The acceptance of the hip protector by senior citizens aged over 70 living at home / Markus Hubacher
Bern : BFU, 2000
(BFU Report; 45).
Descriptoren: non-institutionalized elderly (risk groups). hip protectors. effectiveness. interviews. questionnaires. testing
Senior citizens are very accident-prone, with more than 1,000 fatal accidents occurring every year in Switzerland, especially as the result of a fall, almost half of them due to a hip fracture. Because prevention among the aged is difficult and because most falls are caused by a number of factors (physical and psychic human factors, environmental conditions) one must additionally attempt to prevent, or at least reduce, the potential injuries resulting from an accident. One means to this end is the hip protector, for example in the shape of a shell made of plastic, which – attached to underwear – is worn on the hips. In the event of a fall on to the hip area, this protector absorbs part of the shock energy and distributes it across the surrounding soft parts so that the forces acting on the hip itself are no longer strong enough to cause a fracture.
The effectiveness of hip protectors has been proved purely mechanically in the laboratory as well as in trials with test subjects. The fact that use of hip protectors is not very widespread is mainly due to the lack of acceptance by fall-prone senior citizens. The objective of this study was to investigate the factors on which the acceptance of the hip protector depends. For the tests the HIPSŪ protector was used. The advantage of this protector over other products that are sewn into the underwear is that it can be removed from underwear, which is of particular advantage in cases of incontinence.
The study consisted of three independent surveys, the first two serving as preliminary studies for the main investigation (survey 3). The first survey involved carrying out a qualitative interview aimed at clarifying the acceptance of the hip protector among senior citizens living at home; the second was a quantitative investigation of how widespread falls, fear of falls, etc. are and what effects this has on opinions about the hip protector. The third survey, which was also of a quantitative nature, served mainly to establish the determinants for the acceptance of the hip protector.
This third part of the survey was the most important and extensive of the entire study. A total of 522 senior citizens aged 70 and older were interviewed in depth about the state of their health as well as about the problems of falls and hip fractures. After being introduced to the Hips hip protector, they were required to express an opinion about various features. At the end of the interview the senior citizens were offered the opportunity of taking part in a wearing test lasting two months. Those who chose to take part (N= 83) were subsequently required to enter wearing times in a diary. After completion of the test phase, the participants were again asked to assess the protector (N= 67; absence of 16 people due to committal to a home, death, etc.).
The interview revealed that about 65 per cent of the senior citizens felt well or very well at the time of the interview, 29 per cent only moderately well, whereas 6 per cent felt ill or very ill. The current state of health has an effect on the fall frequency: the poorer the state of health, the greater the number of falls that had occurred in the past 12 months. Those suffering from an impaired ability to walk, frequent attacks of dizziness and a marked fear of falls tend to fall more often. Based on these findings, a fall-proneness scale was drawn up and every person allocated a fall-proneness score. Two-thirds of the senior citizens (66.8 per cent) could be considered as only slightly fall-prone and one third (33.2 per cent) as very fall-prone.
In the interview interest was focused mainly on the HIPSŪ hip protector. After this had been examined it had to be evaluated in terms of several features. About half of the participants were of the opinion that the hip protector was not visible from the outside, 37 per cent thought it was easily visible while 13 per cent felt it was very conspicuous, with women rating the protector as easily visible or conspicuous significantly more often than the men. The wearing comfort was generally considered to be relatively poor; only roughly 30 per cent of the interviewees assumed that the protector would not be uncomfortable. On the other hand, the handling when putting on and taking off the protector and its protective effect were doubted less than its comfort, with the very accident-prone senior citizens giving handling a significantly worse rating than those with only a slight fall risk.
Of the interviewees, 16 per cent agreed to submit to a wearing test over a period of two months. The willingness to do so was based mainly on the personal fall risk, the assessment of the wearing comfort and the protective effect. Whoever attributed a good protective effect to the protector was 3.5 times more likely to wear it than those who had doubts in this respect. Those who had a positive opinion of wearing comfort were almost three times more likely to wear the protector than those who had a negative opinion. Likewise those who had a high fall risk; compared with those with a low fall risk the willingness to wear the protector was also some three times higher.
The wearing test showed that over time fewer and fewer subjects actually wore the protector during the day (from 64 per cent in the first week to 10 per cent in the ninth week). During the night between 5 and 10 per cent initially wore the protector, in the ninth week nobody. On average the protector was worn for 79.2 hours, with women wearing it about 27 hours longer than men. The assessments of the two protector features „visibility from outside“ and „comfort“ prior to the wearing test were also of significance. Whoever was convinced that the protector was not visible from outside wore it roughly four times longer than persons who did not share this view. And those who rated the protector as not uncomfortable wore it about three times longer than senior citizens who rated the wearing comfort as poor.
In the concluding evaluation after the wearing test the overall opinion of the protector tended to be rather negative. Only about 25 per cent of the participants rated the hip protector as being good or very good; on the other hand, almost 50 per cent rated it as being poor or very poor. Senior citizens with a high fall risk differed from those with a low risk only in respect of positioning the protector correctly on the hips: the high-risk participants admitted to having significantly greater difficulties in placing the protector correctly than the senior citizens in the low fall risk category.
The findings of the study enable an estimate to be made concerning the hip protector’s potential for preventing hip fractures: of the roughly 7,500 such fractures sustained annually by those over the age of 70 living at home approximately 150 would be prevented (of which about 10 fatalities). This suggests that it would not be sensible to promote the hip protector widely. However, it should be mentioned that the aforementioned potential was calculated under unfavourable circumstances: lack of knowledge on the part of the general public about the existence of the hip protector, no choice of models and no medical recommendations to wear a protector. In order that the wearing rate can be improved and the morbidity and mortality rates resulting from a hip fracture can be reduced, a number of measures are necessary. For example, the whole problem of hip-fracture-related falls and their most dramatic consequences (for example, loss of independence, being committed to a home, death) should be given greater prominence. At the same time the hip protector should be promoted as an effective method of protection. Competent persons in the medical field or employees of home nursing services must make all senior citizens aware of the problem and suggest to fall-prone individuals that they should wear a protector. In order that the protector enjoys more acceptance, manufacturers must design comfortable and easy-to-fit protectors. Those who sell them would then have the task of communicating these characteristics. Furthermore, it would be an advantage if various protector models were on the market, so that the senior citizens who are interested could choose a protector having the features on which they place particular value (for example, easy handling, high protective effect). Finally, it should be said that the development of hip protectors did not begin very long ago and that their use by the general public is only in its infancy. In view of the probable demographic development, involving a high percentage of senior citizens, it is advisable to ensure as quickly as possible that the hip protector is known about and that a high readiness to wear it is achieved.