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

Korall, Alexandra M.B.; Feldman, Fabio; Yang, Yijian; Cameron, Ian D.; Leung, Pet-Ming; Sims‐Gould, Joanie; Robinovitch, Stephen N.

doi:10.1016/j.jamda.2019.07.010

Cited by 22 publications

(12 citation statements)

References 42 publications

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“…Our finding that 77% of hip fractures occurred from impacts to the posterolateral aspect of the hip may help to guide improvements in the design of hip protectors, which are currently designed to protect against lateral impacts. (35,36) Our observed rate of hip fracture is within the range reported previously for older adults in LTC. Of the 2377 falls we captured and analyzed, 1.26% resulted in hip fracture.…”

Section: Discussionsupporting

confidence: 87%

“…In contrast, our results reflect the value of specific types of hip protectors (Safehip and Hipsaver) for residents of LTC who are willing to wear them. Our finding that 77% of hip fractures occurred from impacts to the posterolateral aspect of the hip may help to guide improvements in the design of hip protectors, which are currently designed to protect against lateral impacts …”

Section: Discussionmentioning

confidence: 89%

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The Effect of Fall Biomechanics on Risk for Hip Fracture in Older Adults: A Cohort Study of Video-Captured Falls in Long-Term Care

Yang

Komisar

Shishov

et al. 2020

Journal of Bone and Mineral Research

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Over 95% of hip fractures in older adults are caused by falls, yet only 1% to 2% of falls result in hip fracture. Our current understanding of the types of falls that lead to hip fracture is based on reports by the faller or witness. We analyzed videos of real-life falls in longterm care to provide objective evidence on the factors that separate falls that result in hip fracture from falls that do not. Between 2007 and 2018, we video-captured 2377 falls by 646 residents in two long-term care facilities. Hip fracture was documented in 30 falls. We analyzed each video with a structured questionnaire, and used generalized estimating equations (GEEs) to determine relative risk ratios (RRs) for hip fracture associated with various fall characteristics. All hip fractures involved falls from standing height, and pelvis impact with the ground. After excluding falls from lower than standing height, risk for hip fracture was higher for sideways landing configurations (RR = 5.50; 95% CI, 2.36-12.78) than forward or backward, and for falls causing hip impact (3.38; 95% CI, 1.49-7.67). However, hip fracture risk was just as high in falls initially directed sideways as forward (1.14; 95% CI, 0.49-2.67), due to the tendency for rotation during descent. Falling while using a mobility aid was associated with lower fracture risk (0.30; 95% CI, 0.09-1.00). Seventy percent of hip fractures involved impact to the posterolateral aspect of the pelvis. Hip protectors were worn in 73% of falls, and hip fracture risk was lower in falls where hip protectors were worn (0.45; 95% CI, 0.21-0.99). Age and sex were not associated with fracture risk. There was no evidence of spontaneous fractures. In this first study of video-captured falls causing hip fracture, we show that the biomechanics of falls involving hip fracture were different than nonfracture falls for fall height, fall direction, impact locations, and use of hip protectors.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 89%

The Effect of Fall Biomechanics on Risk for Hip Fracture in Older Adults: A Cohort Study of Video-Captured Falls in Long-Term Care

Yang

Komisar

Shishov

et al. 2020

Journal of Bone and Mineral Research

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“…Data on the kinematics of falls can also guide the design of improved sensor-based automatic fall detection systems [ 18 – 23 ]. Furthermore, data on the impact velocities of the body during falls is essential for the design and evaluation of fall protective gear [ 24 – 28 ] and compliant flooring.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Kinovea software in estimating body segment movements during falls captured on standard video: Effects of fall direction, camera perspective and video calibration technique

et al. 2021

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Falls are a major cause of unintentional injuries. Understanding the movements of the body during falls is important to the design of fall prevention and management strategies, including exercise programs, mobility aids, fall detectors, protective gear, and safer environments. Video footage of real-life falls is increasingly available, and may be used with digitization software to extract kinematic features of falls. We examined the validity of this approach by conducting laboratory falling experiments, and comparing linear and angular positions and velocities measured from 3D motion capture to estimates from Kinovea 2D digitization software based on standard surveillance video (30 Hz, 640x480 pixels). We also examined how Kinovea accuracy depended on fall direction, camera angle, filtering cut-off frequency, and calibration technique. For a camera oriented perpendicular to the plane of the fall (90 degrees), Kinovea position data filtered at 10 Hz, and video calibration using a 2D grid, mean root mean square errors were 0.050 m or 9% of the signal amplitude and 0.22 m/s (7%) for vertical position and velocity, and 0.035 m (6%) and 0.16 m/s (7%) for horizontal position and velocity. Errors in angular measures averaged over 2-fold higher in sideways than forward or backward falls, due to out-of-plane movement of the knees and elbows. Errors in horizontal velocity were 2.5-fold higher for a 30 than 90 degree camera angle, and 1.6-fold higher for calibration using participants’ height (1D) instead of a 2D grid. When compared to 10 Hz, filtering at 3 Hz caused velocity errors to increase 1.4-fold. Our results demonstrate that Kinovea can be applied to 30 Hz video to measure linear positions and velocities to within 9% accuracy. Lower accuracy was observed for angular kinematics of the upper and lower limb in sideways falls, and for horizontal measures from 30 degree cameras or 1D height-based calibration.

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“…In 1993, Lauritzen et al conducted the first clinical trial to report positive outcomes with the use of hip protectors in nursing home residents [ 5 ]. Korall et al found that the wearing of a hip protector can reduce the risk of a hip fracture at the time of a fall by nearly three-fold [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

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

Nolan¹,

Tiedt²,

Ellanti³

et al. 2022

Cureus

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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.

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

Cited by 22 publications

References 42 publications

The Effect of Fall Biomechanics on Risk for Hip Fracture in Older Adults: A Cohort Study of Video-Captured Falls in Long-Term Care

The Effect of Fall Biomechanics on Risk for Hip Fracture in Older Adults: A Cohort Study of Video-Captured Falls in Long-Term Care

Accuracy of Kinovea software in estimating body segment movements during falls captured on standard video: Effects of fall direction, camera perspective and video calibration technique

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

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