Risk of hip fracture in protected and unprotected falls in nursing homes in Norway

Abstract

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.

The effect of positioning on the biomechanical performance of soft shell hip protectors

“…While there is controversy about the efficacy of hip protectors from clinical studies (Koike et al, 2009;Kiel et al, 2007;Parker et al, 2006;Forsen et al, 2004;Birks et al, 2004;O'Halloran et al, 2004;van Schoor et al, 2003;Meyer et al, 2003;Harada et al, 2001;Kannus et al, 2000;Chan et al, 2000;Lauritzen et al,1993), this is thought to be due largely to poor adherence in wearing the device, and there is general agreement that they reduce fracture risk if worn at the time of a fall (Cameron et al, 2001(Cameron et al, , 2010(Cameron et al, , 2003Robinovitch et al, 2009;Ekman et al, 1997). However, additional evidence is required to understand the factors that influence both adherence and biomechanical performance.…”

Compliance with external hip protectors in nursing homes in Norway

“…12 The second paper concluded that persons at high risk of hip fracture in nursing homes may decrease the risk to one third by wearing a hip protector in a fall. 13 Many studies have shown that the percentages of acceptance and daily use of hip protectors are often low because many elderly people find the protector uncomfortable when resting and cumbersome when dressing and undressing. 11 14 15 These studies were randomised controlled trials that investigated the effect of hip protectors to prevent hip fractures in nursing homes.…”

Hip, Osteoporosis: New Paradigm

“…Data from studies powered to evaluate hip protectors is consistent: hip protectors reduce hip fracture incidence by more than a half (best results were reported in Norwegian nursing homes, 69%) [55]. They have no influence on other fractures.…”

“…[29]. The incidence of falls and hip fractures in residential elderly patients can be reduced with a multifactorial interdisciplinary prevention program (MIPP) [30][31][32][33][34][35][36][37][38][39][40]:…”