Objectives:To investigate compliance with hip protector use.Design:Observational prospective study.Setting:19 nursing homes (1040 beds).Subjects:All residents during an 18 month period were included in this study.Intervention:Hip protectors were introduced as a regular part of health care service for all residents. Residents at high risk were encouraged to use hip protectors regularly. Each nursing home had a contact person.Main outcome measures:The percentage of residents accepting the hip protector offer, probability of continued use, reasons for terminating use, and percentage of falls with hip protector were evaluated.Results:Fifty five percent of the residents accepted the hip protector offer. The percentage increased by age, but showed no significant dependence on gender, profession of the contact person, or size of nursing home. The probability of continued use showed no significant dependence on age and gender. Nursing homes with a nurse as contact person showed 51% higher risk of residents terminating regular hip protector use than nursing homes with a physiotherapist as contact person (relative risk (RR) 1.51, 95% confidence interval (CI) 1.11 to 2.05, p = 0.008). The corresponding result for large (75–92 beds) compared with small (24–68 beds) nursing homes was RR = 1.44 (95% CI 1.02 to 2.02, p = 0.036). Seventy six percent of 2323 falls occurred while using hip protectors.Conclusion:The contact person and size of the nursing home seemed to be important factors for continued use of hip protectors while age and gender seemed to be less important.

Objectives: To compare the probability of hip fracture in protected and unprotected falls in a real world setting in nursing homes. Design: Observational study. Setting: Seventeen nursing homes (965 beds) in Norway. Subjects: All residents in the nursing homes with at least one fall during the intervention period. Intervention: Hip protectors were introduced as a regular part of the health care service for all the residents for an intervention period of 18 months. Residents who were considered high risk were especially encouraged to be regular users of hip protectors. Main outcome measures: Hip fracture in protected and unprotected falls. Results: At the time of the first fall within each faller, 430 were non-users of hip protectors, while 84 were registered as users, but did not wear it, and 191 were users and did wear it. The odds ratio of suffering a hip fracture was 0.31, 95% confidence interval 0.13 to 0.75 for wearers compared with non-wearers in the first fall, adjusted for age, gender, and whether they were registered as users or not. Conclusion:The odds of suffering a hip fracture for nursing home high risk residents was reduced to less than a third in protected falls compared with unprotected falls. Or, in other words, the odds of hip fracture showed a 69% reduction in protected falls compared with unprotected falls.

This non-randomized study showed that hip protectors introduced to all residents in nursing homes considerably reduced the incidence of hip fracture. It may be possible to achieve higher compliance and a further reduction in the incidence of hip fractures if the producers of hip protectors increase the comfort of the protector without reducing its effect. In addition, it is important that health workers encourage more individuals at high risk to use the protector.

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