A randomised trial of hip protector use by frail older women living in their own homes

Abstract

Objectives:To investigate the efficacy and effectiveness of hip protectors in frail community living older women.Design:Randomised controlled trial.Setting:Aged care health services in New South Wales, Australia.Patients:600 women 74 years of age or more (mean age 83 years), who had two or more falls or one fall requiring hospital admission in the previous year, and who lived in their own homes.Intervention:Use of hip protectors.Main outcome measures:Adherence with use of hip protectors, falls, incidence of hip fracture, and adverse effects of use of hip protectors.Results:Adherence was approximately 53% over the duration of the study and hip protectors were worn at the time of 51% of falls in the intervention group. The risk of hip fracture when falling while wearing hip protectors, compared with a fall with no hip protectors in place, was significantly reduced (relative risk (RR) 0.23, 95% confidence interval (CI) 0.08 to 0.67). On an intention to treat analysis, 21 and 22 hip fractures occurred in the intervention and control groups respectively (adjusted RR 0.92, 95% CI 0.51 to 1.68). Three users of hip protectors sustained a hip fracture while wearing properly applied protectors, while 16 hip protector users (5%) developed minor local complications.Conclusions:Hip protectors prevent hip fractures in community dwelling older women if worn at the time of a fall. The overall effectiveness of hip protectors was not established in this study, because of incomplete adherence with use of the protectors, and limited statistical power.

External hip protectors are effective for the elderly with higher-than-average risk factors for hip fractures

“…Making definitive comparisons between studies is difficult, as compliance has been measured in many different ways [24]. However, seven randomised controlled studies provided the rate of wearing hip protectors at the time of fall (24-74%) [11][12][13][14][16][17][18]. The level of compliance achieved in this study was superior to previous studies, particularly in terms of the percentage of falls protected with hip protectors (85.3%, Table 5).…”

“…To date, at least 15 randomised controlled trials (RCTs) examining the effect of external hip protectors on incidence of hip fractures have been published. Hip protectors led to a significant reduction in the incidence of hip fractures in five studies [8][9][10][11][12] while results were borderline significant in two studies [13,14] and no significant reduction in hip fracture incidence was seen in eight studies [15][16][17][18][19][20][21][22]. These discrepancies among RCTs might be attributable to differences in the methods of randomisation, biomechanical properties of the actual hip protectors used and compliance rates for use of hip protectors.…”

Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis

“…Finally, we have used this approach to highlight the effectiveness of hip protectors in decreasing the risk of hip fractures in a vulnerable, often ignored population with a significant burden of disease. Process of exclusion of studies from the systematic review [26][27][28][29][30][31][32][33][34][35][36]. Table 1 Assessment of the methodologic features of included studies The unit of randomization was not clearly described in the primary publication.…”

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

“…These outcomes were all measured by the recall of the participant if he or she was living in the community or from records in the hospital ward for the time that the participant had spent in hospital. These methods have been successfully used by the investigators in other studies [22,23].…”

“…There have been three randomised trials reporting the effectiveness of hip protectors [22,28,29] for this group, and the pooled result of these studies showed no effect in reducing hip fractures [7]. The main reason for lack of effect suggested by these studies was that incomplete adherence meant that overall effectiveness could not be established.…”