In a study conducted in Great Britain by Salkeld and colleagues (2000), 80 percent of older women report they would rather be dead than experience loss of independence as a consequence of a hip fracture and admission to a nursing home. Older adults' dread of hip fractures is understandable, since the personal and financial costs associated with hip fractures have been well documented. Additionally, according to the U.S. Department of Health and Human Services (2000), no progress has been made toward the Healthy People 2000 target of reducing the hospitalization rate for hip fractures. Consequently, that objective has been included in Healthy People 2010, which outlines major health priorities for the nation (U.S. Department of Health and Human Services, 2000). Finally, although more than twenty randomized trials of interventions to prevent falls have been conducted, conclusive practice directives for the prevention of fall-related injuries, especially among frail or hospitalized elderly, have not yet emerged. Compared to other evaluated strategies (e.g., exercise, multifactorial interventions), hip protectors are a novel approach to the prevention of fall-related hip fractures among older adults (Kannus and Khan, 2001). Increasing evidence of the effectiveness of certain types of hip protectors, combined with the increasing number of people at greatest risk for hip fracture, has focused attention on this secondary prevention strategy. HOW HIP PROTECTORS WORK Biomechanical studies have demonstrated that although bone strength and the force of the impact are important factors contributing to hip fracture, the point of impact must be on or near the hip for a fall to cause a hip fracture (Hayes et al., 1993). In most cases of hip fracture, the immediate cause of the fracture is a sideways fall with direct impact on the greater trochanter (a prominence at the top) of the proximal femur (Lauritzen, Peterson, and Lund, 1993). Hip protectors are anatomically designed to protect the hip bones during a fall by diminishing the force transferred to the proximal femur. The hip protector can both absorb some of the force of the fall and shunt the energy of the impact away from the greater trochanter of the femur to the surrounding soft tissues. DESIGN VARIATIONS About ten types of hip protectors are currently on the market. These products share the function of providing protection directly to the greater trochanter. However, the products vary dramatically in design and appearance. Most hip protectors on the market feature hard (padded) shields or soft pads sewn or inserted into a pair of underwear. In contrast, the HipGuard hip protector is held to the body by a belt worn around the hips. The shields used in hip protectors vary in thickness and construction. The HipSaver hip protector, which has been adopted by the National Health Service in the United Kingdom, uses foam (developed by NASA) in an airtight waterproof pouch that inflates in the event of a fall. The underwear used in hip protectors is typically stretchy, but at least one product uses loose, boxer-type shorts. All products are intended to be light-weight. While many of the shields used in hip protectors are oval or disc-shaped, the shape of hip protector shields may be changing. Funded by the National Institutes of Health and the Centers for Disease Control and Prevention, Toby Hayes and his colleagues at the Beth Israel Deaconess Medical Center have designed and tested a hip protector shaped like an inverted horseshoe. The pad is filled with cornstarch and water. Known as a dilatant fluid, the cornstarch-filled prototype changes from a soft medium to a solid form of protection during impact from a fall (Beth Israel Deaconess Medical Center, 1999). EFFICACY OF HIP PROTECTORS Hip protectors have been shown to prevent fractures among the frail elderly through individual randomized, controlled trials and through comprehensive analyses of well-designed studies as a whole. …

Elizabeth Walker Peterson

Category	Quartile
社会学	4
社会学, 老年医学	4

Hip Protectors to Prevent Fall-Related Fractures

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