Hip protector compliance among older people living in residential care homes

Abstract

Objectives: To estimate the compliance rates for the use of hip protectors among people living in residential care homes. Population/setting: People aged 65 years and over living in residential care homes with 20 or more beds in East Kent, south east England. Methods: Seventeen homes with the highest historical frequency of hip fractures were selected. All residents were offered SAFEHIP hip protectors. Care staff recorded daily hip protector compliance on diary cards over six months. Compliance rates were estimated from the number of sessions (morning, afternoon, evening, night) that a person wore hip protectors. Results: A total of 153 (51%) out of 299 residents agreed to wear hip protectors The 24 hour compliance rate for those who were issued with hip protectors and wore them at least once was 29%: 37% in the daytime and 3% at night. Daytime compliance rates reduced from 47% for the first month, to around 30% for months 5 and 6. Conclusion: This study highlights the problems of persuading older people living in residential care homes to wear hip protectors. They have been shown to prevent hip fracture in nursing home (high risk) populations, and a recent trial showed their effectiveness in a mixed geriatric population. People living in residential care homes are also at greater risk of falling and fracturing than their counterparts living in the community. Initiatives to prevent hip fracture within residential care homes are also justified. F alling among older people is a significant problem. [1][2][3][4][5] Approximately 30% of people aged 65 and over living in the community fall each year, half of those do so repeatedly, and an estimated 50% of people aged 85 and over fall each year.

Factors associated with the initial acceptance of hip protectors amongst older people in residential care

“…The methods used in this study were presented elsewhere [4]. A synopsis is presented in Appendix 2 in the supplementary data on the journal website (http://www.ageing.oxfordjournals.org/).…”

“…In severe disease, patients often have limited respiratory reserve and the resultant tachypnoea, increased work of breathing, and subsequent exhaustion may lead to hypercapnia, hypoxia and respiratory acidosis. The prevalence of COPD increases with increasing age [4], and in addition elderly patients are at increased risk of developing respiratory failure, for example as a result of limited reserve, loss of muscle mass, nutritional deficiencies and associated co-morbidities. Conventional treatment for respiratory failure resulting from acute exacerbations of COPD (AECOPD) includes bronchodilators, corticosteroids, antibiotics and controlled oxygen [5].…”

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

“…68 Definitions also ranged from the wearing of a hip protector at least once during the past 3 months 56 to a month, 66 at least once a day for more than 1 hour, 63 for all hours of the daytime, 71 or at all times except when bathing. 51 Therefore, we advocate that investigators comply with recommendations from Kurrle et al 83 (2004), and report adherence as the percentage of time hip protectors are worn as directed using a standardized definition, or alternatively, whether hip protectors are being used at the time of falling through examination of fall reports or clinical records.…”

“…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.…”

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

“…A description of the characteristics and functional status of the study population, recruitment, and methods used to collect the data for this study has been presented previously 8 11. In short, the population comprised residents from 17 RCHs with 20 or more beds from five Primary Care Groups (PCGs) in East Kent (England)—three homes from each of four PCGs and five from the remaining one.…”