Factors associated with hip protector adherence among older people in residential care.
BACKGROUND
There is evidence to suggest that hip protectors (HPs) prevent fractures among older people living in nursing homes. Studies have found HP wearing rates (adherence) to be low.


OBJECTIVE
To investigate factors that are associated with adherence and whether those factors account for the variation in adherence between residential care homes (RCHs).


METHODS
Six-month prospective study.


METHODS
299 people aged 65 years and over (80% female, mean age 86 years) living in 17 RCHs. 128 of these wore HPs at least once.


METHODS
All residents in the homes were offered three pairs of SAFEHIP HPs, and adherence was measured using diaries completed daily. A mixed model regression analysis was used to investigate predictive factors for wearing HPs and the effects of these factors on the between-home variability in adherence.


RESULTS
Increased HP adherence was associated with hypertension, incontinence, a previous history of falls and fractures, and hip fracture history in the RCH. Decreased adherence was associated with arthritis of the lower limbs and dizziness on first rising. The large variation in adherence between RCHs was almost completely explained by these factors.


CONCLUSIONS
The evidence for the efficacy of HPs is weakening. Low adherence compromises the power of trials to detect a real effect. The literature is inconsistent regarding what factors are associated with adherence. Nevertheless, it suggests that some people who are at increased risk of fracture are more likely to wear HPs. Variations in staff or resident knowledge and attitude towards HPs may explain some variation between homes.
Cryer
C
C
Centre for Health Services Studies, University of Kent, Canterbury, UK. colin.cryer@ipru.otago.ac.nz
Knox
A
A
Stevenson
E
E
D000058:Accidental Falls / Q000517:prevention & control; D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000517:prevention & control*; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D009735:Nursing Homes; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011482:Protective Devices / Q000706:statistics & numerical data*; D040242:Risk Reduction Behavior