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Hip Protectors Lower Risk of Fractures in Nursing Home Residents

January 17, 2003 — The number of hip fractures among nursing home residents could be reduced by 40% through the use of hip protectors and a staff education program, according to a recent article in the British Medical Journal.

Nursing home residents have a high risk of falling and fracturing their hips. Although hip protectors can effectively prevent many hip fractures, the nursing home staff is often not familiar with their use. Also, residents are hesitant to use hip protectors.

This study involved 942 residents in 42 nursing homes in Hamburg, Germany. The residents, who were considered prone to falls, were at least 70 years old, not bedridden, and had lived in the nursing homes for more than three months. In one group (the “intervention group”), the staff learned about the risks of fractures and how to prevent falls. They also received instruction about the effectiveness of hip protectors and how to make them comfortable and better–fitting. They shared their new knowledge with the residents, who were given free hip protectors during the course of the 15–month study.

The hip protectors were used by about 70% of the residents in the intervention group, and by 15% of those in the control group. Twice as many hip fractures occurred within the control group as within the intervention group. Residents in the control group were also hospitalized more frequently due to falls. The researchers estimated that increasing the use of hip protectors within nursing homes and creating a staff training program about falls could decrease the rate of fractures among residents by 40%.

Falls in Nursing Homes

In the United States, about 50% of the 1.5 million nursing home residents fall at least once each year, and among people 85 years and older, 20% of fall–related deaths occur in nursing homes (Falls and Instability in the Elderly, J Am Geriatr Soc 1988 Mar; 36(3): 266–78). Falls account for 87% of fractures in the elderly.

Of all fractures from falls, hip fractures cause the greatest number of deaths and lead to the most severe health problems. In 1996, there were approximately 340,000 hospital admissions for hip fractures nationwide (Falls and Hip Fractures Among Older Adults, National Center for Injury Prevention and Control).

The federal Centers for Disease Control and Prevention (CDC) recommends the use of hip protectors to decrease the effects of falls. The agency does not recommend the use of physical restraints because they weaken and decondition muscles.

Other suggested ways to prevent falls include:

  • Conditioning and exercise to improve strength and endurance, physical therapy, gait training, or walking programs.
  • Physical changes to nursing homes, including installing grab bars, adding raised toilet seats, lowering bed heights, and installing handrails in the hallways.
  • A review of each senior’s medication because some drugs effect balance.

(From Falls in Nursing Homes, CDC.)

Osteoporosis and Fractures

Low bone density or osteoporosis may greatly increase the risk of fractures in elderly women living in nursing homes, according to one report (Low Bone Mineral Density and Risk of Fracture in White Female Nursing Home Residents, JAMA 2000 Aug 23–30; 284(8): 972–7). The study showed that women who had bone density levels below the nursing home average were more than twice as likely to suffer a fracture than women with higher–than–average bone density levels. The risk was more than three times greater for residents with low bone density who also had the ability to move around independently.

“In addition to evaluating a resident’s bone strength, we should also consider their level of activity,” says Dr. Magaziner, one of the authors of the study. “Although further study is needed, medications and dietary supplements to improve bone density or prevent bone loss may offer some protection. Patients who are more mobile may benefit from exercises to improve strength and balance and reduce the risk of falling.”

For more information about fractures and falls, see the web site of the Administration on Aging (Center for Communication and Consumer Services, Falls and Hip Fractures). If you have concerns about an elderly relative in a nursing home, and wish to know about his or her legal rights, please feel free to contact us at Brayton Purcell. We are experienced in all facets of elder abuse law, including nursing home violations and inadequate pain management issues.

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