Carpets can be used to reduce injury from falls

EDITOR—It takes about 40 years of wearing hip protectors to prevent one fracture, according to the editorial by Cameron,1 so other strategies may be helpful. Hip protectors look like institutional underwear—white, plain, and unfashionable. Making them more attractive might improve their acceptability. The alternative approach is to pad the floor. Carpet improves gait in older people2 and in a small observational study dramatically reduced serious injury from falls.3 Perhaps it's time for the Axminster trial of hip protection.

Integrated approach to care of older people is necessary

EDITOR—We wish to raise the contentious issue of funding in the context of the management of falls in care homes. Critical success factors for the use of hip protectors are accurate fitting and compliance, as mentioned in the editorial by Cameron1; these can be difficult in care homes now that the prevalence of dementia is increasing. Furthermore, wearing hip protectors may be a confounding factor in continence and an impediment to the promotion of continence. A more environmental approach in care homes might be as effective and less intrusive.

The mechanical assault on a hip from a fall will depend on the properties of the flooring. Floor coverings in institutional settings are inevitably a compromise between homeliness, clinical appropriateness (largely the maintenance of cleanliness), and cost. Floor coverings are available with cushioning, as has been used for reducing head …