Predictors of adherence to the use of hip protectors in nursing home residents

OBJECTIVES: To assess predictors of hip-protector use in nursing home residents under usual-care conditions and after intervention consisting of structured education of nurses and nursing home residents and provision of free hip protectors. DESIGN: Nested cohort analyses within a cluster randomized, controlled trial with 18 months follow-up. SETTING: Forty-nine nursing home clusters in Hamburg, Germany. PARTICIPANTS: Residents with at least one fall during the study period (intervention group, n=237; usual-care group, n=274). MEASUREMENTS: Use of hip protector while falling. Regression analyses were performed for each of the two cohorts of fallers using the time to the first fall without hip protector as the dependent variable. Predefined nursing home cluster-related parameters (center, staffing ratio, proportion of registered nurses in nursing staff, hip-protector use before study period) and resident-related parameters (sex, history of falls and fractures, fear of falling, urinary incontinence, use of walking aid, degree of disablement) were considered as explanatory variables. RESULTS: Under usual care, 97% of fallers (n=266), compared with 62% (n=148) in the intervention group, experienced at least one fall without hip protection. Using Cox proportional hazards models with and without frailty parameter (random cluster effect), the following predictors were identified: intervention group: use of walking aid, hazard ratio (HR)=1.53 (95% confidence interval (CI):0.98-2.39) and no urinary incontinence, HR=1.47 (95% CI:1.03-2.09); usual care: nursing staff per 10 residents, HR=0.78 (95% CI=0.63-0.96); high degree of disablement, HR=1.38 (95% CI=1.06-1.80); strong fear of falling, HR=0.78 (95% CI=0.60-1.02). The nursing home cluster was a significant predictor in the control group (P=.029), but not in the intervention group (P=.100). CONCLUSION: Only a few and weak predictors of hip-protector use of questionable relevance could be identified in both groups. Future research should concentrate on the implementation of interventions of proven efficacy, such as provision of hip protectors combined with structured education of staff and residents.