Over 200,000 hip fractures occur in the U.S. yearly among older persons, primarily due to osteoporosis and an increased risk of falls. Among the elderly in nursing homes, falls account for more than 90% of reported injuries and 60% of those who sustain fractures die shortly thereafter. Falls and injurious falls are serious health problems and research is needed to test interventions to prevent falls and injuries. Care costs of elderly persons following falls is also of critical concern, with acute care costs for femoral neck fractures alone projected at 3 billion dollars in the U.S. in 1990 (Burnside, 1988). The proposed research tests the effectiveness of two interventions in reducing the number of falls and the injuries due to falls in a large sample of institutionalized elderly in 14 nursing homes. The first intervention, elimination rounds, prevents falls by providing assistance to and from the toilet on an individualized schedule. The second intervention, hip joint protective clothing, reduces the chance and extent of injurious falls by redistributing and absorbing the shock load to the hip (greater trochanter) when a fall occurs. About 450 non-severely cognitively impaired elderly (65 or >) residents will be randomly assigned to one of 4 groups formed by the cross-classification of the two interventions. The following questions will be answered: 1) Are there between group differences in the number of falls, number and type of injurious falls, and extent of injury from falls for elderly patients who participate in the 3 experimental treatments and compared to those elderly in the control condition? 2) Will persons using the hip joint pads sustain fewer and less severe hip injuries and more injuries in other body locations as a result of redistribution of shock load on the hip? 3) Is there a difference in care costs for patients who participate in the treatment groups? 4) What are the differences in illness morbidity and mortality, use of medications, medical and nursing treatments, use of restraints and/or assistive devices, and social and recreational activities following a fall, and how does each contribute to the cost of care for patients in the 4 groups? Between-group differences on the dependent variables over time and at separate time points, the magnitude of these effects, and within-group changes before and after the interventions will be investigated.
|Wallace, R B; Ross, J E; Huston, J C et al. (1993) Iowa FICSIT trial: the feasibility of elderly wearing a hip joint protective garment to reduce hip fractures. J Am Geriatr Soc 41:338-40|