Hip protector compliance among older people living in residential care homes. (Original Article).

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 cords 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.

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Falling among older people is a significant problem. (1-5) 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. (1 6-10) The rate of falling among those living in institutions (excluding acute hospitals) has been estimated at 50%, with 10%-25% suffering severe consequences. (11 12) One of the most serious consequences of falling is fractured neck of femur (hip fracture). (8) The vast majority of fractured hips result from a fall. (13) Around 1%-2% of community dwelling older people and 5%-7% of nursing home residents fracture their hip each year. (8 14 15) The service cost of treatment and care of an older person with a hip fracture has been estimated at over [pounds sterling]12 000 during the first year after hip fracture, at 1995/6 costs. (3) Estimated one year mortality ranges from 12% to 25%, and fewer than half of surviving patients recover their pre-fracture levels of physical functioning. (16-19)

The principal ways of preventing hip fracture are: prevention of falls, ensuring bones are strong enough to withstand the impact after a fall, and/or protecting the hips with pads which deflect much of the energy away from the vulnerable area. (20) This paper focuses on the latter of these interventions. Direct impact on and around the hip is the cause of the majority of hip fractures. (1 3 21-25)

Recent national guidelines, commissioned by the Department of Health in England, recommended that: "Hip protectors should be offered to all nursing home residents". (26) There have been a number of published trials that provide evidence for the effectiveness of hip protectors in preventing hip fracture in nursing home (high risk) populations, (27-32) described in the review by Parker and colleagues. (33) A further trial showed an estimated reduction in hip fractures of 60% in a mixed population of people living in geriatric long stay facilities and people living at home supported by health care centres. (34)

Hip protectors appear highly effective if the older person wears them; however, only a minority of older people appear to find them acceptable. Compliance rates in nursing homes, estimated using a variety of definitions and methods, of 44%- 90% have been reported (28-32 35) Estimates of regular wearing of hip protectors in a nursing home has been as low as 24% (27) and in "rest homes" as low as 30%. (36) In a mixed geriatric population (long stay facility or home care) the compliance rate was 48%. (34) Compliance rates are measured in consenting populations. The average rate can be far less if non-consenting older people are taken into account.

Like nursing home residents, people living in residential care homes are at substantially greater risk of falling than their counterparts living in the community. Consequently, initiatives that prevent hip fracture within residential care homes are also justified.

The aims of this work were to estimate compliance rates for the use of hip protectors among people living in residential care homes in East Kent Health Authority area of England (south east England, adjacent to the English Channel). The provision of hip protectors and the investigation of compliance were part of a…