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

Abstract

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.

Facilitators of and Barriers to Hip Protector Acceptance and Adherence in Long-term Care Facilities: A Systematic Review

“…Data on both acceptance and adherence was provided in 12 studies, while information on acceptance only and adherence only was provided in 1 and 11 studies, respectively. For the remaining 4 studies, measures of compliance were not applicable as they explored staff opinions on hip protector design and usage 53,54,62 and staff exposure to hip protectors. 75 Of the 13 studies reporting on acceptance, rates ranged from 32% 64 to 85% 74 with a median acceptance of 48%.…”

“…Compliance was enhanced when caregivers were convinced of the ability of hip protectors to reduce risk for injury from falls, 52,53,57,63 and diminished when caregivers were conflicted about their effectiveness. 53,54,67,75,78 Davies et al 53 (2004) concluded that residents were more likely to wear hip protectors when caregivers understood the value of their use. According to Sawka et al 75 (2007), staff frequently cited (33.3%) lack of evidence of benefit in LTC populations as a major barrier to adherence.…”

“…In 13 studies, investigators acknowledged the importance of staff commitment to work with hip protectors in determining compliance. 51,52,54,56,57,60,61,63,64,67,69,73,76 For example, in the comparative study by Zimmerman et al (2010), a one unit increase in the commitment of registered nurses to hip protector use (scored from 0 to 4) was associated with a 3.1% (95% CI: 0.83e5.3) increase in adherence (P < .01). 64 No others attempted to quantify the strength of this relationship.…”

“…Lack of acceptability often arose from concerns about hygiene, 59,62 cost-effectiveness, 62 maintaining the dignity of residents, 54,59 the development of unwanted side effects (ie, pressure damage, redness of the skin), 54,56 and most often, the amount of effort required when helping residents to don and doff hip protectors. 53,58e60,74 In 1 study, night shift respondents were more likely to rate a hip protector policy as time-consuming (50% vs 13.7%; P ¼ .021) and stressful (75% vs 24.1%; P ¼ .006) compared with day-time caregivers, even though nearly all (97.3%) considered a hip protector policy in LTC as feasible.…”

“…According to 1 study, compliance was sometimes compromised when caregivers experienced difficulty understanding a residents' decision to wear hip protectors. 54 Often, caregivers had to interpret consent through behavioral signs, such as a lack of protest. In some situations, staff made the decision not to offer hip protectors because they perceived they would have been forcing residents to wear the garment against their will and were dedicated to upholding their rights' to individual choice and autonomy.…”