Hip Protectors for the Elderly

Hip protectors are specially designed garments fitted with plastic shields or foam pads over both sides of the hip to protect the wearer from hip fracture during a fall.

Wearing a hip protector is like putting on a short pants with specially designed pads protecting both hip bones.
The hip bones are protected by wearing a hip protector.

The role of hip protector is much the same as that of seatbelt, lifejacket, helmet etc. They don’t prevent accidents, but may reduce the risk of  injuries, save money and perhaps life in the event of an accident.

Hip protector is recommended for use by frail, elderly people, people with low bone density or people with osteoporosis because they are the most vulnerable to fractures if they fall. 

Hip protector was first introduced in 1993. Since then, there has been quite some development and improvement in the designs and materials. And there are many brands and designs in the market with varying mechanical properties and quality. The more well known brands include: GeriHip, SafeHip, HipSaver, ImpactActive, Lyds, AHIP and KPH. 

How does a hip protector work?

Hip fracture is most likely to occur when a person falls sideway from standing height. The hip bone is cracked by the impacting force when the hip hits the ground. 

Hip protector works by either absorbing (soft pad) or dispersing (hard shield) the impact energy away from the critical area, thus saving the bone from breaking.

Hip fracture is caused by the impacting force on the hip bone when falling sideways. Wearing a hip protector may prevent the injury..
The impacting force on the hip bone when falling sideways might be absorbed or dispersed by a hip protector.

Is hip protector effective in preventing hip fracture?

Clinical trials on the efficacy of hip protectors are inconsistent and sometimes controversial. Some trials suggested that hip protectors helped to reduce hip fractures, in some cases by as much as 80%. Other randomised studies found hip protectors ineffective for older adults living in the community, and questionable effectiveness for those living in care facilities.

The inconsistent test results could be due to 1) different makes of hip protectors being used in the trials, and 2) varying compliance with wearing hip protectors. 

In the 2014 Cochrane Review, the author concluded:

Hip protectors probably reduce the risk of hip fractures if made available to older people in nursing care or residential care settings, without increasing the frequency of falls. However, hip protectors may slightly increase the small risk of pelvic fractures. Poor acceptance and adherence by older people offered hip protectors is a barrier to their use. Better understanding is needed of the personal and design factors that may influence acceptance and adherence.

Despite all the controversial issues, selected brands of hip protectors have been approved by FDA for use by older people with known osteoporosis. 

Recent studies using specific hip protectors, which the elderly would wear, seem to support the benefits of hip protectors. Fraser Health in British Columbia, Canada advocates the use of hip protector in their fall prevention program. The health authority recommends HipSaver and SaveHip brands and suggests that the risk of fracture could be reduced by 80%.

Researchers from Simon Fraser University, Canada, published their analysis of 2377 video captured falls in two long-term care homes. The recordings covered 11 years,  spanning 2007 to 2018 and involved 646 residents. There were 30 hip fractures in these falls.

The research team analyzed these videos to obtain objective evidence on factors and fall characteristics that result in hip fracture. 

  • They found that the risk for hip fracture was higher for falls landing sideways, and for falls causing hip impact.
  • They found that hip fracture risk was lower in 73 % of falls where hip protectors were worn. 
  • They also found that the use of a mobility aid was associated with lower fracture risk.

The Effect of Fall Biomechanics on Risk for Hip Fracture in Older Adults: A Cohort Study of Video‐Captured Falls in Long‐Term Care (2020)

How can compliance be improved?

Hip protectors should ideally be worn 24/7, even when sleeping,  as it only works when worn. Fall can happen at all times. It could happen when an elderly gets up at night to go to the bathroom. 

Lack of compliance is common among people living at home. Older adults with memory impairment might forget to wear the protectors; people with incontinence problems might find them too troublesome to put on and off; some people need help to put on the protectors properly. Lastly, some people reject wearing a hip protector because of the bulky appearance at the hips.

In contrast, residents living in nursing homes are under guidance and supervision at all times. They are more likely to be reminded and helped to wear the hip protectors.

Compliance can be improved through motivation, education and proper instruction. Health providers can organize awareness programs to involve users, relatives and caregivers in the use and importance of wearing the hip protectors.

Fraser Health hip protectors patient education brochure

In conclusion, hip protectors can help to reduce hip fractures in the elderly provided it is worn correctly and at all times. The improved design in some brands is welcoming. These protectors are easy to put on and off, and comfortable to wear even when in bed.

Always get advice before making a purchase to make sure that the product is safe and suitable for you or your loved one.

Further readings:

Colón-Emeric, Datta and Matchar (2003). An economic analysis of external hip protector use in ambulatory nursing facility residents. Age and Ageing, Volume 32, Issue 1, January 2003, Pages 47–52

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