My Mum is a faller and always has been. One of my earliest memories is of walking with her when she suddenly sprawled onto the pavement. I was horrified, but the only injuries were to her tights, her dignity and my belief that she was invulnerable. Years later, a fall headlong into deep sand on a lovely Tuscan beach left her unable to get up until a bemused holidaymaker, gazing after our retreating backs as we trooped ahead with our beach paraphernalia, came to her rescue. The first we knew of it was when she caught us up, covered in sand and helpless with laughter. Her most recent fall, in her mid-seventies, resulted in a broken hip.

 How about wearing hip protectors?

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With falls more likely and the chance of injury higher, would it be a smart move for my Mum, and other older people, especially the frequent fallers perhaps, to wear hip protectors? These are devices worn over the hips in underwear designed to hold them (or some over clothing), with the aim of lessening the riskA way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent. of breaking a hip should the wearer fall. They are either soft pads, which absorb the shock on impact, or hard shells, which deflect the force of the impact away from the hip bone to the soft tissue of the thigh. A quick Internet search brings up plenty of adverts for these. In exchange for about £40 you are offered the pants and pads along with promises of ‘peace of mind’, ‘round-the-clock comfort’ and a ‘clinically proven’ means of protection from a broken hip. Have we got evidence to support these claims?

A Cochrane reviewCochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. looking at the effectivenessThe ability of an intervention (for example a drug, surgery, or exercise) to produce a desired effect, such as reduce symptoms. of hip protectors for preventing hip fractures was first published in 1999 and the evidence looked pretty promising. Subsequent updates with new evidence have shown a less hopeful picture. The most recent version of the review was published last month. It now includes evidence from 19 trialsClinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known. with around 17,000 older people, including those living independently and in care facilities and using both hard and soft hip protectors in underwear. So what did they find?

 Protection from breaking a bone?

Not very promising evidence here. Hip protectors slightly reduced the number of hip fractures in people in residential care. The evidence was moderate quality and suggests that for every 1000 people wearing hip protectors 11 fewer will break a hip, but this could range from 20 fewer to none. There is poor quality evidence that hip protectors may actually slightly increase the small riskA way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent. of a pelvic fracture. They probably have no effect on other breaks or on falls. For those living in the community, hip protectors seem to make no difference.

 Round-the-clock comfort and peace of mind?

Well this is interesting. There’s good evidence that very few people had side effects such as skin irritation. But lots of people didn’t want to wear the hip protectors in the first place and of those who did many did not stick to wearing them, which rather calls into question how comfortable people found them. The reviewers note that other research has found that common reasons given for not wearing them include discomfort, the extra time and effort needed to wear them, problems with incontinence and other physical difficulties or illness. They also cite a studyAn investigation of a healthcare problem. There are different types of studies used to answer research questions, for example randomised controlled trials or observational studies. carried out in Norwegian nursing homes which compared soft and hard protectors and found that people were more likely to continue with soft ones and to wear them day and night. They conclude that there needs to be a better understanding of both personal and design factors that may influence their acceptability and use.

Of course, we know that prevention is better than cure and it’s best not to fall at all, to which end we have some pretty good evidence about things that older people can do to reduce their risk of falling in two Cochrane reviews, one relevant to people living in the community and the other (with less good evidence) for those in hospitals and care facilities.

Featured image: Credit – Wellcome Library, London. Detail from A man falling over on a cobbled street in Rome, his wife praying to Sansovino’s Virgin and Child, 27 May 1851. Mixed media. 

References and further reading may be found here. You may like to see this Special Collection on Preventing falls and fall-related injuries in older people.

Sarah Chapman has nothing to disclose.

Page last updated 01 October 2019.