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Robinovitch SN, Onyejekwe C. Research Priorities for Wearable Hip Protectors for Hip Fracture Prevention in Long-Term Care. J Am Med Dir Assoc 2023; 24:1010-1012. [PMID: 37349048 DOI: 10.1016/j.jamda.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/10/2023] [Indexed: 06/24/2023]
Affiliation(s)
- Stephen N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.
| | - Cynthia Onyejekwe
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
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Kuhnow J, Hoben M, Weeks LE, Barber B, Estabrooks CA. Factors Associated with Falls in Canadian Long Term Care Homes: a Retrospective Cohort Study. Can Geriatr J 2022; 25:328-335. [PMID: 36505912 PMCID: PMC9684024 DOI: 10.5770/cgj.25.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Half of Canadians living in long-term care (LTC) homes will fall each year resulting in consequences to independence, quality of life, and health. The objective in this study was to analyze factors that contribute to, or are protective against, falls in Canadian LTC homes. Methods We analyzed of a retrospective cohort of a stratified random sample of Canadian LTC homes in Western Canada from 2011-2017. We accessed variables from the RAI-MDS 2.0 to assess the association of the dependent variable "fall within the last 31-180 days" with multiple independent factors, using generalized estimating equation models. Results A total of 28,878 LTC residents were analyzed. Factors found to increase the odds of falling were other fractures (OR 3.64 [95% confidence interval; CI 3.27, 4.05]), hip fractures (OR 3.58 [3.27, 3.93]), moderately impaired cognitive skills (OR 2.45 [2.28, 2.64]), partial support to balance standing (OR 2.44 [2.30, 2.57]), wandering (OR 2.31 [2.18, 2.44]). Conclusion A range of factors identified were associated with falls for people living in LTC homes. Individual physical ability represented the largest group of independent factors contributing to falls. Residents who experience any fracture or an acute change in behaviour, mobility, or activities of daily living (ADL) should be considered at increased risk of falls.
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Affiliation(s)
- Jason Kuhnow
- Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Matthias Hoben
- School of Health Policy & Management, York University, Toronto, ON
| | - Lori E. Weeks
- School of Nursing, Dalhousie University, Halifax, NS
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Post E, Komisar V, Sims-Gould J, Korall A, Feldman F, Robinovitch SN. Development of a stick-on hip protector: A multiple methods study to improve hip protector design for older adults in the acute care environment. J Rehabil Assist Technol Eng 2019; 6:2055668319877314. [PMID: 31839983 PMCID: PMC6896132 DOI: 10.1177/2055668319877314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 08/28/2019] [Indexed: 11/15/2022] Open
Abstract
Introduction Over 90% of hip fractures in older adults result from falls, and hospital patients are at especially high risk. Specific types of wearable hip protectors have been shown to reduce hip fracture risk during a fall by up to 80%, but user compliance has averaged less than 50%. We describe the development and evaluation of a "stick-on" hip protector (secured over the hip with a skin-friendly adhesive) for older patients in acute care. Methods An initial version of the product was evaluated with six female patients (aged 76-91) in a hospital ward, who were asked to wear it for one week. We subsequently refined the product through biomechanical testing and solicited feedback from 43 health professionals on a second prototype. Results The first prototype was worn by five of six patients for the full week or duration of their hospital stay. The second prototype (20 mm thick, surface area 19 × 15.5 cm) provided 36% force attenuation, more than common garment-based models (20-21%). Feedback from patients and health professionals highlighted usability, comfort, cost, and appearance. Conclusions Our results from biomechanical and user testing support the need for further work to determine the value of stick-on hip protectors in acute care.
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Affiliation(s)
- E Post
- Department of Biomedical Physiology and Kinesiology, Injury Prevention and Mobility Laboratory, Simon Fraser University, Burnaby, Canada
| | - V Komisar
- Department of Biomedical Physiology and Kinesiology, Injury Prevention and Mobility Laboratory, Simon Fraser University, Burnaby, Canada
| | - J Sims-Gould
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Amb Korall
- Department of Biomedical Physiology and Kinesiology, Injury Prevention and Mobility Laboratory, Simon Fraser University, Burnaby, Canada
| | - F Feldman
- Department of Biomedical Physiology and Kinesiology, Injury Prevention and Mobility Laboratory, Simon Fraser University, Burnaby, Canada.,Older Adult Program, Fraser Health Authority, Surrey, Canada
| | - S N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Injury Prevention and Mobility Laboratory, Simon Fraser University, Burnaby, Canada
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Korall AMB, Feldman F, Scott VJ, Wasdell M, Gillan R, Ross D, Thompson-Franson T, Leung PM, Lin L. Facilitators of and barriers to hip protector acceptance and adherence in long-term care facilities: a systematic review. J Am Med Dir Assoc 2016; 16:185-93. [PMID: 25704127 DOI: 10.1016/j.jamda.2014.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 12/02/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hip protectors represent an attractive strategy for reducing hip fractures among high-risk fallers in long-term care facilities. However, clinical studies yield conflicting results regarding their clinical value. This is mainly due to poor acceptance and adherence among users in wearing these devices. As a result, there is an urgent need to identify potential barriers and facilitators to initial acceptance and continued adherence with hip protector use. PURPOSE The objective of this systematic review is to synthesize available research evidence to identify factors that influence acceptance and adherence among older adults living in long-term care facilities. METHODS A key word search was conducted for studies published in English between 2000 and 2013 that employed quantitative, qualitative, or mixed-methods research designs. Two independent reviewers evaluated each article for inclusion, with a third reviewer when needed to resolve discrepancies. RESULTS Twenty-eight articles met our inclusion criteria, and facilitators and barriers were clustered into 4 socio-ecological levels: system (eg, facility commitment, staff shortages), caregiver (eg, belief in the efficacy of protectors, negative perceptions), resident (eg, clinical risk factors for falls and related fractures, acute illness), and product (eg, soft shell, discomfort). DISCUSSION The outcomes provide decision makers, health professionals, and caregivers with a greater awareness of strategies to improve compliance with the use of hip protectors. Furthermore, researchers can use this information to design clinical trials that yield high acceptance and adherence.
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Affiliation(s)
- Alexandra M B Korall
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Fabio Feldman
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada; Older Adult Program, Fraser Health Authority, Surrey, Canada.
| | - Vicky J Scott
- British Columbia Injury Research and Prevention Unit, Vancouver, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Michael Wasdell
- Research and Academics, Ontario Shores Centre for Mental Health Sciences, Ontario, Canada
| | | | | | | | - Pet-Ming Leung
- Older Adult Program, Fraser Health Authority, Surrey, Canada
| | - Lisa Lin
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
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Sobolev B, Sheehan KJ, Kuramoto L, Guy P. Risk of second hip fracture persists for years after initial trauma. Bone 2015; 75:72-6. [PMID: 25681701 DOI: 10.1016/j.bone.2015.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Secondary prevention often targets women who suffer from higher rates of second hip fracture than men, especially in the early years after first fracture. Yet, the occurrence of second hip fracture by certain times also depends on the death rate, which is higher in men than women. We compared the risk of sustaining second hip fracture by a certain time between women and men remaining alive at that time. METHODS We retrieved 38,383 hospitalization records of patients aged 60 years or older, who were discharged alive after admission for hip fracture surgery between 1990 and 2005 in British Columbia, Canada. The outcome variable was the time to a subsequent hip fracture. RESULTS During ten years of follow-up, 2,902 (8%) patients sustained a second hip fracture, and 21,428 (56%) died before sustaining a second hip fracture. The risk of second hip fracture in the surviving post-fracture patients was higher in women than in men: 2% vs 2%, 5% vs 4%, 9% vs 7%, 15% vs 13%, and 35% vs 30% at 1, 2, 3, 5, and 10 years after initial trauma, respectively, crude OR=1.25 (95% CI: 1.13-1.39). However, the risk did not differ between women and men after adjustment, OR=1.09 (95% CI: 0.98-1.21). CONCLUSIONS The risk of second hip fracture persists for at least ten years among hip fracture survivors, and therefore secondary prevention should continue beyond an early post-fracture period. Women and men have similar risks of second hip fracture and both should be considered for secondary prevention.
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Affiliation(s)
- Boris Sobolev
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Katie Jane Sheehan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.
| | - Lisa Kuramoto
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Pierre Guy
- Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
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Sims-Gould J, McKay HA, Feldman F, Scott V, Robinovitch SN. Autonomy, choice, patient-centered care, and hip protectors: the experience of residents and staff in long-term care. J Appl Gerontol 2014; 33:690-709. [PMID: 24652886 DOI: 10.1177/0733464813488658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to examine long-term care (LTC) resident and staff perceptions on the decision to use hip protectors and identify the factors that influence attitudes toward hip protector use. Staff (N = 39) and residents (N = 27) at two residential care facilities in British Columbia, Canada were invited to participate in focus groups on fall prevention and hip protector use. A total of 11 focus groups were conducted. Using framework analysis results show that residents and staff shared concerns on aesthetic and comfort issues with hip protectors. Residents also generally felt they did not need, or want to use, hip protectors. However, they also had desire to be cooperative within the LTC environment. Staff underscored their role in advocating for hip protector use and their desire to protect residents from harm. Practice considerations for facilities wishing to promote hip protectors within a patient centered framework are highlighted.
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Morley JE. Osteoporosis and Fragility Fractures. J Am Med Dir Assoc 2011; 12:389-92. [DOI: 10.1016/j.jamda.2011.04.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 04/28/2011] [Indexed: 02/01/2023]
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Hospital admissions from nursing homes: rates and reasons. Nurs Res Pract 2011; 2011:247623. [PMID: 21994816 PMCID: PMC3170020 DOI: 10.1155/2011/247623] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 02/14/2011] [Indexed: 11/29/2022] Open
Abstract
Hospital admissions from nursing homes have not previously been investigated in Norway. During 12 months all hospital admissions (acute and elective) from 32 nursing homes in Bergen were recorded via the Norwegian ambulance register. The principal diagnosis made during the stay, length of stay, and the ward were sourced from the hospital's data register and data were merged. Altogether 1,311 hospital admissions were recorded during the 12 months. Admissions from nursing homes made up 6.1% of the total number of admissions to medical wards, while for surgical wards they made up 3.8%. Infections, fractures, cardiovascular and gastri-related diagnoses represented the most frequent admission diagnoses. Infections accounted for 25.0% of admissions, including 51.0% pneumonias. Of all the admissions, fractures were the cause in 10.2%. Of all fractures, hip fractures represented 71.7. The admission rate increased as the proportion of short-term beds increased, and at nursing homes with short-term beds, admissions increased with increasing physician coverage. Potential reductions in hospitalizations for infections from nursing homes may play a role to reduce pressure on medical departments as may fracture prevention. Solely increasing physician coverage in nursing homes will probably not reduce the number of hospitalizations.
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Kasturi GC, Adler RA. Osteoporosis: nonpharmacologic management. PM R 2011; 3:562-72. [PMID: 21478069 DOI: 10.1016/j.pmrj.2010.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 12/10/2010] [Accepted: 12/17/2010] [Indexed: 01/01/2023]
Abstract
Osteoporosis is a chronic disorder of the skeleton causing increased bone fragility and fractures. In the second of our 3-part series, we discuss the beneficial effects of nonpharmacologic agents in the management of osteoporosis. We review the evidence supporting the use of exercise, whole-body vibration, hip protectors, low-intensity pulsed ultrasound, bracing, and vertebral augmentation procedures. The mechanism of action, precautions, and expected outcomes are discussed. Nonpharmacologic management of osteoporosis blends in very well with an overall exercise prescription. The nonpharmacologic interventions discussed are readily available and easy to implement. The use of such techniques demonstrates the important role of the physiatrist in the management of osteoporosis.
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Affiliation(s)
- Gopi C Kasturi
- Department of Neurology/Rehabilitation, VA Central California Health Care System, 2615 E Clinton Ave, Fresno, CA 93703, USA.
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Cameron ID, Kurrle SE, Quine S, Sambrook PN, March L, Chan DK, Lockwood K, Cook B, Schaafsma FF. Improving Adherence With the Use of Hip Protectors Among Older People Living in Nursing Care Facilities: A Cluster Randomized Trial. J Am Med Dir Assoc 2011; 12:50-7. [DOI: 10.1016/j.jamda.2010.02.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 02/07/2010] [Accepted: 02/09/2010] [Indexed: 11/30/2022]
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Milisen K, Coussement J, Boonen S, Geeraerts A, Druyts L, Van Wesenbeeck A, Abraham I, Dejaeger E. Nursing staff attitudes of hip protector use in long-term care, and differences in characteristics between adherent and non-adherent residents: a survey and observational study. Int J Nurs Stud 2010; 48:193-203. [PMID: 20708185 DOI: 10.1016/j.ijnurstu.2010.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 07/06/2010] [Accepted: 07/07/2010] [Indexed: 12/01/2022]
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.
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Affiliation(s)
- Koen Milisen
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
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Morley JE. Phronesis and the Medical Director. J Am Med Dir Assoc 2009; 10:149-52. [DOI: 10.1016/j.jamda.2008.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 10/24/2008] [Indexed: 12/15/2022]
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Phillips VL, Yarmo Roberts D, Hunsaker AE. Certified Nursing Aides’ and Care Assistants’ Views on Falls: Insight for Creation and Implementation of Fall Prevention Programs. J Am Med Dir Assoc 2008; 9:168-72. [DOI: 10.1016/j.jamda.2007.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 11/12/2007] [Accepted: 11/28/2007] [Indexed: 11/25/2022]
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