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The EXO+ hip protector was developed to minimize the risk of hip fractures in seniors following falls. This study evaluated its usability in a Singapore nursing home from the perspective of the staff, focusing on learnability, efficiency, and satisfaction. A mixed-method design was employed, with nursing home residents wearing the EXO+ daily for eight weeks. Quantitative data on wear time were collected alongside qualitative insights from four repeated focus group discussions with care staff. In total, 15 residents (including 8 residents with cognitive impairments) and 9 staff participated. The analysis revealed six themes and fourteen subthemes related to EXO+’s usability. The residents wore the device for an average of 1.54 h per day, with those having cognitive impairments showing increased wear times, especially in the mornings and on weekdays. The findings indicated that the EXO+ was learnable and satisfactory for nursing home use, provided there are adequate supporting features. The efficiency of the EXO+ was not fully measured since no falls were reported during the study period. The study offers valuable insights for potential design modifications and workflow adaptations to enhance the implementation of hip protectors in healthcare settings, highlighting facilitators and barriers to support device uptake.

The EXO+ hip protector was developed to minimize the risk of hip fractures in seniors following falls. This study evaluated its usability in a Singapore nursing home from the perspective of the staff, focusing on learnability, efficiency, and satisfaction. A mixed-method design was employed, with nursing home residents wearing the EXO+ daily for eight weeks. Quantitative data on wear time were collected alongside qualitative insights from four repeated focus group discussions with care staff. In total, 15 residents (including 8 residents with cognitive impairments) and 9 staff participated. The analysis revealed six themes and fourteen subthemes related to EXO+'s usability. The residents wore the device for an average of 1.54 h per day, with those having cognitive impairments showing increased wear times, especially in the mornings and on weekdays. The findings indicated that the EXO+ was learnable and satisfactory for nursing home use, provided there are adequate supporting features. The efficiency of the EXO+ was not fully measured since no falls were reported during the study period. The study offers valuable insights for potential design modifications and workflow adaptations to enhance the implementation of hip protectors in healthcare settings, highlighting facilitators and barriers to support device uptake. [ABSTRACT FROM AUTHOR]

During the global pandemic, social distancing rules made it difficult to conduct human-centred research into hip fracture protection, and in-person focus groups were abandoned. An online survey was developed to safely gather insights from people living with osteoporosis who are at risk of fragility fractures. The survey data informed the design of five personas that provide a critical lens to drive innovation in hip protector garment design and evaluate ongoing concept development. Although the pandemic disrupted people-facing research, the use of survey data provided a greater breadth of voices to inform the personas than focus groups alone. [ABSTRACT FROM AUTHOR]

Osteoporosis is characterized by loss of bone mineral density and increased fracture risk. Reduction of hip fracture incidence is of major clinical importance. Hip protectors aim to attenuate the impact force transmitted to the femur upon falling, however different conclusions on their efficacy have been reported; some authors suggest this may be due to differences in compliance. The aim of this study was to apply an In Silico trial methodology to predict the effectiveness of hip protectors and its dependence on compliance. A cohort of 1044 virtual patients (Finite Element models of proximal femur) were generated. A Markov chain process was implemented to predict fracture incidence with and without hip protectors, by simulating different levels of compliance. At each simulated follow-up year, a Poisson distribution was randomly sampled to determine the number of falls sustained by each patient. Impact direction and force were stochastically sampled from a range of possible scenarios. The effect of wearing a hip protector was simulated by applying attenuation coefficients to the impact force (12.9 %, 19 % and 33.8 %, as reported for available devices). A patient was considered fractured when impact force exceeded the femur strength. Without hip protector, virtual patients experienced 66 ± 5 fractures in 10 years. Wearing the three devices, fracture incidence was reduced to 43 ± 4, 35 ± 4 and 17 ± 2 respectively, at full compliance. As expected, effectiveness was dependent on compliance. This In Silico trial technology can be applied in the future to test multiple interventions, optimise intervention strategies, improve clinical trial design and drug development. [ABSTRACT FROM AUTHOR]

Many elderly people use hip protectors to prevent hip fractures from sideways falls. These hip protectors absorb or shunt away the energy applied to the greater trochanter. Herein, shear-thickening polymer (STP)-based hip protectors composed of STP and polyurethane foam are studied. The purpose of this study was to identify the main factor that reduces the impact force directly applied to the femoral neck region and to determine the optimal thickness of STP in hip protectors. Seven hip protectors of different thicknesses were prepared, and two sets of free-fall mechanical tests with a low impact energy of 25.1 J and moderate impact energy of 44.1 J were conducted for each hip protector. When the thickness of STP exceeded 8 mm, the resultant peak force tended to plateau under both impact conditions, and the force attenuation capacity decreased even under low impact energy conditions. Thus, a hip protector with a 6 mm or 8 mm STP and 5 mm foam was recommended. The STP was the key factor affecting force attenuation capacity, not the polyurethane foam. However, the foam also played an important role in helping the STP function and improving compliance for users. [ABSTRACT FROM AUTHOR]

Abstract The purpose of this study was to develop a highly comfortable 3D male hip protector using 3D modeling and printing technologies. The hip protector pads and patterns were devised using 3D human body shapes, and three types of pads were chosen in consideration of snowboarding motions. The three types of pads were as follows: first, the original type with no hole; second, an inner open type with an incision on the inside; and third, an outer open type, with an incision on the outside. Another variable of the protective pads was the material: 3D printed thermoplastic polyurethane (TPU) pad + ethylene–vinyl acetate (EVA) foam or only EVA foam. Six types of pad prototypes were 3D printed and evaluated for subjective wearing comfort. Subjective comfort, fit, activity comfort, and shock absorption were evaluated on an 11-point Likert scale. The study results showed that protectors printed using TPU material were not different from the results of 3D modeling. The evaluation results revealed that comfort, fit, and motion comfort were all negatively evaluated by subjects when wearing the original pad. While fit, comfort, and motion comfort were all positively evaluated by subjects when wearing the outer open-type pad, and comfort and motion comfort were positively evaluated by subjects when wearing the inner open-type pad. With respect to materials, pads made with the 3D printing (TPU) and EVA foam combination provided the best results in terms of overall comfort, buttocks comfort, and activity comfort.

Hip fractures in older adults, which often lead to lasting impairments and an increased risk of mortality, are a major public health concern. Hip fracture risk is multi-factorial, affected by the risk of falling, the load acting on the femur, and the load the femur can withstand. This study investigates the influence of impact direction on hip fracture risk and hip protector efficacy. We simulated falls for 4 subjects, in 7 different impact directions (15° and 30° anterior, lateral, and 15°, 30°, 60°, and 90° posterior) at two different impact velocities (2.1 and 3.1 m/s), all with and without hip protector, using previously validated biofidelic finite element models. We found the highest number of fractures and highest fragility ratios in lateral and 15° posterior impacts. The hip protector attenuated femur forces by 23–49 % for slim subjects under impact directions that resulted in fractures (30° anterior to 30° posterior). The hip protector prevented all fractures (6/6) for 2.1 m/s impacts, but only 10% of fractures for 3.1 m/s impacts. Our results provide evidence that, regarding hip fracture risk, posterior-lateral impacts are as dangerous as lateral impacts, and they support the efficacy of soft-shell hip protectors for anterior- and posterior-lateral impacts. [ABSTRACT FROM AUTHOR]

This study investigates the effects of fall configurations on hip fracture risk with a focus on pelvic soft tissue shape. This was done by employing a whole-body finite element (FE) model. Soft tissue thickness around the pelvis was measured using a standing CT system, revealing a trend of increased trochanteric soft tissue thickness with higher BMI and younger age. In the lateroposterior region from the greater trochanter, the soft tissues of elderly females were thin with a concave shape. Based on the THUMS 5F model, an elderly female FE model with a low BMI was developed by morphing the soft tissue shape around the pelvis based on the CT data. FE simulation results indicated that the lateroposterior fall led to a higher femoral neck force for the elderly female model compared to the lateral fall. One reason may be related to the thin soft tissue of the pelvis in the lateroposterior region. Additionally, the effectiveness of interventions that can help mitigating hip fractures in lateroposterior falls on the thigh-hip and hip region was assessed using the elderly female model. The attenuation rate of the femoral neck force by the hip protector was close to zero in the thigh-hip fall and high in the hip fall, whereas the attenuation rate of the compliant floor was high in both falls. This study highlights age-related changes in the soft tissue shape of the pelvis in females, particularly in the lateroposterior regions, which may influence force mitigation for the hip joint during lateroposterior falls. [ABSTRACT FROM AUTHOR]

Hip fractures cause severe worldwide morbidity and loss of independence, costing national healthcare systems millions of pounds each year. The incidence is increasing with the expanding elderly population common of many Western countries. Hip protectors have been progressively studied in recent years focussing upon their use in hip fracture prevention, and compliance levels. This review aims to determine the effectiveness of protectors, and also investigates compliance levels. A search for English language Randomised Controlled Trials (RCTs) testing effectiveness of hip protectors was performed on Medline and Embase. Nine articles fulfilling the search criteria were found. Each was reviewed for hip protector effectiveness and compliance rates within the study, with results and conclusions critically-appraised. Of the nine articles, six (66.6%) found hip protectors to be effective in preventing hip fractures in selective populations. However, poor compliance rates were found in all reviewed trials. Future research should therefore focus upon improving compliance rates in the studied population.

The purpose of this study was to develop a highly comfortable 3D male hip protector using 3D modeling and printing technologies. The hip protector pads and patterns were devised using 3D human body shapes, and three types of pads were chosen in consideration of snowboarding motions. The three types of pads were as follows: first, the original type with no hole; second, an inner open type with an incision on the inside; and third, an outer open type, with an incision on the outside. Another variable of the protective pads was the material: 3D printed thermoplastic polyurethane (TPU) pad + ethylene–vinyl acetate (EVA) foam or only EVA foam. Six types of pad prototypes were 3D printed and evaluated for subjective wearing comfort. Subjective comfort, fit, activity comfort, and shock absorption were evaluated on an 11-point Likert scale. The study results showed that protectors printed using TPU material were not different from the results of 3D modeling. The evaluation results revealed that comfort, fit, and motion comfort were all negatively evaluated by subjects when wearing the original pad. While fit, comfort, and motion comfort were all positively evaluated by subjects when wearing the outer open-type pad, and comfort and motion comfort were positively evaluated by subjects when wearing the inner open-type pad. With respect to materials, pads made with the 3D printing (TPU) and EVA foam combination provided the best results in terms of overall comfort, buttocks comfort, and activity comfort. [ABSTRACT FROM AUTHOR]

Shear-thickening polymer (STP) has a unique property of increasing its viscosity with an increase in shear strain to attenuate the application of force, implying that it can be used as a material for hip protectors. This study introduces a new hip protector composed of STP and compares its force attenuation capacity to that of other commercial hip protectors in simulated sideways falls. The performance of the STP-based hip protector was analyzed against eight commercial hip protectors (Pelican, Posey, SafeHip, Hornsby, FallSafe, HipSaver, Impact Wear (Hard), Impact Wear (Soft)). The simulated sideways fall conditions were created by a drop weight impact testing system using an anatomical hip model. The machine was dropped from a 20 or 30 cm height resulting in impact energy of 25.1 J (low) or 44.1 J (moderate), respectively. At low impact energy, the commercial hip protectors showed an attenuation range from 21.6 % to 53.3 %, and the STP-based hip pad was able to attenuate the force by 42.7 %. At moderate impact energy, the commercial hip protectors showed an attenuation range from 23 % to 54.3 %, and the STP-based hip pad was able to attenuate the force by 32.6 %. The low coefficient of variance showed a high precision in the execution of the experiments. Although the STP-based hip protector was thinner than the average of commercial soft shell pads and retained comfortable fit, it showed comparable force attenuation capacity to the commercial ones for the low impact energy test. This study highlights that STP, in combination with a polyurethane foam layer, provides the best features in energy-absorption and shunting, showing that it can be used in hip protectors to gain a competitive advantage over others. [ABSTRACT FROM AUTHOR]

Abstract Background If worn during a fall, hip protectors substantially reduce risk for hip fracture. However, a major barrier to their clinical efficacy is poor user adherence. In long-term care, adherence likely depends on how committed care providers are to hip protectors, but empirical evidence is lacking due to the absence of a psychometrically valid assessment tool. Methods We conducted a cross-sectional survey in a convenience sample of 529 paid care providers. We developed the 15-item C-HiP Index to measure commitment, comprised of three subscales: affective, cognitive and behavioural. Responses were subjected to hierarchical factor analysis and internal consistency testing. Eleven experts rated the relevance and clarity of items on 4-point Likert scales. We performed simple linear regression to determine whether C-HiP Index scores were positively related to the question, “Do you think of yourself as a champion of hip protectors”, rated on a 5-point Likert scale. We examined whether the C-HiP Index could differentiate respondents: (i) who were aware of a protected fall causing hip fracture from those who were unaware; (ii) who agreed in the existence of a champion of hip protectors within their home from those who didn’t. Results Hierarchical factor analysis yielded two lower-order factors and a single higher-order factor, representing the overarching concept of commitment to hip protectors. Items from affective and cognitive subscales loaded highest on the first lower-order factor, while items from the behavioural subscale loaded highest on the second. We eliminated one item due to low factor matrix coefficients, and poor expert evaluation. The C-HiP Index had a Cronbach’s alpha of 0.96. A one-unit increase in championing was associated with a 5.2-point (p

Various mechanical and biomechanical test systems to evaluate the effectiveness of hip protectors designed to prevent hip fracture as a result of falls were examined in this review. The articles considered were selected systematically. The effect of differences in design criteria was demonstrated, and it was observed that the impact energy employed during testing dramatically affects the performance of the hip protector. Over the past three decades, researchers have continuously experimented with various systems to determine the efficacy of various hip protectors. The primary aim has been to make informed decisions in optimizing hip protector design. This article provides a systematic review of various test systems employed in the determination of the biomechanical efficacy of hip protectors. A systematic literature search was carried out, and 28 relevant articles were included to demonstrate the effect of test systems in the evaluation of the biomechanical effectiveness of hip protectors. Methodological studies illustrated the appropriate use of impact testing systems for the simulation of hip anatomy and fall dynamics in evaluating the effectiveness of hip protectors in preventing a hip fracture. This systematic review has demonstrated the effect of the variability of test systems on the evaluation of impact attenuation by various hip protectors. The lack of standardized test systems accounts for the inconsistencies in the test results of the efficacy of hip protectors. This has been a major challenge in the efforts of researchers to optimize the interventions. The standardization of test systems may require needed improvements immediately as opposed to the development of new interventions in order to ensure that only hip protectors with adequately proven efficacies are deployed for clinical trials or for the protection of the hips of vulnerable individuals from sideways impact. [ABSTRACT FROM AUTHOR]

Improved understanding is required of how the mechanics of the fall affect hip fracture risk. We used a hip impact simulator to determine how peak stresses at the femoral neck were affected by pelvis impact angle, hip abductor muscle force, and use of a wearable hip protector. We simulated falls from standing (2 m/s impact velocity) involving initial hip abductor muscle forces of 700 or 300 N. Trials were acquired for impact to the lateral aspect of the greater trochanter, and impact to the pelvis rotated 5°, 10° and 15° anteriorly (positive) or posteriorly (negative). Measures were acquired with and without a commercially available hip protector. During trials, we measured three-dimensional forces with a load cell at the femoral neck, and derived peak compressive and tensile stresses. Peak compressive stress increased 37% (5.91 versus 4.31 MPa; p < 0.0005) and peak tensile stress increased 209% (2.31 versus 0.75 MPa; p < 0.0005) when the pelvis impact angle changed from 15° anterior to −15° posterior. For lateral impacts, the peak tensile and compressive stresses averaged 73% and 8% lower, respectively, in the 700 N than 300 N muscle force condition, but the effect was reversed for anteriolateral or posteriolateral impacts. The attenuation in peak compressive stress from the hip protector was greatest for posteriolateral impacts (−15 to −5°; 36–41%), and least for anteriolateral (+15°; 10%). These results clarify the effects on hip fracture risk during a fall of pelvis impact angle and muscle forces, and should inform the design of improved hip protectors. [ABSTRACT FROM AUTHOR]

An innovative 3D printed hip protector has been designed and tested to decrease the possibility of hip fracture in a sideways fall to a hard surface. The main design purpose was to create custom fit hip protector, reduce the manufacturing period and make the protector comfortable to wear. This work compares the new energy shunting 3D printed hip protector design with an existing energy absorbing hip protector. A drop tower mechanical test rig was designed and developed to simulate a sideways fall with sufficient impact energy to fracture an unprotected greater trochanter (GT). The test rig incorporates the actual geometry of a femur made from steel and uses a foam to simulate trochanteric soft tissue over the greater trochanter. Similar impact energy was used for the testing of each hip protector. The weight of the striker mass was maintained, and the height was adjusted to obtain an impact energy of 21–43J to produce femoral neck force of 3–9 kN. Results illustrate that the 3D hip protector compares favorably in attenuating impact force capable of causing hip fracture to a value below the fracture threshold of 3.472 kN. The influence of the 3D hip protector on peak transmitted forces to the vulnerable site of the greater trochanter is shown to be positive. It is anticipated that future protectors can be 3D printed after optimizations to end the bundling of same hip protector for different body geometry.

Introduction: In order to develop a good hip protector to prevent in the elderly hip fracture as a result of a fall, we studied the buffer characteristics of sponges and air cushions. Methods: The buffer rate of material was defined, and the absorption ability of the material to instantaneous impact was evaluated. An experimental device was developed and used to measure the buffer rates of sponges and leak-allowed air cushions with orifice(s). Results: According to the experimental results, the buffer rate largely depended on the hardness of the sponge materials, and on the total area of the orifice(s) for the leak-allowed air cushions. Compared with the sponge with correct hardness and thickness, the buffer characteristic of the air cushion seems slightly inferior. Conclusions: Nevertheless, the air cushion’s overall performance, including the better buffer rate, ultra-lightness, flexibility, and low cost, makes it a potentially useful material for hip protectors and other sport protectors. [ABSTRACT FROM AUTHOR]

Zusammenfassung Hintergrund Für den Bruch des Knochens bei hüftnahen Frakturen sind v.a. seitliche Kräfte von mehr 1-2 kN bei älteren und 8 kN bei jüngeren Personen verantwortlich. Material und Methoden Um die Schutzwirkung von Hüft- und Rückenprotektoren (HP/RP) zur Minderung der Aufprallkräfte zu testen, wurde eine Kegelkugel (3,1 kg) aus verschiedenen Höhen (H: 25–100 cm) auf 29 verschiedene Protektoren, die auf einer Kraftmessplatte positioniert waren, fallen gelassen. Die verbleibenden Kraftspitzen (KS) und Verzögerungen bis zur Kraftspitze (VKS) wurden gemessen. Ergebnisse Schon bei einer Fallhöhe von 45 cm wurden ohne Protektor KS von 16,2 kN gemessen. Bei den 14 orthopädischen HP reduzierten sich die KS im Mittel auf 1,6 kN (H25) bzw. 9,9 kN (H100) mit VKS von 5,6 ms (H25) bzw. 3,9 ms (H100). Bei den 7 Sport-HP reduzierten sich die KS auf 3,3 kN (H 25) bzw. 12,4 kN (H100) mit VKS von 2,1 ms (H25) bzw. 1,5 ms (H100). Bei den 12 Sport-RP reduzierten sich die KS auf 2,1 kN (H25) bzw. 6,6 kN (H100) mit VKS von 5,3 ms (H25) bzw. 2,8 ms (H100). Schlussfolgerungen Insgesamt überschreiten die verbleibenden KS aktueller Protektoren oft und schnell vermeintlich verträgliche Kräfte für Knochenfrakturen, v.a. bei älteren Personen. Protektoren können die hohen Erwartungen noch nicht erfüllen und werden in ihrem Schutzvermögen deutlich überschätzt. Sie sollten eine Dicke von mindestens 15 mm haben, bevorzugt viskoelastisches Material in Kombination mit einer Hartschale. Sport-HP zeigen noch große Defizite. RP schützen nur vor direkten Kontusionen, nicht jedoch vor axialen Kompressionen oder die HWS. Summary Background Forces exceeding 1-2 kN for elderly and 8 kN for younger people that act laterally on the hip mainly are responsible for fractures of this bone. Material and Methods In order to test how effective different hip and back protectors HP/BP can reduce the impact forces, a bowl (3.1 kg) was dropped from different heights (H: 25–100 cm) onto 29 different protectors, placed on a force plate. The remaining peak force (PF) and the time delay to peak force (DPF) were measured. Results Without any protector, a PF of 16.2 kN was measured when using a drop height of just 45 cm. In the 14 HP for orthopedic usage, PF decreased to an average of 1.6 kN (H25) and 9.9 kN (H100) with a DPF of 5.6 ms (H25) and 3.9 ms (H100). In the 7 sports HP, PF was less reduced to 3.3 kN (h 25 cm) and 12.4 kN (h 100 cm) with a VKS of 2.1 ms (h 25 cm) and 1.5 ms (h 100 cm). For the 12 sports BP, the PF was reduced to 2.1 kN (H25) and 6.6 kN (H100) with a DPF of 5.3 ms (H25) and 2.8 ms (H100). Conclusions Overall remaining PF of current protectors often and quickly exceed supposed limits of bone fracture strength, particularly in elderly people. Therefore, sufficient safety does not seem to exist yet and protectors must not be overestimated in their protection potential. Protectors should have a certain thickness of at least 15 mm preferably with viscoelastic material in combination with a hardshell. HP for sports still show large deficits. BP only protect against direct contusion but not against axial compressions or cervical spine. [ABSTRACT FROM AUTHOR]

Background: If worn during a fall, hip protectors substantially reduce risk for hip fracture. However, a major barrier to their clinical efficacy is poor user adherence. In long-term care, adherence likely depends on how committed care providers are to hip protectors, but empirical evidence is lacking due to the absence of a psychometrically valid assessment tool.Methods: We conducted a cross-sectional survey in a convenience sample of 529 paid care providers. We developed the 15-item C-HiP Index to measure commitment, comprised of three subscales: affective, cognitive and behavioural. Responses were subjected to hierarchical factor analysis and internal consistency testing. Eleven experts rated the relevance and clarity of items on 4-point Likert scales. We performed simple linear regression to determine whether C-HiP Index scores were positively related to the question, "Do you think of yourself as a champion of hip protectors", rated on a 5-point Likert scale. We examined whether the C-HiP Index could differentiate respondents: (i) who were aware of a protected fall causing hip fracture from those who were unaware; (ii) who agreed in the existence of a champion of hip protectors within their home from those who didn't.Results: Hierarchical factor analysis yielded two lower-order factors and a single higher-order factor, representing the overarching concept of commitment to hip protectors. Items from affective and cognitive subscales loaded highest on the first lower-order factor, while items from the behavioural subscale loaded highest on the second. We eliminated one item due to low factor matrix coefficients, and poor expert evaluation. The C-HiP Index had a Cronbach's alpha of 0.96. A one-unit increase in championing was associated with a 5.2-point (p < 0.01) increase in C-HiP Index score. Median C-HiP Index scores were 4.3-points lower (p < 0.01) among respondents aware of a protected fall causing hip fracture, and 7.0-points higher (p < 0.01) among respondents who agreed in the existence of a champion of hip protectors within their home.Conclusions: We offer evidence of the psychometric properties of the C-HiP Index. The development of a valid and reliable assessment tool is crucial to understanding the factors that govern adherence to hip protectors in long-term care. [ABSTRACT FROM AUTHOR]

Fused deposition modeling has provided a cheap and effective method for the rapid production of prototypes and functional products in many spheres of life. In this study, three-dimensional (3D) printing techniques to produce and optimize a hip protector that will assure clinical efficacy are presented. The I-Optimal design was used to optimize the hip protector's significant parameters (infill density, shell thickness, and material shore hardness) to obtain maximum femoral neck force attenuation of the 3D-printed hip protector. A drop impact tower device simulates the impact force at the hip's parasagittal plane during a fall. The results show that the infill density has the most significant influence on attenuation properties, followed by the infill density combined with the material shore hardness. By maximizing all the parameters, it is demonstrated that using an additive manufacturing technique to print hip protectors could be an effective strategy in curbing hip fractures., Competing Interests: No competing financial interests exist., (Copyright 2023, Mary Ann Liebert, Inc., publishers.)

Victoria Leytin, Francesca L Beaudoin Department of Emergency Medicine, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USADate of preparation: 6th December 2010 Conflict of interest: None declaredClinical question: Is there evidence that hip protectors and vitamin D with calcium supplementation reduce hip fractures in the elderly?Results: The results are that vitamin D and calcium supplementation reduce incidence of hip fractures. Hip protectors provide some benefit in reducing hip fractures in elderly patients in residential facilities.Implementation: Primary care providers should assess patients for the risk of hip fracture and consider using hip protectors and nutritional supplementaton in selected individuals to prevent fractures.Keywords: hip fracture, hip protector, vitamin D, calcium

Hip protectors can reduce the incidence of hip fractures. However, low user acceptance and compliance in use remain a major obstacle in the effective use of hip protectors, due to its discomfort and extra effort needed to wear it, etc. A leak-allowed air cushion is an air-bubble cushion designed to have one or some orifices on the side. In this cushion, an impact load is shunted to open air with airflow through orifice(s), and the energy is dissipated by the friction of the airflow. With the lightness, the flexibility, and the inexpensiveness, this cushion has a potential to be accepted by the target users at high levels of compliance. The purpose of this study was to evaluate a potential of the cushion as a hip-protector material by comparing with other three commercially-variable impact attenuation materials: polyethylene elastmer; silicon gel; and porous polyurethane. To this end, we performed impact tests for pads made of the materials using a falling-mass impact loader. The pad made of leak-allowed air cushions reduced the peak impact force from 7700N (recorded with no pad) to 1213 N, which was 38—64 % lower than the attenuated peak forces recorded in the other material pads. We concluded that the leak-allowed air cushion could be a novel hip protector material with high capacity of impact-force attenuation.

The present paper is concerned with the development of a hip protector with a circular hole in the center to prevent hip fracture by fall. Firstly, we performed fall simulations by use of an elderly Japanese female model of a rigid whole body with a detailed finite element thigh model. The simulation showed that the hole in a hip protector significantly reduced impact, and that a protector with a hole of 50 mm diameter gave the minimum impact load in most cases. It also showed that thicker protectors and protectors of stiffer materials were more effective for hip fracture prevention. The effects of a protector offset from reference position, vacancies under the hole, and the shortening of protector length on the reduction ratio of impact were elucidated in detail. Secondly, based on the design guide suggested by the simulations, we developed a weight-drop test apparatus and performed experiments to examine the simulation results. It is ascertained that the hip protector with a hole of 50 mm diameter has excellent performance for hip fracture prevention.

Purpose Falls cause up to 95% of geriatric hip fractures, of which the rates are two- to three-fold higher in care facilities. Hip protectors (HP) have been proven effective against fall-related hip fractures (Korall et al., 2019); however, user compliance with HPs in care facilities remains very low, particularly in Hong Kong (<20%). Recent studies show that user compliance can be facilitated through structured education for caregivers and better design of HP that enhances comfort of wearing (Korall et al., 2015). Therefore, our study sought to promote user compliance with wearable HP among older adults in care facilities in Hong Kong through structured training for caregivers and innovative designs of 3D-printed HP. Method Ninety-four care workers from five care facilities attended a 60-minute educational session on the epidemiology of hip fractures and related consequences, strategies to prevent falls and hip fractures, and effectiveness and approaches for successful implementation of HP. After the education sessions, we recruited 69 residents from the care facilities and provided free hip protectors to them. Resident compliance with wearing hip protectors was recorded on a weekly basis, and the sustained adherence was evaluated after six months. Qualitative feedback on the use of hip protectors from residents and their care givers was collected via phone interviews and incident reports. Meanwhile, based on participants' feedback and previous research evidence, we developed a customized, comfortable and breathable HP through 3D-printing technology. Specifically, selective laser sintering technology was applied to fabricate TPU (Thermoplastic Polyurethane) such that HP could be designed based on the users' hip profile. More importantly, we used our newly invented implicit design method, a conformal TPMS (triply periodic minimal surface) structure-infill generation scheme (Ding et al., 2021), to mass-customize hip protectors, with lattice structures to be automatically generated from the 3D scan data for multiple participants with individually tailored design (Figure 1). The biomechanical performance of the prototype of HP was then tested through an impact on the force plate using a drop tower. Results and Discussion Our preliminary data showed a satisfactory adherence rate [46.4% (32/69)]. For residents who failed to adhere to wearing HP, more than half of them [54.1% (20/37)] stopped using within first two weeks. Common reasons for not using HP include discomfort [62.2% (23/37)] (e.g., protectors are not breathable, too tight, or causing skin irritation), inconvenience [37.8% (23/37)] (e.g., don off garment during toileting), and perceived ineffectiveness [8.1% (3/37)]. The feedback coincided with barriers in promoting HP user compliance identified from previous research (Korall et al., 2015). Clearly, perceived ineffectiveness can be further enhanced by providing education to users. Meanwhile, our novel 3D-printed HP was lighter, more breathable, and better fit than conventional HPs. It would be more suitable for users in Hong Kong, where summer days are hot and humid. Pilot biomechanical tests showed higher force attenuation in our 3D-printed HP than the conventional models. Further investigation on user compliance with the novel 3D-printed HP will be carried out. [ABSTRACT FROM AUTHOR]

Hip fractures caused by falls are important health problems for the elderly. Many studies used finite element (FE) models of the femur and its surroundings to evaluate the hip fracture risk during the impact phase in a fall. In this study, the whole-body human FE model (THUMS) of a small female was applied from the descent to the impact phase in a fall to understand the effect of the whole body. Brosh's material model was used for the soft tissue of the hip. A low-BMI and high-BMI model were developed based on THUMS (middle-BMI). For the middle-BMI model, the torso angle and the pelvis impact velocity were 45.2° and 2.62 m/s at the time of pelvis impact. The effective mass changed with time, and was 18.3 kg when the femoral neck force was maximum. The femoral neck force was 2.11 kN for the low-BMI model. The femoral neck forces when wearing a soft and a hard hip protector, and when falling on an energy-absorbing floor were compared for the FE models of human and a hip protector testing system. Though the force attenuation of the protective devices was 32.0–44.3 % in the testing system, the force attenuation in the middle-BMI was 0.1–22.2 %. In the low-BMI model, the attenuation of the soft protector was limited (4.2 %) because the hip protector protruded from the outer surface, so the contact force was concentrated at the hip region. This research suggests the importance of including the whole body to evaluate the hip fracture risk. [ABSTRACT FROM AUTHOR]

Hip protectors are often prescribed to the elderly who are at risk of falling, with the goal of preventing hip fractures. However, determining the effectiveness of hip protectors has been hampered by unreliable compliance data. This study reports a reliable objective method of measuring compliance and the developed method could be used in any climate, regardless of temperature. Custom compliance monitors were built and embedded inside hip protectors. An algorithm was developed to utilize both temperature and acceleration to determine compliance. Seven young volunteers (age 24.6 ± 4.2 years old) wore the protectors for a total of 667 h while closely recording their compliance. One female (77 years old) who had hip fracture history wore the compliance monitors for 91.6 % of the time during a 1-week stay in a hospital. From the volunteers' trial, using temperature alone overpredicted compliance by 1.2 % and using acceleration alone overpredicted by 5.4 %, but using a combination of the two methods plus a correction factor only underestimated by 0.6 %. From the elderly data, the average compliance recorded from the temperature, acceleration, and combined methods with correction was 94.6, 88.9, and 90.2, respectively. The high accuracy of temperature sensors in this study will not be attainable in hot climates where most of the worldwide increase in hip fractures is occurring. The developed monitor with the algorithm provided high accuracy in determining compliance and was able to determine both the longitudinal and cross-sectional compliance at any time. [ABSTRACT FROM AUTHOR]

Use of hip protectors and compliant flooring has been recommended for preventing hip fracture due to falls. We aimed to identify the factors attenuating forces in falls by comparing and analyzing the impact forces occurring with various combinations of hip protectors and flooring materials. We designed a simplified pendulum device to simulate the impact force at the hip during falling. The impact force was measured on pressure-sensitive recording film under combined conditions of two kinds of hip protector (hard or soft shell) and three kinds of floor material (concrete, wooden, or tatami matting). We then calculated the percentage force attenuation under each test condition compared with the use of a concrete floor and no hip protector. All the tests using tatami matting reduced the impact to below the average fracture threshold of elderly people (3472 N). A combination of tatami and soft hip protector provided the best attenuation (72.5%). Multiple regression analyses showed that use of tatami matting and a soft hip protector had the biggest force-attenuation effect. The soft hip protector gave better percentage force attenuation than did the hard one. Use of tatami matting as a flooring material could be an effective strategy for helping prevent hip fractures. [ABSTRACT FROM AUTHOR]

Summary: Potential predictors of availability and use of hip protectors were studied in residents of 48 nursing homes. The likelihood of being offered a hip protector was reduced in men, in residents with very low or very high care needs, in residents with migration background, and in recipients of welfare aid. Introduction: The purpose of this study is to analyze potential predictors of availability and use of hip protectors in residents of nursing homes. Methods: In 48 German nursing homes, individual information on availability and use of hip protectors was collected from all institutionalized residents (3,924 residents; 78.2% women). Information on nursing home characteristics was obtained by telephone interview. The effect of individual variables and of nursing home characteristics on hip protector availability and use was estimated using multilevel logistic regression analyses. Results: The prevalence of hip protectors being made available was 10.0% in women and 6.2% in men. Sixty-four percent of those with a hip protector used it during the 4 weeks prior to the examination. The likelihood of being offered a hip protector was reduced in men (odds ratio (OR), 0.59; 95% confidence interval (CI), 0.43; 0.83), in residents with very low or very high care needs (OR, 0.32; 95% CI, 0.18; 0.56 and OR, 0.55; 95% CI, 0.38; 0.79, respectively), in residents with a migration background (OR, 0.30; 95% CI, 0.09; 0.99), and in recipients of welfare aid (OR, 0.60; 95% CI, 0.44; 0.81). Nursing home characteristics such as the size of the nursing home or staff participation rate in training measures had no effect on hip protector availability and use. Conclusion: Predictors of hip protector availability were sex, the degree of care need, migration status, and welfare aid. The lower availability of hip protectors in residents with welfare aid and migration status may be an indicator for health inequality in the German health system. [ABSTRACT FROM AUTHOR]

Abstract: Background: Hip fractures represent an increasing public health burden with a simple fall to the floor as the most common cause. Because nursing home residents are particularly at risk, nursing homes should implement a broad range of fall prevention strategies. However, not all fall incidents can be avoided and external hip protectors may contribute to prevent hip fractures. A major problem in studying the effectiveness of hip protectors is residents’ poor adherence. In nursing homes, adherence is dependent not only on the resident, but also on staff knowledge of and attitudes about hip protectors. Objectives: To describe (1) attitudes of day versus night shift caregivers towards the use of a soft hip protector, (2) residents’ adherence about the use of such protectors, and (3) differences in characteristics between adherent and non-adherent residents. Design: Survey and observational study. Setting: Nursing home. Participants/methods: : Survey of care staff (n =37) in a nursing home after 8 months of continued application of a soft hip protector policy in residents (n =68). Adherence to wearing the hip protector, measured by weekly unannounced, randomly determined checks during day and night in the 8 months after the start of the study. Results: Overall, 85% agreed to wear a hip protector. At 8 months, only 29% was still wearing their hip protector; with significant differences between day and night shifts. Although virtually all caregivers (97%) considered a hip protector policy in residential care as feasible, the attitude towards hip protectors was found to be significantly different between day and night caregivers. Pain and discomfort, patient insight in the usefulness of these devices, interference with incontinence materials, and the overall resident mix and care acuity were reported as major barriers. Conclusion: Implementing a hip protector policy for injury prevention in long-term care is not an issue of whether or not to use the devices. Rather, it is a continued clinical nursing decision process about when and when not, by whom and by whom not, why and why not, for how long, and to what clinical benefit – considering both the needs of the individual resident and the feasibility of such a policy in the context of resident mix and nursing staff. [Copyright &y& Elsevier]

Summary: For people at high risk of hip fracture living in community settings, providing hip protectors at no cost increased adherence, but the additional effect of an educational programme was limited. Overall, the level of adherence was modest. Introduction: The objective of the study was to increase adherence with hip protector use by older people at high risk of hip fracture. The study included two randomised controlled trials with 308 older people recruited from three hospital rehabilitation wards and 171 older people recruited from the community. Methods: Participants were randomised into three groups. The control group received a brochure about hip protectors. The no cost group were fitted with free hip protectors and asked to use them. The combined group received free hip protectors and education sessions about their use. Adherence with the use of hip protectors at 3 and 6 months after recruitment was measured. Secondary outcomes were falls, fractures and hospitalisations. Results: Very few participants in the two control groups bought a hip protector. Overall adherence in the four intervention groups was modest, but higher in the community recruitment setting (49%) than in the hospital recruitment setting (36%) at 6 months. In the community recruitment group, at 3 months of follow-up, a significantly higher number of participants in the combined group (62%) were wearing hip protectors compared to the no cost group (43%, p = 0.04). Five hip fractures occurred during the study, with four sustained whilst not wearing the hip protectors. Conclusion: Providing hip protectors at no cost to community living older people at high risk of hip fractures modestly increases initial acceptance and adherence with hip protector use. Additional education may further increase hip protector use in people living in the community in the short term. [ABSTRACT FROM AUTHOR]

Objectives: To test different adherent strategies aimed at improving hip protector use among nursing care facility residents. Design, Setting and Participants: A cluster randomized controlled trial with 234 residents older than 75 years from 9 units of 7 nursing care facilities in the Northern Sydney region, Australia. Intervention: Residents were cluster randomized in 3 groups. The first group received hard shell hip protectors without cost (no cost group). The second group received an educational session, a demonstration of the use of hip protectors, and free choice of type of hip protectors without cost (combined group). The third group was the control group who received a brochure about hip protectors. Measurements: Primary outcome was adherence with the use of hip protectors at 3 and 6 months after recruitment. Secondary outcomes were falls, injuries, and fractures. Results: No participants in the control group purchased hip protectors at any stage. At 3 months, 33% of participants in the no cost group and 27% in the combined group wore a hip protector at the time of visit. This declined to 25% and 24% respectively at 6 months. No significant difference was seen in any of the 3 adherence outcomes between the 2 intervention groups. The number of falls or hospitalizations did not differ between groups, with 5 hip fractures reported during the intervention period. Residents were more likely to be adherent if they were female and had greater restriction in daily activities. Conclusion: Providing free hip protectors to older people living in nursing care facilities was necessary to increase initial acceptance and adherence. Nevertheless, after 6 months the achieved level of adherence was not high enough to be associated with a reduction of hip fractures. The provision of educational sessions and demonstrations to nursing staff and participants had no added value in this trial. [Copyright &y& Elsevier]

In our cluster randomised controlled trial for efficacy of hip protector with 672 ambulatory elderly women, a hip protector was more effective for prevention of hip fractures in residents with fall history ( n = 202; hazard ratio (HR), 0.375; 95%CI, 0.14–0.98; p = 0.05) and body-mass index (BMI) ≤ 19.0 ( n = 206; HR, 0.37; 95%CI, 0.14–0.95; p = 0.04) by a Cox proportional hazards regression model. Hip fractures result from both osteoporosis and falling. A potentially cost-effective method of preventing hip fractures involves the use of hip protectors but recent studies have revealed the uncertain effectiveness of hip protectors even in institutional settings. This study was a cluster randomised controlled trial with nursing homes. We randomly assigned 76 homes with 672 ambulatory but frail elderly women. Several risk factors were assessed at baseline and incorporated into a Cox proportional hazards regression model. UMIN Clinical Trials Registry number is UMIN000000467. Research period was between January 2004 and March 2006. In the intervention group, 19 hip fractures occurred (54.0/1,000 person-years), whereas 39 hip fractures occurred in the control group (78.8/1,000 person-years). Hazard ratio of hip fracture in the intervention group was 0.56 (95%CI, 0.31–1.03; p = 0.06) after adjusting for risk factors. In subgroup analysis, hip protectors were more effective for prevention of hip fractures in residents with fall history ( n = 202; HR, 0.375; 95%CI, 0.14–0.98; p = 0.05) and BMI ≤ 19.0 ( n = 206; HR, 0.37; 95%CI, 0.14–0.95; p = 0.04). Overall compliance with use of hip protectors was 79.7%. Risk of hip fracture can be reduced by hip protectors among elderly women with fall history and low BMI. [ABSTRACT FROM AUTHOR]

Abstract: The rate of hip fractures due to falls increases with age. External hip protectors placed over the greater trochanter can prevent hip fractures, but the willingness to wear such protective devices is rather low. Most of the commercially available hip protectors consist either of an energy-absorbing foam pad or of a hard shell that distributes the load to the surrounding tissue. In the present study, a fibre-reinforced shell composed of three curved strips bonded with a ring, was designed and lined with shock absorbing foam. The development of the new shell design was based on quasi-static and impact tests of manufactured shells in combination with finite element simulations. The results of the numerical analysis showed the potential protection effect of the shell and indicated how the design can be further improved. First impact tests on an anatomical hip model showed promising results of the new protector shell in combination with a foam pad. [Copyright &y& Elsevier]

Hip fractures are an important problem in nursing homes. Hip protectors are external devices that decrease the risk of hip fracture in elderly nursing home residents. We estimated the overall healthcare cost savings from a hypothetical strategy of provision of hip protectors to elderly nursing home residents in Ontario, Canada. In a recent meta-analysis, we determined that a strategy of provision of hip protectors decreases the risk of hip fracture in nursing home residents. Our objective was to determine whether the provision of hip protectors to all Ontario nursing home residents aged ≥65 years could result in cost savings, stemming from reductions in initial hospitalizations for hip fracture. We conducted a cost analysis from a Ministry of Health perspective (one year cycle length). The efficacy of the intervention was estimated from a meta-analysis of randomized controlled trials. A strategy of provision of hip protectors to all 60,775 elderly Ontario nursing home residents could result in an overall mean cost savings of 6.0 million Canadian dollars in one year (95% credibility interval, −26.4 million, 39.7 million), with a probability of cost savings of 0.63 (assuming no additional labor costs). In sensitivity analyses, decreasing hip protector price increased cost savings, whereas additional labor expenditures for application for hip protectors decreased cost savings. In conclusion, if hip protectors can be provided to elderly Ontario nursing home residents without additional labor expenditures, there is a reasonable probability that such a strategy may result in healthcare cost savings. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To estimate the maximum potential preventive effect of hip protectors in older persons living in the community or homes for the elderly. DESIGN: Observational cohort study. SETTING: Emergency departments in the Netherlands. PARTICIPANTS: Hip fracture patients aged 70 and older who visited the emergency departments of five hospitals in the Netherlands (n=520). MEASUREMENTS: Using the risk score of the Dutch Guidelines for Osteoporosis, how many patients had a high risk for fractures was retrospectively assessed. In addition, the circumstances of the hip fracture were assessed (n=299). Four factors were specified that might influence the maximum potential preventive effect of hip protectors: (1) hip fracture occurred in persons having a low risk, (2) hip fracture was not the consequence of a fall, (3) hip fracture occurred during circumstances that preclude the use of hip protectors, and (4) hip fracture occurred during the night. RESULTS: When providing hip protectors to women at high risk of fractures, 48.2% of all hip fractures could have been prevented. CONCLUSION: Many hip fractures occur in persons with a low risk for hip fracture or under circumstances that preclude the use of hip protectors. It was estimated that the maximum potential preventive effect of hip protectors is approximately 50% in older women living in the community or homes for the elderly. The actual preventive effect will be lower and depends on the acceptance and effectiveness of hip protectors and adherence to wearing them. [ABSTRACT FROM AUTHOR]

The prevention of fractures amongst older people consists of (i) prevention and treatment of osteoporosis, (ii) prevention of falling and (iii) prevention of fractures using injury-site protection. As the great majority of hip fractures are caused by a sideways fall with direct impact on the greater trochanter of the proximal femur, one approach to prevention is the use of an adequately configured padded, firm-shield external hip protector. With this type of two-part design, the impacting force and energy are, at the time of the fall-impact, first weakened by the padding part of the protector and then diverted away from the greater trochanter by the shield part of the same. Following this line, a series of consecutive studies by the Accident & Trauma Research Center at the UKK Institute, Tampere, Finland, found that a padded, strong-shield hip protector was effective in preventing hip fractures. In the context of the wider literature on hip protectors, these more encouraging results suggest the need for a more rigorous regulation of protector design and characteristics. Alongside inadequacies of design, the other most frequent general problem with hip protectors is compliance. Not all elderly people with a high risk of hip fracture will agree to use hip protectors and in those who do, long-term adherence may decrease. Caregiver motivation and involvement appear therefore to be crucial. [ABSTRACT FROM AUTHOR]

Hip protectors seemed to be the only non-pharmacological intervention to effectively prevent hip fractures in high-risk populations. In contrast, recently published trials did not find hip fracture reduction through hip protector interventions. An updated Cochrane review concluded that the device is ineffective for community-dwelling elderly and of uncertain effectiveness for institutionalised elderly. However, some primary studies used suboptimal implementation of hip protectors, which has led to low adherence and ineffectiveness of the intervention. Shortcomings in implementation techniques have not been assessed by the Cochrane review. Therefore, reviewers should explicitly assess whether the intervention was well planned and competently administered. As a checklist cannot adequately assess individual, study-specific implementation flaws, we suggest narrative expert review and feedback to the authors of the primary study. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: : Hip protectors appear to be promising in preventing hip fractures. Currently, many different hip protectors exist, and it is not clear which hip protector has the best biomechanical properties. Therefore, the objective of this study was to compare the force attenuation capacity of 10 different hip protectors. Both hard hip protectors, which primarily shunt away energy, and soft hip protectors, which primarily absorb energy, were included. Methods: : Using a drop weight impact testing system and a surrogate femur, a weight of 25 kg was dropped from a height of 8 cm causing a force of almost 7806 N on the bare femur, which simulates a severe fall. After this calibration test, soft tissue and the different hip protectors in combination with the soft tissue were tested. Each test was repeated six times. To simulate normal-weight elderly people, a 1/2-inch-thick layer of foam was chosen, reducing the force by 18%. To examine the influence of soft tissue thickness, soft tissue was also simulated by a 1-inch-thick layer of foam, reducing the force by 49%. Results: : In the 1-inch soft tissue test, all hip protectors were capable in reducing the impact to below the average fracture threshold of elderly people (3100 N), although the hard types performed significantly better than the soft ones (P < 0.001). In the 1/2-inch soft tissue test, only the hard hip protectors were capable of attenuating the peak force to below the average fracture threshold of 3100 N (hard vs. soft hip protectors: P < 0.001). Conclusions: : This study showed that the hard, energy-shunting hip protectors were superior to the soft, energy-absorbing ones, especially in a simulation of normal-weight elderly people. With increased soft tissue thickness, soft hip protectors were also capable in reducing the impact to below the average fracture threshold of 3100 N. [Copyright &y& Elsevier]

Abstract: An anatomical hip model has been developed to simulate the impact load on the hip of a falling person wearing a hip protector. The hip consists of an artificial pelvis made of aluminium, linked by a ball-and-socket joint to an anatomically shaped steel femur (thigh bone). The femur is embedded in silicone material with a hip-shaped surface to allow realistic positioning of the protectors with accessory underwear. Additionally, the silicone simulates the damping and load-dispersal effect of soft tissue. A triaxial load sensor is integrated in the neck of the femur to measure the axial and cross-sectional force components in response to external impact forces on the hip. The performance of the hip model was investigated in drop tests and validated against biomechanical data. In a first series of measurements, the shock absorption of 10 different hip protectors, including both energy-absorbing and energy-shunting systems, was analysed. To determine the importance of hip protector placement, each protector was tested in the correct anatomical alignment over the hip and anteriorly displaced by 3cm. Considerable differences were found between individual hip protectors in their effectiveness to reduce impact forces on the femur. Position of the hip protector also influenced the forces applied to the femur. [Copyright &y& Elsevier]

A randomized controlled trial was performed to examine the cost-effectiveness of external hip protectors in the prevention of hip fractures. Since the hip protectors were not effective in preventing hip fractures in our study, the main objective became to examine whether the use of hip protectors results in lower average costs per participant in the hip protector group as compared with the control group. In addition, the average costs of a hip fracture and subsequent rehabilitation in frail, institutionalized elderly were calculated. Residents from apartment houses for the elderly, homes for the elderly and nursing homes with a high risk for hip fractures were randomized to the hip protector group (n=276) or control group (n=285). Costs were calculated for the hip fracture and subsequent rehabilitation until 1 year after the fracture. Six months after each hip fracture, a nurse was interviewed and after 12 months, a questionnaire was sent to the general practitioner or nursing home physician to determine the utilization of health care resources. Differences in costs between the groups were analyzed using non-parametric bootstrapping. Eighteen hip fractures occurred in the intervention group and 20 hip fractures (in 19 persons) in the control group (log rankP-value=0.86). The average costs per participant, including the costs of the intervention, were €913 in the intervention group and €502 in the control group (cost difference of €-411; 95% confidence interval: -723; 57). The average costs of a hip fracture and subsequent rehabilitation were €8100 (95% CI: 6716-10,010). The use of hip protectors was not associated with lower costs. In addition, the average costs of a hip fracture and subsequent rehabilitation in the first year after the fracture were estimated at €8100 in institutionalized elderly. [ABSTRACT FROM AUTHOR]

The aim of the present study was to survey the interest of Japanese orthopedists in preventing fractures in the elderly, and investigate their awareness with regard to main prevention strategies such as medications and hip protectors. From the list of 20,899 members of the Japanese Orthopedic Association, we randomly selected a sample of 2035 people. Each orthopedist was sent an anonymous survey consisting of 12 questions during July to August 2001. At that time, risedronate, raloxifene, and parathyroid hormone had not been approved for clinical use in Japan, and even alendronate had just been approved. Of the survey forms sent, 1011 responses were received, for a response rate of 50%. Analysis of these responses showed a very high interest in osteoporosis, fractures in the elderly from falls, and the prevention of such fractures. This interest was associated with physician age, with those above the age of 50 years being 2.3 times more likely to have an interest in each of these than physicians below that age. The respondents considered the most promising measure for the prevention of fractures in the elderly from falls to be fall prevention, followed by exercise and osteoporosis medications. The medication considered to be effective as a monotherapy by the overwhelming number of respondents was bisphosphonates, followed by vitamin D3 and calcitonin. Combination agents cited were vitamin D3, bisphosphonates, and calcitonin, in that order. Forty-two percent of respondents had some knowledge of hip protectors, but confidence in them as a means to prevent fractures was still low. The practical information from our survey should serve as a starting point for comparison to periods when new bisphosphonates or hip protectors become commonly available to Japanese orthopedists. The overall results indicate that Japanese orthopedists are very positive toward fracture prevention. [ABSTRACT FROM AUTHOR]

Hip protectors appear to be effective in reducing the incidence of hip fractures. However, compliance is often poor. Therefore, the objective of this study was to examine the compliance and determinants of compliance with external hip protectors. A prospective study was performed in residents from apartment houses for the elderly, homes for the elderly and nursing homes with a high risk for hip fracture (n=276). The study was performed within the framework of the Amsterdam Hip Protector Study, a randomized controlled trial examining the effect of external hip protectors on the incidence of hip fractures. Compliance was assessed by unannounced visits at 1, 6 and 12 months after inclusion in the study. During the visits, a member of the research team checked whether the participant was wearing the hip protector and, if so, whether it was worn correctly. Furthermore, data on potential determinants of compliance were collected by interviewing the participants or their nurses. Compliance was 60.8% after 1 month (n=217), 44.7% after 6 months (n=246), and 37.0% after 12 months (n=230). Of those wearing the hip protector, 86.7%, 91.7% and 96.5% of the participants were wearing the hip protector correctly after 1, 6 and 12 months respectively; and 14.8%, 16.1% and 8.8% respectively reported wearing the hip protector at night. Compliance after 12 months was predicted by the compliance after 1 month (RR=2.04; 90% CI: 1.05–3.96). Furthermore, people who experienced one or more falls in the half year before baseline had a lower probability of being compliant at 6 months (RR=0.72; 90% CI: 0.52–0.99). In conclusion, compliance is a very important issue in hip protector research and implementation. Although, the compliance percentages were moderately high during the unannounced visits in this study, not everyone was wearing the protector correctly and most participants did not wear the hip protector during the night. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate the effectiveness of a multifaceted, nonpharmaceutical intervention on incidence of falls and fallers. DESIGN: Prospective, cluster-randomized, controlled 12-month trial. SETTING: Six community nursing homes in Germany. PARTICIPANTS: Long-stay residents (n = 981) aged 60 and older; mean age 85; 79% female. INTERVENTIONS: Staff and resident education on fall prevention, advice on environmental adaptations, progressive balance and resistance training, and hip protectors. MEASUREMENTS: Falls, fallers, and fractures. RESULTS: The incidence density rate of falls per 1,000 resident years (RY) was 2,558 for the control group (CG) and 1,399 for the intervention group (IG) (relative risk (RR) = 0.55, 95% confidence interval (CI) = 0.41–0.73). Two hundred forty-seven (52.3%) fallers were detected in the CG and 188 (36.9%) in the IG (RR = 0.75, 95% CI = 0.57–0.98). The incidence density rate of frequent fallers (>2/year) was 115 (24.4%) for the CG and 66 (13.0%) for the IG (RR = 0.56, 95% CI = 0.35–0.89). The incidence density rate of hip fractures per 1,000 RY was 39 for the CG and 43 for the IG (RR = 1.11, 95% CI = 0.49–2.51). Other fractures were diagnosed with an incidence density rate of 52 per 1,000 RY for CG and 41 per 1,000 RY for IG (RR = 0.78, 95% CI = 0.57–1.07). CONCLUSION: The incidence density rate of falls and fallers differed considerably between the control and intervention groups. The study was underpowered to demonstrate a significant difference of hip or nonhip fractures. Because of a low fracture rate in both groups, the investigation of fracture rates would have required a larger sample size to detect an effect of the intervention. [ABSTRACT FROM AUTHOR]

: Hip fractures may be prevented by the use of external hip protectors, but compliance is often poor. Therefore, the objective of this study was to assess the determinants of compliance with hip protectors by systematically reviewing the literature. A literature search was performed in PubMed, Embase and the Cochrane Library. Primary acceptance with hip protectors ranged from 37% to 72% (median 68%); compliance varied between 20% and 92% (median 56%). However, in most studies it was not very clear how compliance was defined (e.g., average wearing time on active days and during waking hours, number of user-days per all available follow-up days, percentage falls with hip protector) and how it was measured. To provide more insight in the compliance percentages, the different methods of defining and measuring compliance were presented for the selected studies, when provided. Because of the heterogeneity in study design of the selected studies and the lack of quantitative data in most studies, results regarding the determinants of compliance could not be statistically pooled. Instead a qualitative summary of the determinants of compliance was given. The reasons most frequently mentioned for not wearing hip protectors, were: not being comfortable (too tight/poor fit); the extra effort (and time) needed to wear the device; urinary incontinence; and physical difficulties/illnesses. In conclusion, compliance is a very complex, but important issue in hip protector research and implementation. Based on the experiences of elderly people who wear the hip protectors, adjustments should be made to the protector and the underwear, while maintaining the force attenuation capacity. Furthermore, methods to improve the compliance should be developed, and their effectiveness tested. [ABSTRACT FROM AUTHOR]