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Elder Care News
Hip Protectors Do Not Stop Hip Fractures Among
Elderly in Nursing Homes
340,000 hip fractures a year may double or triple
by mid-century
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Pictured item a sample from
hiprotector.com and not associated with study. |
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July 24, 2007 - Use of an energy-absorbing hip
protectors did not protect against hip fracture by elderly nursing home
residents, according to a new study that ended due to lack of
effectiveness of the protectors. This adds to increasing evidence that
hip protectors, as currently designed, are not effective for preventing
hip fractures.
The study will be in the July 25 issue of the
Journal of the American Medical Association, which also contains and
editorial calling for more testing due to the importance of the problem
hip fractures in the growing elderly population.
"In the United States, nearly 340,000 hip fractures
occur per year, more than 90 percent of which are associated with falls,
and the number of hip fractures may double or triple by the middle of
this century. The highest incidence rates of hip fractures have been
reported in nursing home residents, where 50 percent of residents fall
each year," according to the authors of the study.
Hip protectors have been developed to reduce the
impact of falls and risk of hip fractures, but previous studies of their
effectiveness have had conflicting results.
Douglas P. Kiel, M.D., M.P.H., of Hebrew SeniorLife
and Harvard Medical School, Boston, and colleagues conducted a
randomized controlled trial from October 2002 to October 2004 to test
the effectiveness of an energy-absorbing and energy-dispersing hip
protector in reducing the incidence of hip fracture among nursing home
residents.
The trial included 37 nursing homes in which 1,042
residents (average age, 85 years; 79 percent women) wore a hip protector
on only one hip, so that each participant served as his or her own
control allowing the researchers to compare the results with each hip.
The average duration of participation for nursing
home residents was 7.8 months. The hip protector consisted of an outer
layer of polyethylene backed by a hard high-density polyethylene shield
that was backed by ethylene vinyl acetate foam. Overall adherence of the
participants was 73.8 percent.
After a 20-month follow-up, the study was
terminated due to a lack of effectiveness.
The researchers found that the incidence rate of
hip fracture on protected hips (3.1 percent) did not differ from the
incidence rate on unprotected hips (2.5 percent).
Similarly, in analysis for the 334 residents with
greater than 80 percent adherence, the incidence of hip fracture on
protected hips (5.3 percent) did not differ from that on unprotected
hips (3.5 percent).
"In summary, this large multicenter clinical trial
failed to demonstrate a protective effect of a hip protector on hip
fracture incidence in nursing home residents despite high adherence,
confirming the growing body of evidence that hip protectors are not
effective in nursing home populations.
With the development of better pad materials and
more thorough testing, future studies should examine new hip protectors
using nonclustered randomized designs like ours to avoid many
methodological biases," the authors write.
Editorial Calls for More Testing
In an accompanying editorial, Pekka Kannus, M.D.,
Ph.D., and Jari Parkkari, M.D., Ph.D., of the UKK Institute for Health
Promotion Research, Tampere, Finland, comment on the findings of Kiel
and colleagues.
An editorial in the same JAMA issue, does not think
this study, or those done earlier, are sufficient to make
evidence-based recommendations for or against hip protectors among
frail, nursing home residents.
Writers of the editorial, Pekka Kannus, M.D.,
Ph.D., and Jari Parkkari, M.D., Ph.D., of the UKK Institute for Health
Promotion Research, Tampere, Finland, say the wide variation in hip
protectors models and potential difference in adherence among uses calls
for more study.
The anti-fracture efficacy of each protector model
should first be examined in vitro (as it was for the protectors used by
Kiel et al) and then in actual falls, continuing with analyses of
protector position at the time of fall impact, as well as user
adherence, the write.
The importance of this health problem-falls and
hip fractures among older adults should make the work a compelling
ongoing priority for health research throughout the world."
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