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

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.