An in-service evaluation of hip protector use in residential homes

The establishment of a hip protector service has allowed us to study eligibility, acceptability and compliance with use, reasons for non-use, and the effect of dementia, confusion, incontinence and risk of falling.

All residents in all residential homes in Poole were assessed at baseline. All eligible residents were offered 1 week's trial of protectors and those who wished to continue were given a set of protectors. Compliance was assessed at 3, 6 and 12 months. Percentages shown for compliance exclude those who died, were transferred, had lost data or in whom follow-up was not yet completed.

Over 18 months, 873 residents from 47 homes were identified (mean age 88 years, female:male 4.5:1). Of these, 745 were considered eligible to wear protectors (86%) and 535 agreed to wear them after 1 week (72%). Compliance over 12 months was 78%. Most wearers wore protectors every day. At 3 months, 83% of demented compared to 73% of not demented residents (P = 0.023), 86% of always confused, 77% of sometimes confused and 72% of never confused (P < 0.009) and 82% of incontinent compared to 73% of continent residents (P = 0.024) were wearing hip protectors. There was a positive linear trend between the risk of falling and compliance (P = 0.048).

The results suggest that there is a 48% chance of a resident wearing the protectors after 1 year. The higher compliance among those with dementia, confusion, incontinence and at high risk of falling supports the concept that hip protectors are worn by those at greatest risk of fracture.