Objectives
Determine nursing home characteristics related to adherence to use of a hip protector
(HP) to prevent fracture; also describe adherence and related resident characteristics.
Design
A multicenter, randomized controlled trial of a HP in which adherence to wearing the
HP was monitored by research staff 3 times a week for up to 21 months; data were collected
by interviews and chart review.
Setting
Thirty-five nursing homes in Boston, St. Louis, and Baltimore.
Participants
A total of 797 eligible residents, 633 (79%) of whom passed the run-in period, 397
(63%) of whom remained in the study until the end of follow-up.
Intervention
Residents wore a single HP on their right or left side.
Measurements
In addition to regular monitoring of adherence, data were collected regarding facility characteristics,
staffing, policies and procedures, perception of HPs and related experience, and research
staff ratings of environmental and overall quality; and also resident demographic
characteristics, and function, health, and psychosocial status.
Results
Facility characteristics related to more adherence were not being chain-affiliated;
less Medicaid case-mix; fewer residents wearing HPs; more paraprofessional staff training;
more rotating workers; and having administrators who were less involved in meetings.
Conclusion
Efforts to increase adherence to the use of HPs should focus on facilities with more
Medicaid case-mix to reduce disparities in care, and those that have less of a culture
of training. Staff may need support to increase adherence, and when adherence cannot
be maintained, HP use should be targeted to those who remain adherent.
Keywords
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References
- Hospital Inpatient Statistics 1996–1999.Agency for Health Care Policy and Research, Rockville, MD1999 (AHCPR Publication 99–0034)
- Changes in functional status attributable to hip fracture: A comparison of hip fracture patents to community-dwelling aged.Am J Epidemiol. 2003; 157: 1023-1031
- Excess mortality attributable to hip fracture in white women aged 70 years and older.Am J Public Health. 1997; 87: 1630-1636
- The prevalence of osteoporosis in nursing home residents.Osteoporos Int. 1999; 9: 151-157
- The incidence of hip fractures in independent and institutionalized elderly people.Osteoporos Int. 1994; 4: 6-10
- High rate of fractures for men in nursing homes.Am J Phys Med Rehabil. 1989; 68: 205
- Hip protectors for preventing hip fractures in older people.Cochrane Database Syst Rev. 2005; 3 (CD001255)
- Efficacy of a hip protector to prevent hip fracture in nursing home residents.JAMA. 2007; 298: 413-422
- Factors associated with hip protector adherence among older people in residential care.Injury Prevention. 2008; 14: 24-29
- Acceptance and compliance with external hip protectors: A system review of the literature.Osteoporosis Int. 2002; 13: 917-924
- Prevention of hip fractures in the elderly: Receptivity to protective garments.Arch Gerontol Geriatr. 1995; 21: 179-189
- External hip protectors: Likely non-compliance among high risk elderly people living in the community.Arch Gerontol Geriatr. 1994; 19: 273-281
- Predictors of adherence with the recommended use of hip protectors.J Gerontol A Biol Sci Med Sci. 2004; 59: 958-961
- Predictors of adherence to the use of hip protectors in nursing home residents.J Am Geriatr Soc. 2004; 52: 340-345
- Effect of external hip protectors on hip fractures.Lancet. 1993; 34: 11-13
- The effect of type of hip protector and resident characteristics on adherence to use of hip protectors in nursing and residential homes—an exploratory study.Int J Nurs Stud. 2005; 42: 387-397
- Hip protector compliance: A 13-month study on factors and cost in a long-term care facility.J Am Med Dir Assoc. 2003; 4: 245-250
- Can hip protector use in the nursing home be predicted?.J Am Geriatr Soc. 2007; 55: 350-356
Statehealthfacts.org. United States: Total Number of Certified Nursing Facilities, 2006. Available at: http://www.statehealthfacts.org/profileind.jsp?ind=411&cat=8&rgn=1. Accessed July 12, 2008.
Statehealthfacts.org. United States: Certified Nursing Facility Beds, 2006. Available at: http://www.statehealthfacts.org/profileind.jsp?ind=413&cat=8&rgn=1. Accessed July 12, 2008.
Statehealthfacts.org. United States: Total Number of Residents in Certified Nursing Facilities, 2006. Available at: http://www.statehealthfacts.org/profileind.jsp?rgn=1&cat=8&ind=408. Accessed July 12, 2008.
- Nursing home characteristics related to Medicare costs for residents with and without dementia.Am J Alzheimers Dis Other Demen. 2008; 1: 57-65
- Nursing home facility risk factors for infection and hospitalization: importance of registered nurse turnover, administration, and social factors.J Am Geriatr Soc. 2002; 50: 1987-1995
- The hip impact protection project: design and methods.Clinical Trials. 2008; 5: 347-355
- The therapeutic environment screening survey for nursing homes (TESS-NH): An observational instrument for assessing the physical environment of institutional settings for persons with dementia.J Gerontol B Psychol Sci Soc Sci. 2002; 57: 69-78
- Alzheimer's disease: A correlational analysis of the Blessed Information-Memory-Concentration Test and the Mini-Mental State Exam.Neurology. 1986; 36: 262-264
- Validation of a measure of fear of falling for nursing home residents.Gerontologist. 2002; 421: 171
- Obesity and cardiovascular risk factors in black and white girls: The NHLBI growth and health study.Am J Public Health. 1992; 82: 1613-1620
- Random-effects models for longitudinal data.Biometrics. 1982; 38: 963-974
- Driven to tiers: Socioeconomic and racial disparities in the quality of nursing home care.Milbank Q. 2004; 82: 227-256
- Educating nursing home staff on fracture prevention: A cluster randomized trial.Age Ageing. 2008; 37: 167-172
- Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial.Ann Intern Med. 2002; 136: 733-741
- Dementia care and quality of life in assisted living and nursing homes.Gerontologist. 2005; 45: 133-146
- Quality of care in the nursing home: Effects of staff assignment and work shift.Gerontologist. 2004; 44: 368-377
- Staying the course: Facility and professional retention among nursing assistants in nursing homes.J Gerontol B Psychol Sci Soc Sci. 2008; 63: 113-121
- Expert nursing assistant care activities.West J Nurs Res. 1998; 20: 584-601
- The impact of ownership type on nursing home outcomes.Health Econ. 1998; 7: 639-653
Rhoades JA, Potter DE, Krauss NA. Characteristics of nursing homes in 1996. Abstr Book Assoc Health Serv Res Meet 1997;14:303–304. Available at: http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102233852.html. Accessed October 17, 2009.
- Effectiveness and acceptability of a newly designed hip protector: A pilot study.Arch Gerontol Geriatr. 2000; 30: 25-34
- Will elderly rest home residents wear hip protectors?.Age Ageing. 1998; 27: 195-198
Article info
Publication history
Published online: January 06, 2010
Footnotes
Funded by National Institutes of Health, National Institute on Aging grant R01 AG018461 and supported in part by the Lawrence J. and Anne Cable Rubenstein Charitable Foundation.
Identification
Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
