Simon Fraser University, Burnaby, British Columbia, Canada; Center for Hip Health and Mobility, Vancouver, British Columbia, Canada.
Simon Fraser University, Burnaby, British Columbia, Canada; Center for Hip Health and Mobility, Vancouver, British Columbia, Canada; Fraser Health Authority, Surrey, British Columbia, Canada.
J Am Med Dir Assoc. 2019 Nov;20(11):1397-1403.e1. doi: 10.1016/j.jamda.2019.07.010. Epub 2019 Aug 30.
To generate evidence of the effectiveness of hip protectors to minimize risk of hip fracture at the time of falling among residents of long-term care (LTC) by contrasting rates of hip fractures between falls with and without hip protectors.
A 12-month, retrospective cohort study. We retrospectively reviewed fall incident reports recorded during the 12 months prior to baseline in participating homes.
A population-based sample comprising all residents from 14 LTC homes owned and operated by a single regional health authority, who experienced at least 1 recorded fall during the 12-month study.
At baseline, the pooled mean (standard deviation) age of residents in participating homes was 82.7 (11.3) years and 68% were female. Hip protectors were worn in 2108 of 3520 (60%) recorded falls. Propensity to wear hip protectors was associated with male sex, cognitive impairment, wandering behavior, cardiac dysrhythmia, use of a cane or walker, use of anti-anxiety medication, and presence of urinary and bowel incontinence. The incidence of hip fracture was 0.33 per 100 falls in falls with hip protectors compared with 0.92 per 100 falls in falls without hip protectors, representing an unadjusted relative risk (RR) of hip fracture of 0.36 (95% confidence interval 0.14-0.90, P = .029) between protected and unprotected falls. After adjusting for propensity to wear hip protectors, the RR of hip fracture was 0.38 (95% confidence interval 0.14-0.99, P = .048) during protected vs unprotected falls.
Hip protectors were worn in 60% of falls, and the risk of hip fracture was reduced by nearly 3-fold by wearing a hip protector at the time of falling. Given that most clinical trials have failed to attain a similar level of adherence, our findings support the need for future research on the benefits of dissemination and implementation strategies to maximize adherence with hip protectors in LTC.
通过对比有和没有使用髋保护器的跌倒事件中髋部骨折的发生率，为长期护理（LTC）居民在跌倒时使用髋保护器来降低髋部骨折风险的有效性提供证据。
一项为期 12 个月的回顾性队列研究。我们回顾性地分析了在参与家庭的基线前 12 个月记录的跌倒事件报告。
一个基于人群的样本，包括由一个单一地区卫生当局拥有和运营的 14 个长期护理之家的所有居民，他们在 12 个月的研究中至少经历了 1 次记录的跌倒。
在基线时，参与家庭居民的平均（标准差）年龄为 82.7（11.3）岁，68%为女性。在 3520 次记录的跌倒中，有 2108 次（60%）佩戴了髋保护器。佩戴髋保护器的倾向性与男性、认知障碍、徘徊行为、心律失常、使用手杖或助行器、使用抗焦虑药物以及存在尿失禁和大便失禁有关。在有髋保护器的跌倒中，髋部骨折的发生率为每 100 次跌倒 0.33 例，而在无髋保护器的跌倒中，每 100 次跌倒 0.92 例，未调整的髋部骨折相对风险（RR）为 0.36（95%置信区间 0.14-0.90，P=0.029）。在调整了佩戴髋保护器的倾向性后，在有保护的跌倒与无保护的跌倒之间，髋部骨折的 RR 为 0.38（95%置信区间 0.14-0.99，P=0.048）。
髋保护器在 60%的跌倒中被佩戴，在跌倒时佩戴髋保护器可将髋部骨折的风险降低近 3 倍。鉴于大多数临床试验都未能达到类似的依从水平，我们的发现支持未来对传播和实施策略的益处进行研究，以最大限度地提高长期护理中髋保护器的依从性。
