According to results recently published in the July 25th issue of the Journal American Medical Association, devices designed to help older adults to lessen the impact of a fall failed to reduce the rate of hip fractures. The study was conducted in nursing homes and was led by Dr. Douglas K. Kiel, associated with Harvard and Hebrew SeniorLife Hospital.
A hip fracture refers to the bone being broken near the femur, the long bone running through the thigh, near the hip joint. Osteoporosis is one of the risks often associated with hip fractures.
Hip fractures are generally caused by older adults falling because of improper body balance and inhability to maintain a standing posture. Many hospitalization of the elderly are dure to hip fractures.
Elderly in long-term care facilities (nursing homes) have a high incidence of hip fractures which seem to be associated with falls that occur in those facilities.
Dr. Kiel and collaborators decided to test the efficacy of a hip protector prototype consisting of a hard polyethylene shield covered with foam and to be use into undergarments by older adults. The hip protector is not available commercially.
Residents at 37 nursing homes from the US were asked to use the hip protector during the time the study was being performed to evaluate the rare of hip fractures among hip protector users and non-users.
The study was a large clinical trial (334 adherent patients ) and was halted because after 20 months of results showed that older adults that used the designed hip protector had a higher incidence (3.1%) of hip fractures due to falls than the non users (2.5%) of the hip protection device. Observed differences were statistically significant.
After 20 months, 1,042 nursing home residents had contributed to the study with an average participation of 7.8 months. A total of 676 person-years were used as observations for this study.
Study participants were long term care patients with significant cognitive impairment. Fifty percent of hem could not get out of bed or walk around. Some were continent of urine (41.5%) and some (57%) had bowel continence problems. Only 6% had had hip replacement and about 15% had a hip fracture.
This was the first study to be carried out in nursing homes in the US. All of the previously published reports have been carried out in nursing facilities abroad. Although results were discouraging, for the designed device, the need for hip protection in high risk older patients staying al log-term facilities remains.
The study concluded that “further studies of hip protectors with better pad materials and better trial designs would be worthwhile.”
Kiel DP, et al (2007). Efficacy of a Hip Protector to Prevent Hip Fracture in Nursing Home Residents: The HIP PRO Randomized Controlled Trial. Journal American Medical Association.
Vol. 298:pages 413-422