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

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7380.76 (Published 11 January 2003) Cite this as: BMJ 2003;326:76
  1. Gabriele Meyer, research fellowa,
  2. Andrea Warnke, research assistanta,
  3. R Bender, statisticianb,
  4. I Mühlhauser, professora (Ingrid_Muehlhauser{at}uni-hamburg.de)
  1. a Unit of Health Sciences and Education, University of Hamburg, Martin-Luther-King-Platz 6, D-20146 Hamburg, Germany
  2. b Department of Epidemiology and Medical Statistics, School of Public Health, University of Bielefeld, PO Box 10 01 31, D-33501 Bielefeld, Germany
  1. Correspondence to: I Mühlhauser
  • Accepted 17 October 2002

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.

What is already known on this topic

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

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%

Footnotes

  • Funding Public Health Research Network Northern Germany (project TP III-1). Rölke Pharma (Hamburg, Germany) provided the hip protectors for this study and has given a grant to the University of Hamburg.

  • Competing interests AW was formerly an employee and is at present a consultant of Rölke Pharma, the German distributor of Safehip. AW and GM have received travel grants from Rölke Pharma.

  • Accepted 17 October 2002
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