0.009) and 82% of incontinent compared to 73% of continent residents (P = 0.024) were wearing hip protectors. There was a positive linear trend between the risk of falling and compliance (P = 0.048). The results suggest that there is a 48% chance of a resident wearing the protectors after 1 year. The higher compliance among those with dementia, confusion, incontinence and at high risk of falling supports the concept that hip protectors are worn by those at greatest risk of fracture.

The effect of type of hip protector and resident characteristics on adherence to use of hip protectors in nursing and residential homes—an exploratory study

Objectives: To investigate the factors influencing the acceptability of hip protectors to residents of nursing and residential homes, especially the effect of hip protector type, and resident characteristics.Design: A randomised controlled trial with 12 weeks follow-up. Participants were randomised to receive either Safehip® or HipSaver™ hip protectors.Setting/Participants: 109 residents aged 61 to 98 years from seven residential homes and two nursing homes in Northern Ireland.Main outcome measures: Percentage day-time use of the hip protectors over 12 weeks and ongoing use at 12 weeks.Results: 42% (119/285) of residents invited to enter the study agreed to take part, and 109 started to wear the hip protectors. 43.1% (47/109) were still using them at 12 weeks. Mean percentage day-time use for all residents during 12 weeks was 48.6%. There was no significant difference in percentage day-time use (p=0.40), or use at 12 weeks (p=0.56) between the residents wearing Safehip® and HipSaver™ protectors. Greater percentage daytime use of hip protectors was associated with being resident in a home for the elderly mentally infirm (75.1%, p⩽0.0005), having a low (12 or less) Barthel score (61.1%, p⩽0.0005), and having been injured in a fall in the last 12 months (57.3%, p=0.012).Conclusions: The type of hip protector appeared to make no difference to their continued use by residents. Residents with a history of a fall and those who are physically and mentally incapacitated appear to be more likely to wear hip protectors. These residents, who are at high risk of falling, are also highly dependent on nursing staff. Efforts to increase hip protector use in residential and nursing home should focus on staff, who are in the best position to advise and influence residents and their relatives.

Preventing hip fractures in care homes 1: views of residents and staff

Hip protectors have been shown to be effective in reducing the incidence of hip fracture among older people living in care homes (Parker et al, 2004). However, there are problems with compliance. This article reports findings from a survey of 138 staff from 23 care homes about experiences and perceptions of using hip protectors. The survey was complemented by qualitative case studies involving staff, to be linked to compliance with wearing hip protectors including comfort, acceptability to the resident and appearance. Few practical difficulties in using hip protectors were identified. Staff and residents' perceptions and experiences of using hip protectors vary and are likely to influence compliance.

What constitutes success in preventive health care? A case study in assessing the benefits of hip protectors

The economic success of preventive health programs is typically assessed by the net health-related utility gain or loss to society relative to the cost. Issues relating to the positive or negative utility associated with participating in a preventive health program are often ignored. However, it is likely that calls for informed consumer choice and respect for patient autonomy will provide an impetus to examine utility associated with the process and outcomes of preventive health programs. In this paper, we outline the nature of the ex ante and ex post perspective in evaluing benefits and the presence of process utility and the utility of gambling in individual's utility function for preventive health care. The implications of including process attributes and psychological states when assessing benefits to society are discussed in relation to an empirical study on the value of external hip protectors for the prevention of hip fractures. We demonstrate that wearing hip protectors and the psychological outcomes of being a participant in the program can have a significant impact on individual's assessment of the benefits. Furthermore, point of reference plays a crucial role in their valuation. Individuals who did not consent to participate in a trial of hip protectors valued all states significantly lower than those who did participate in the trial. We argue that the utility associated with adherence to the intervention is an important issue for preventive health policy. From the viewpoint of applied welfare economics, evaluation of preventive health programs should allow for both process and outcome utility when assessing benefits. In this context, success might be viewed as maximising the opportunity for individuals to make an informed choice.