Effect on hip fractures of increased use of hip protectors in nursing homes: cluster randomised controlled trial. (Papers).

Abstract

Objective To assess the effects of an intervention programme designed to increase use of hip protectors in elderly people in nursing homes.

Design Cluster randomised controlled trial with 18 months of follow up.

Setting Nursing homes in Hamburg (25 clusters in intervention group; 24 in control group).

Participants Residents with a high risk of falling (459 in intervention group; 483 in control group).

Intervention Single education session for nursing staff, who then educated residents; provision of three hip protectors per resident in intervention group. Usual care optimised by brief information to nursing staff about hip protectors and provision of two hip protectors per cluster for demonstration purposes.

Main outcome measure Incidence of hip fractures.

Results Mean follow up was 15 months for the intervention group and 14 months for the control group. In total 167 residents in the intervention group and 207 in the control group died or moved away. There were 21 hip fractures in 21 (4.6%) residents in the intervention group and 42 hip fractures in 39 (8.1%) residents in the control group (relative risk 0.57, absolute risk difference -3.5%, 95% confidence interval -7.3% to 0.3%, P=0.072). After adjustment for the cluster randomisation the proportions of fallers who used a hip protector were 68% and 15% respectively (mean difference 53%, 38% to 67%, P=0.0001). There were 39 other fractures in the intervention group and 38 in the control group.

Conclusion The introduction of a structured education programme and the provision of free hip protectors in nursing homes increases the use of protectors and may reduce the number of hip fractures.

Introduction

Hip fractures are a major cause of disability and functional impairment among elderly people. (1) Trials of hip protectors in nursing homes have reported a reduction of 50% in the incidence of hip fracture. (2) In general, however, the acceptance of hip protectors is poor. (2) We developed a two part intervention, consisting of structured theory based education and provision of free equipment, directed at nursing staff and residents to encourage the use of hip protectors. We evaluated whether there were fewer hip fractures among elderly people in nursing homes that received the intervention programme compared with those in nursing homes with optimised usual care.

Participants and methods

Nursing homes and residents

All 86 nursing homes in Hamburg with at least 70 residents were invited and 42 agreed to participate. The 42 homes made up 49 clusters, since we defined a cluster as a nursing home by itself or an independently working ward of a large nursing home (see figure). In each cluster a study coordinator was nominated. The nursing staff selected 15 to 30 residents according to predefined inclusion criteria: [greater than or equal to] 70 years old, not bedridden, and living in the nursing…