Factors associated with hip protector adherence amongst 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. Objectives: To investigate factors that are associated with adherence and whether those factors account for the variation in adherence between residential care homes (RCHs). Design: Six-month prospective study. Subjects and Setting: 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. Discussion: 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.