BMJ 2003;326:76 ( 11 January )

Papers

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

Gabriele Meyer, research fellow, ^a Andrea Warnke, research assistant, ^a R Bender, statistician, ^b I Mühlhauser, professor. ^a

^a Unit of Health Sciences and Education, University of Hamburg, Martin-Luther-King-Platz 6, D-20146 Hamburg, Germany, ^b Department of Epidemiology and Medical Statistics, School of Public Health, University of Bielefeld, PO Box 10 01 31, D-33501 Bielefeld, Germany

Correspondence to: I Mühlhauser Ingrid_Muehlhauser{at}uni-hamburg.de

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.

What is already known on this topic Nursing home residents are at particularly high risk of fracturing a hip Hip protectors can effectively prevent hip fractures Adherence to the use of hip protectors is poor What this study adds The use of hip protectors in nursing homes can be substantially increased by a single session education targeted at nursing staff and residents and provision of free hip protectors Increasing the use of hip protectors resulted in a relative reduction of hip fractures of about 40%

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© 2003 BMJ Publishing Group Ltd
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Rapid Responses:

Read all Rapid Responses

The need for a community trial

David J Torgerson, et al.
bmj.com, 10 Jan 2003 [Full text]

Another way to think about hip protectors

Paul J Young
bmj.com, 10 Jan 2003 [Full text]

Use of hip protectors in nursing homes: clarifications requested.

Susan E Kurrle, et al.
bmj.com, 11 Jan 2003 [Full text]

Re: The need for a community trial

Gabriele Meyer, et al.
bmj.com, 11 Jan 2003 [Full text]

Re: Another way to think about hip protectors

Gabriele Meyer, et al.
bmj.com, 11 Jan 2003 [Full text]

Re: Use of hip protectors in nursing homes: clarifications requested.

Gabriele Meyer, et al.
bmj.com, 11 Jan 2003 [Full text]

Re: Re: Another way to think about hip protectors

Paul J Young
bmj.com, 12 Jan 2003 [Full text]

A clarification of previous submission

Paul J Young
bmj.com, 14 Jan 2003 [Full text]

Is the hip protector effective?

Percy V van Eerten
bmj.com, 14 Jan 2003 [Full text]

Re: Is the hip protector effective?

Gabriele Meyer, et al.
bmj.com, 15 Jan 2003 [Full text]

Effectiveness of the studied hip protector remained uncertain

Pekka A Kannus
bmj.com, 16 Jan 2003 [Full text]

Re: Effectiveness of the studied hip protector remained uncertain

Ingrid Mühlhauser, et al.
bmj.com, 17 Jan 2003 [Full text]

Re: Re: Effectiveness of the studied hip protector remained uncertain

Pekka A Kannus
bmj.com, 18 Jan 2003 [Full text]