title: Can hip protector use in the nursing home be predicted?
abstract: OBJECTIVE
  To identify resident- and caregiver-related factors that influence hip protector (HP) usage.
  
  
  METHODS
  Prospective observational cohort study over 6 weeks.
  
  
  METHODS
  A 409-bed nursing home located in New York City.
  
  
  METHODS
  Fifty-two residents and 60 certified nursing assistants (CNAs).
  
  
  METHODS
  Free HPs were provided to residents enrolled in the study.
  
  
  METHODS
  HP adherence (number of hours HPs were worn/shift); HP users (subjects who used HPs for more than 1 hour during any 8-hour shift as recorded by CNAs in week 6 or who used HPs at checks performed by research staff in week 6 and intended future use); CNAs' scores on a questionnaire quantifying osteoporosis knowledge, opinions on HPs, job satisfaction, and health locus of control.
  
  
  RESULTS
  Sixty-eight percent of residents were HP users. Factors independently associated with this outcome included male sex, age, Parkinson's disease, family involvement, impaired cognition, dependent ambulation, and CNAs' sense that chance affects health outcomes. In multivariate models, anxiety, resistive behaviors, ambulation, and fall history in residents and CNAs' perceptions of HPs and their sense of how chance or other staff determine health outcomes predicted HP adherence.
  
  
  CONCLUSIONS
  Resident-related factors and CNAs' sense of external controls predicted HP users and HP adherence. CNAs' understanding of osteoporosis and HP affected only HP adherence. Most resident-related factors were not remediable but might help to target likely HP users. To improve HP adherence, educational programs should be designed to improve CNAs' understanding of osteoporosis and HP. Larger studies are needed to confirm these findings.
authors.affiliation: Division of Geriatrics and Gerontology, Weill Medical College, Cornell University, New York, New York 10021, USA. lih2002@med.cornell.edu
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Honkanen
authors.forename: Niall
authors.initials: N
authors.lastname: Monaghan
authors.forename: M C
authors.initials: MC
authors.lastname: Reid
authors.forename: David
authors.initials: D
authors.lastname: Newstein
authors.forename: Karl
authors.initials: K
authors.lastname: Pillemer
authors.forename: Mark S
authors.initials: MS
authors.lastname: Lachs
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006620:Hip Fractures / Q000453:epidemiology / Q000517:prevention & control*; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009519:New York City; D009728:Nursing Assistants; D009735:Nursing Homes / Q000706:statistics & numerical data; D010024:Osteoporosis / Q000150:complications / Q000453:epidemiology; D010300:Parkinson Disease / Q000150:complications / Q000453:epidemiology; D011446:Prospective Studies; D011481:Protective Clothing / Q000706:statistics & numerical data*; D012307:Risk Factors; D012931:Social Environment