DORON DORON GARFINKEL, M.D.GARFINKEL, M.D.
HEAD, GERIATRIC PALIATIVE DEPARTMENT HEAD, GERIATRIC PALIATIVE DEPARTMENT
SHOHAM GERIATRIC MEDICAL CENTER
PARDES โ HANA,
I S R A E L
SHOHAM GERIATRIC MEDICAL CENTER
PARDES โ HANA,
I S R A E L
Falls and Fall Prevention in the
Elderly
Falls and Fall Prevention in the
Elderly
OverviewOverview
โข PrevalencePrevalence
โข Clinical ImportanceClinical Importance
โข Risk Factors & EtiologyRisk Factors & Etiology
โข Evaluation Evaluation
โข Prevention & ManagementPrevention & Management
โข Falls & restraint useFalls & restraint use
โข SummarySummary
โข PrevalencePrevalence
โข Clinical ImportanceClinical Importance
โข Risk Factors & EtiologyRisk Factors & Etiology
โข Evaluation Evaluation
โข Prevention & ManagementPrevention & Management
โข Falls & restraint useFalls & restraint use
โข SummarySummary
Falls in the ElderlyFalls in the Elderly
PrevalencePrevalencePrevalencePrevalence
โข 30% of those over 65 fall annually30% of those over 65 fall annually
โข Half are repeat fallersHalf are repeat fallers
โข Falls go up with each decade of lifeFalls go up with each decade of life
โข Over half of those in nursing homes Over half of those in nursing homes
and hospitals will fall each yearand hospitals will fall each year
โข The incidence of falls increase with age The incidence of falls increase with age
โข Each year 30 - 40% of community-dwelling Each year 30 - 40% of community-dwelling persons > 65 years old have a fall.persons > 65 years old have a fall.
โข The annual incidence of falls among people The annual incidence of falls among people who experienced a fall in the previous year, who experienced a fall in the previous year, is almost 60%. is almost 60%.
FALLS - INCIDENCEFALLS - INCIDENCE
25% - 25% - AGE 65 โ 74, 33% - AGE > 75AGE 65 โ 74, 33% - AGE > 75
120% AGE > 80 ( > ONE FALL / Year120% AGE > 80 ( > ONE FALL / Year))
Clinical Importance Impact of Hip Fractures
Clinical Importance Impact of Hip Fractures
โข 1% of falls result in hip fracture1% of falls result in hip fracture
โข $2 billion + in medical costs annually$2 billion + in medical costs annually
โข 25% die within 6 months25% die within 6 months
โข 60% have restricted mobility60% have restricted mobility
โข 25% remain functionally more 25% remain functionally more
dependentdependent
Falls Cause Morbidity & MortalityFalls Cause Morbidity & Mortality
โข Mortality: indirect effectsMortality: indirect effects
โข Fractures: 6% of fallsFractures: 6% of falls
โข Soft tissue injury, head injury, subdural hematomaSoft tissue injury, head injury, subdural hematoma
โข Fear of falling can result in decreased activity, Fear of falling can result in decreased activity,
isolation, and further functional declineisolation, and further functional decline
โข Nursing home Nursing home placementplacement & loss & loss ofof independence independence
FALLS - - A LEADING CAUSE OF A LEADING CAUSE OF MORBIDITY, DISABILITY & DEATHMORBIDITY, DISABILITY & DEATHFALLS - - A LEADING CAUSE OF A LEADING CAUSE OF MORBIDITY, DISABILITY & DEATHMORBIDITY, DISABILITY & DEATH
โขComplications resulting from falls are the leading cause of death from injury in adults aged 65 and older.
โขFear, Loss of Confidence
โขDecreased Functioning
โขDependency
โขPhysical Trauma - 10%
โข FRACTURES - 5%- 15%
Risk Factors & Etiology
Falls are Multifactorial
Risk Factors & Etiology
Falls are Multifactorial
Intrinsic FactorsIntrinsic Factors Extrinsic FactorsExtrinsic Factors
FALLSFALLS
Medical Medical conditionsconditions
Impaired vision Impaired vision and hearingand hearing
Age related Age related changeschanges
MedicationsMedications
Improper use of Improper use of assistive devicesassistive devices
EnvironmentEnvironment
Age - Related Changes
Age - Related Changes
โข NeurologicNeurologic
โ Increased reaction timeIncreased reaction time
โ Decreased righting reflexesDecreased righting reflexes
โ Decreased proprioceptionDecreased proprioception
โข Vision ChangesVision Changes
โ Decreased accommodation & dark Decreased accommodation & dark adaptationadaptation
โข Decreased muscle massDecreased muscle mass
Age - Related ChangesG A I TG A I T
Age - Related ChangesG A I TG A I T
โขSlower gaitSlower gait
โขDecreased stride length & arm swingDecreased stride length & arm swing
โขForward flexion at head and torsoForward flexion at head and torso
โขIncreased flexion at shoulders and Increased flexion at shoulders and
kneesknees
โขIncreased lateral swayIncreased lateral sway
D y s m o b i l i t yD y s m o b i l i t y
โขDysmobility and falling closely relatedDysmobility and falling closely related
โข15% of those over 65 have trouble 15% of those over 65 have trouble
walkingwalking
โข1/4 men and 1/3 women over age 85 1/4 men and 1/3 women over age 85
have difficulty with walkinghave difficulty with walking
โข2/3 of people in hospital or NH unable to 2/3 of people in hospital or NH unable to
ambulate without assistanceambulate without assistance
Risk Factors for FallsRisk Factors for Falls
โ 2828
โ Cognitive ImpairmentCognitive Impairment 55
โ Lower extremity problemLower extremity problem 44
โ Pathologic ReflexPathologic Reflex 33
โ Foot ProblemsFoot Problems 22
โ > balance/gait problems> balance/gait problems 1.91.9
Tinetti NEJM 1988Tinetti NEJM 1988
Risk FactorRisk Factor OROR
SSedative useedative use
Common Pathologies associated with FallsCommon Pathologies associated with Falls
โข Ophthalmologic diseasesOphthalmologic diseases
โข Arthritis Arthritis
โข Foot problems Foot problems
โข Neurologic illnessNeurologic illnessโ ParkinsonParkinsonโโs & related disorderss & related disordersโ StrokesStrokesโ Peripheral neuropathyPeripheral neuropathy
โข Dizziness and dysequilibriumDizziness and dysequilibrium
Dizziness: A Multifactorial Dizziness: A Multifactorial SyndromeSyndrome
Dizziness: A Multifactorial Dizziness: A Multifactorial SyndromeSyndrome
โข Vertigo: Posterior CVA/TIA, Cervical Vertigo: Posterior CVA/TIA, Cervical
โข Presyncope: Orthostatic, Dysrythmia, Presyncope: Orthostatic, Dysrythmia, AnemiaAnemia
โข Dysequilibrium: Peripheral neuropathy, Dysequilibrium: Peripheral neuropathy,
VisualVisual
โข Other: Anxiety, depressionOther: Anxiety, depression
โข In older people, usually multifactorialIn older people, usually multifactorial
Tinetti, Annals of Internal Med 2000Tinetti, Annals of Internal Med 2000Tinetti, Annals of Internal Med 2000Tinetti, Annals of Internal Med 2000
Falls in the CommunityFalls in the Community
โขAccidents/environment 37%
โขWeakness, balance, gait 12%
โขDrop attack 11%
โขDizziness or vertigo 8%
โขOrthostatic hypotension 5%
โขAcute illness, confusion, drugs, decreased vision 18%
โขUnknown 8%
โขAccidents/environment 37%
โขWeakness, balance, gait 12%
โขDrop attack 11%
โขDizziness or vertigo 8%
โขOrthostatic hypotension 5%
โขAcute illness, confusion, drugs, decreased vision 18%
โขUnknown 8%
Rubenstein JAGS 1988Rubenstein JAGS 1988
Falls in Residential Care
Falls in Residential Care
โข Generalized weaknessGeneralized weakness 31%31%
โข Environmental hazardEnvironmental hazard 27%27%
โข Orthostatic hypotensionOrthostatic hypotension 16%16%
โข Acute illnessAcute illness 5% 5%
โข Gait or balance disorderGait or balance disorder 4% 4%
โข DrugsDrugs 5% 5%
โข Other or unknownOther or unknown 10% 10%
Rubenstein Ann Int Med 1990Rubenstein Ann Int Med 1990
Medications and FallsMedications and Falls
โขSedative-hypnotics, especially long acting Sedative-hypnotics, especially long acting benzodiazepines, benzodiazepines,
โขSmall association between most Small association between most psychotropics and fallspsychotropics and falls
โขSSRIs and TCAs both increase fallsSSRIs and TCAs both increase falls
โขWeak association between Type 1A Weak association between Type 1A antiarrythmics, digoxin, diuretics, and antiarrythmics, digoxin, diuretics, and fallsfalls
Leipzig JAGS 1999
Thapa NEJM 1998
Leipzig JAGS 1999
Thapa NEJM 1998
Evaluation of Falls in the Evaluation of Falls in the Elderly Medical HistoryElderly Medical History
Evaluation of Falls in the Evaluation of Falls in the Elderly Medical HistoryElderly Medical History
โขLocation & circumstances of FallLocation & circumstances of Fall
โขAssociated symptomsAssociated symptoms
โขOther falls or near fallsOther falls or near falls
โขMedications (including Medications (including
nonprescription) and alcoholnonprescription) and alcohol
โขInjury & ability to get upInjury & ability to get up
Evaluation of Falls in the Evaluation of Falls in the
Elderly Elderly
Physical Examination Physical Examination
Evaluation of Falls in the Evaluation of Falls in the
Elderly Elderly
Physical Examination Physical Examination
โข Supine and standing BP - alwaysSupine and standing BP - always
โข Routine physical examinationRoutine physical examination
Focus on cardiovascular, MS, neuro, feetFocus on cardiovascular, MS, neuro, feet
โข Vision and hearing evaluationVision and hearing evaluation
โข Consider acute medical illness & deliriumConsider acute medical illness & delirium
โข Formal gait and balance assessmentFormal gait and balance assessment
Evaluation of Falls: Evaluation of Falls:
Home Evaluation Home Evaluation
Evaluation of Falls: Evaluation of Falls:
Home Evaluation Home Evaluationโข Can be Can be performed by nurse, OT, PT, performed by nurse, OT, PT, othersothers
โขStairsStairs
โขLightingLighting
โขBathroomBathroom
โขSpecific hazards: cords, throw rugsSpecific hazards: cords, throw rugs
Evaluation of Falls: Evaluation of Falls: Risk Factors for Injury Risk Factors for Injury
Evaluation of Falls: Evaluation of Falls: Risk Factors for Injury Risk Factors for Injury
โขOsteoporosis assessmentOsteoporosis assessment
โขAnticoagulation: Usual benefits Anticoagulation: Usual benefits outweigh risks unless repeat or high outweigh risks unless repeat or high risk fallerrisk faller
โขCan the person get up from fall?Can the person get up from fall?
โขIs there a way to notify others in Is there a way to notify others in case of falling?case of falling?
POMA: Balance ComponentPOMA: Balance Component
Sitting (in hard, armless chair)Sitting (in hard, armless chair)
ArisingArising
Standing balance (immediate and delayed)Standing balance (immediate and delayed)
Balance with NudgeBalance with Nudge
Balance with Eyes closedBalance with Eyes closed
Balance with 360 degree turnBalance with 360 degree turn Tinetti JAGSTinetti JAGS 1986 1986
Formal Gait EvaluationFormal Gait EvaluationFormal Gait EvaluationFormal Gait EvaluationGet up and Go TestGet up and Go Test
Tinetti Gait & Balance Evaluation Tinetti Gait & Balance Evaluation (POMA)(POMA)
Get up and Go TestGet up and Go Test
Tinetti Gait & Balance Evaluation Tinetti Gait & Balance Evaluation (POMA)(POMA)
POMA: Gait ComponentPOMA: Gait ComponentPOMA: Gait ComponentPOMA: Gait ComponentInitiationInitiation
Step length and heightStep length and height
Step symmetry & continuityStep symmetry & continuity
PathPath
Stance Stance
Ability to pick up speedAbility to pick up speed
Tinetti JAGS 1986Tinetti JAGS 1986
Prevention & Prevention & TreatmentTreatmentPrevention & Prevention & TreatmentTreatment
โขTreat acute injury & underlying medical conditions
โขRemove unnecessary medications
โขRehab, exercises, assistive devices
โขCorrect sensory impairments
โขEnvironmental modifications & safety
โขEvaluate for osteoporosis treatment
OsteoporosisOsteoporosisOsteoporosisOsteoporosisโข Calcium and vitamin D for most elders at Calcium and vitamin D for most elders at
riskrisk โข Dawson-Hughes, NEJM, 1997Dawson-Hughes, NEJM, 1997
โข Osteoporosis evaluation and treatment Osteoporosis evaluation and treatment
โข Thiazides may help slightlyThiazides may help slightly
โข Statins?Statins?
โข Hip protectors appear to protect from hip Hip protectors appear to protect from hip fractures in those who wear themfractures in those who wear them
โข Kannus, NEJM, 2000 Kannus, NEJM, 2000
ChangeChange Estimated Change in RiskEstimated Change in Risk
Quit smokingQuit smoking 38%38%
Treat impaired visionTreat impaired vision 50%50%
Stop sedativesStop sedatives 40%40%
Add 1 Gram CalciumAdd 1 Gram Calcium 24%24%
Hip ProtectorsHip Protectors 50%? 50%?
Adapted from Steeve CummingsAdapted from Steeve Cummings
Risk Factor ModificationsRisk Factor Modifications for Fractures for Fractures
Risk Factor ModificationsRisk Factor Modifications for Fractures for Fractures
Falls: Primary PreventionFalls: Primary PreventionFalls: Primary PreventionFalls: Primary Prevention
โข301 community dwelling elders with 1+ risk factors for falling
โขIntervention: adjustment in medications, behavioral instructions, exercise programs aimed at modifying risk factors
โขOne year follow up
โข301 community dwelling elders with 1+ risk factors for falling
โขIntervention: adjustment in medications, behavioral instructions, exercise programs aimed at modifying risk factors
โขOne year follow up
Tinetti et al. 1994 NEJMTinetti et al. 1994 NEJMTinetti et al. 1994 NEJMTinetti et al. 1994 NEJM
Multifactorial Multifactorial InterventionIntervention
Multifactorial Multifactorial InterventionIntervention
0
10
20
30
40
50
0 3 6 9 12
Months
% Falling
Control
InterventMoi
P = .04
Tinetti et al 1994 NEJM
Exercise Training & Exercise Training & NutritionNutrition
Exercise Training & Exercise Training & NutritionNutrition
-20
0
20
40
60
80
100
120
140
Exer Exer +Su
Sup Control
STUDY GROUP
% Change Muscle
strength
Exer
Exer + Su
Sup
Control
Fiatarone et al NEJM 1994
Tai Chi and FallingTai Chi and FallingTai Chi and FallingTai Chi and Fallingโข Atlanta FICSIT Trial Atlanta FICSIT Trial
โ 200 community dwelling elders 70+200 community dwelling elders 70+
โ Intervention: 15 weeks of education, balance training, Intervention: 15 weeks of education, balance training,
or Tai Chior Tai Chi
โ Outcomes at 4 months: Strength, flexibility, CV Outcomes at 4 months: Strength, flexibility, CV
endurance, composition, IADL, well being, fallsendurance, composition, IADL, well being, falls
โข Falls reduced by 47% in Tai Chi groupFalls reduced by 47% in Tai Chi group
Wolf JAGS 1996Wolf JAGS 1996
Campbell BMJ 1997Campbell BMJ 1997
Training frail older persons: Training frail older persons:
The New Zealand Study of The New Zealand Study of WomenWomen
Training frail older persons: Training frail older persons:
The New Zealand Study of The New Zealand Study of WomenWomen
223 women >80 years223 women >80 yearsIntervention: PT tailored to Intervention: PT tailored to
individual needs, with resistance individual needs, with resistance and balance trainingand balance training
ResultsResults::Clinical balance, chair rise improvedClinical balance, chair rise improvedRR for falls .47 (CI .04-.90)RR for falls .47 (CI .04-.90)RR for injurious falls .61 (.39-.97)RR for injurious falls .61 (.39-.97)
SummarySummaryโขFalls are common in the elderly & Falls are common in the elderly &
may lead to injuries and decline in may lead to injuries and decline in functionfunction
โขEvaluation should included risk Evaluation should included risk factor assessment, gait assessment, factor assessment, gait assessment, and home assessmentand home assessment
โขExercise can improve outcomesExercise can improve outcomesโขWe have no evidence that restraints We have no evidence that restraints
reduce fall related injuriesreduce fall related injuries
Doron GarfinkelDoron Garfinkel
EFFICACY OF HIP PROTECTORS
IN THE PREVENTION OF HIP FRACTURES
IN PATIENTS WITH DEMENTIA
EFFICACY OF HIP PROTECTORS
IN THE PREVENTION OF HIP FRACTURES
IN PATIENTS WITH DEMENTIA
Shoham Geriatric Medical Center
Pardes โ Hana, Israel
Shoham Geriatric Medical Center
Pardes โ Hana, Israel
A G I N GA G I N G
INSTABILITYINSTABILITY
SARCOPENIASARCOPENIADISABILITYDISABILITY
ยฑ DEMENTIADEMENTIA
OSTEOPOROSISOSTEOPOROSISFRACTUREFRACTURE
THE VICIOUS CIRCLE THE VICIOUS CIRCLE
F A L L SF A L L S
10-15% of Falls result in fractures10-15% of Falls result in fractures In the US - 90 percent of more In the US - 90 percent of more
than 350,000 hip fractures each than 350,000 hip fractures each year are the result of a fallyear are the result of a fall.
FALLS & HIP FRACTURESFALLS & HIP FRACTURES
An estimate of An estimate of 1.3 million1.3 million hip hip fractures occurred worldwide in fractures occurred worldwide in 1990,1990, By 2050 in the US alone, there By 2050 in the US alone, there will be an estimated No. of will be an estimated No. of 650,000 650,000 hip fractureship fractures annually annually
Nearly Nearly 1800 hip fractures a day1800 hip fractures a day!!
0
100
200
300
400
500
600
700
O
No.(x
1000)
USAUSAUSAUSA
UKUK
?
1980 2000 2050
ESTIMATEDESTIMATED
ืืขืืื ืืฉืืืืืช ืฉืืจืื ืืฆืืืืจ ืืืจื ืขื ืืฉื ืื
ืืขืืื ืืฉืืืืืช ืฉืืจืื ืืฆืืืืจ ืืืจื ืขื ืืฉื ืื
Hip fractures is the commonest reason for admission of Hip fractures is the commonest reason for admission of
elderly people to an acute orthopedic wardelderly people to an acute orthopedic ward
HIP FRACTURES - OUTCOMESHIP FRACTURES - OUTCOMES
Johnell & Kanis, Osteopor Int 2004; 15: 897 โ 902. Johnell & Kanis, Osteopor Int 2004; 15: 897 โ 902.
The death rate attributed to falls also increase with age, reaching at age > 85 โ 180 deaths per 100,000 population
The death rate attributed to falls also increase with age, reaching at age > 85 โ 180 deaths per 100,000 population
Each year, 8% of people > 70 years old Each year, 8% of people > 70 years old reach the Emergancy Room, as a result reach the Emergancy Room, as a result of Fall - related injuriesof Fall - related injuries
Those admitted are hospitalized for Those admitted are hospitalized for an average of 8 days. an average of 8 days.
These hip fractures may result in These hip fractures may result in .. permanent disabilitypermanent disability accounting for accounting for a significant portion of the a significant portion of the
Global Burden of DiseaseGlobal Burden of Disease
HIP FRACTURES - OUTCOMESHIP FRACTURES - OUTCOMES
Only 25 percent of patients with hip Only 25 percent of patients with hip
fractures will make a full recoveryfractures will make a full recovery
50 percent will need some assistance 50 percent will need some assistance
- cane or walker - cane or walker
HIP FRACTURES - OUTCOMESHIP FRACTURES - OUTCOMES
40% will require Long โ Term Care 40% will require Long โ Term Care (nursing homes & nursing (nursing homes & nursing departments) departments)
In the US, the cost of fall-related In the US, the cost of fall-related
injuries injuries isis estimated as estimated as
12,6 billion dollars yearly12,6 billion dollars yearly
ืฉืืืืืช ืฉืืจื ืฆืืืืจ ืืืจื ืฉืืืืืช ืฉืืจื ืฆืืืืจ ืืืจื ืืืฉืจืืืืืฉืจืื
ืฉืืืืืช ืฉืืจื ืฆืืืืจ ืืืจื ืฉืืืืืช ืฉืืจื ืฆืืืืจ ืืืจื ืืืฉืจืืืืืฉืจืื
ืืืฉืจืืืืืฉืจืื 700,000700,000 ื- ื-
6565ืงืฉืืฉืื ืืขื ืืื ืงืฉืืฉืื ืืขื ืืื
ืืืฉืจืืืืืฉืจืื ืฉืืืืืช ืฉืืจื ืืจืืฉืืืืืช ืฉืืจื ืืจื
ืืฉื ื ืืฉื ื6,0006,000ื - ื -
ืืืืฆืื ืืืืคืื ืืืืฆืื ืืืืคืื
ืฉืืจ ืืื ืืฆืืืืจ ืืืจืืฉืืจ ืืื ืืฆืืืืจ ืืืจื
ืฉ"ื ืฉ"ื75,00075,000ื- ื-
ืืืืืื โช ืืืืืื โช 450450 ื-ื-
ืืฉื ื!!!ืืฉื ื!!!
ืืขืจืืช ืืกืืืื ืืืืจื ืืขืจืืช ืืกืืืื ืืืืจื ืืืืืื
ืืขืจืืช ืืกืืืื ืืืืจื ืืขืจืืช ืืกืืืื ืืืืจื ืืืืืื
50 ืืื ืืกืืืื ืฉื ืืืฉื ืืขืืืืืืช ืฉืืจ ืืืกืืืืคืืจืืื ืืืืื ืืืื
50 ืืื ืืกืืืื ืฉื ืืืฉื ืืขืืืืืืช ืฉืืจ ืืืกืืืืคืืจืืื ืืืืื ืืืื
50ืกืืืื ืฉื ืืืฉื ืืขื ืืื ืืกืงืืืจืืช ืืืืืช ืืืืื ืงืจืืื
50ืกืืืื ืฉื ืืืฉื ืืขื ืืื ืืกืงืืืจืืช ืืืืืช ืืืืื ืงืจืืื ==40
%40%
ืืกืคืจ ืืื ืืืฉืคืื ืืชืืฆืื ืืฉืืจื ืฆืืืืจ
ืืืจื
ืืกืคืจ ืืื ืืืฉืคืื ืืชืืฆืื ืืฉืืจื ืฆืืืืจ
ืืืจื
ืืกืคืจ ืืื ืืืฉืคืื =ืืกืืืจืช, ืืชืงืคื ืื ืืกืจืื ืฉื ืืชืืฆืื
ืืกืคืจ ืืื ืืืฉืคืื ืืกืืืจืช, ืืชืงืคื ืื ืืกืจืื ืฉื ืืชืืฆืื
::ืืืืจ ืฉืืจ ืืฆืืืืจ ืืืจืืืืืจ ืฉืืจ ืืฆืืืืจ ืืืจื ืืื ื ืืกืืืืื ืืืืช ืืื ืืื ื ืืกืืืืื ืืืืช ืืื 40%40%- ืืฉื ื ืฉืืืจื ืืฉืืจ - ืืฉื ื ืฉืืืจื ืืฉืืจ
ืกืืืข,ืกืืืข,).).ADLADL ืืงืืงืื ืืขืืจื ืืชืคืงืื ืืืืืืื ( ืืงืืงืื ืืขืืจื ืืชืคืงืื ืืืืืืื (60%60%
- ืกืืืื ืืชืืืชื/ืชืืืืื ืขืืื ืืฉืืขืืชืืช ืืฉืืืืื - ืกืืืื ืืชืืืชื/ืชืืืืื ืขืืื ืืฉืืขืืชืืช ืืฉืืืืื ืฉืขืืช, ืืืขืืงืจ ืืืฉืจ ืืื ื ืฉืขืืช, ืืืขืืงืจ ืืืฉืจ ืืื ื 4848 - - 2424ืืื ื ืื ืืชื ืชืื ืืื ื ืื ืืชื ืชืื
ืื ืืชื ืืืืื ืืชื ืืื
ืืฆืืืืจ ืืืจื ืืขืจืืช ืืกืืืื ืืฉืืจ ืืฆืืืืจ ืืืจื ืืขืจืืช ืืกืืืื ืืฉืืจ
ืจืื ืฉืืจื ืฆืืืืจ ืืืจื ื ืืจืืื ืขืงื ื ืคืืื ืืคืืืขื ืืฉืืจื ืฉื ืืืจืืืื ืืจ
.ืืฉืื ืงืฉืืืขื
ืืขืืจ ืืืืจ ืฉื ืื ืจืืื ืืืืืจ ืืจืงืืืช ืืจืืืช ืืขืืจ ืจืงืืืช ืืขืฆื,
ืืืฆืจ ืฉืืจ ืืขืฆื ืฆืืืืจ ืืืจื
ืืื ืืืจืืืื - ืืืคืฉืจ ืฉืืืช ืืื ื ืืืื ืืช, ืืฉืืืจืช ืขื ืืืืจ ืขืฆืืืช
ืืืจืืืื.
ืืืื ืืืื ืืืฉืื ืืช ืขืืฆืืช ืืืื ืื ืืจืืช ืื ืคืืื ืืคืืืขื ืืฉืืจื.
ืืืื ืืื-ืืืื ื ืืืขืืืืช ืืื ืืืจืกืืืช ืชืืฆืืืช ืืจืืืจื
ืืืื ืืื-ืืืื ื ืืืขืืืืช ืืื ืืืจืกืืืช ืชืืฆืืืช ืืจืืืจื
Hip pads to prevent hip Hip pads to prevent hip fracturefracture
Hip pads to prevent hip Hip pads to prevent hip fracturefracture
โข โโRCTโ of 1801 frail subjects in FinlandโNursing home or frail community patients
โMean age 81โ 78% womenโ 63% assisted walking
Kannus. NEJM;2000;343;1506-1513.
โข โโRCTโ of 1801 frail subjects in FinlandโNursing home or frail community patients
โMean age 81โ 78% womenโ 63% assisted walking
Kannus. NEJM;2000;343;1506-1513.
โข Fractures with Hip ProtectorsFractures with Hip Protectorsโ 2.1% per year vs. 4.6% per year (p<.01) 2.1% per year vs. 4.6% per year (p<.01)
โ 40 patients needed to be treated with hip 40 patients needed to be treated with hip protector for 1 year to prevent one fractureprotector for 1 year to prevent one fracture
โ 2.4% of falls resulted in hip fracture when not 2.4% of falls resulted in hip fracture when not wearing protectorwearing protector
โ 0.4% resulted in hip fracture when wearing 0.4% resulted in hip fracture when wearing protector (80% risk reduction)protector (80% risk reduction)
โข But patient acceptance lowBut patient acceptance low
Hip pads to prevent hip Hip pads to prevent hip fracturefracture
Hip pads to prevent hip Hip pads to prevent hip fracturefracture
Kannus. NEJM;2000;343;1506-1513Kannus. NEJM;2000;343;1506-1513
ืื ืืืืช ืืืืข ืขื ืืขืืืืช ืืืื ื ืื ืืืืช ืืืืข ืขื ืืขืืืืช ืืืื ื ืืืจืืืื?ืืืจืืืื?
ืื ืืืืช ืืืืข ืขื ืืขืืืืช ืืืื ื ืื ืืืืช ืืืืข ืขื ืืขืืืืช ืืืื ื ืืืจืืืื?ืืืจืืืื?
Effectiveness of Hip Protectors for Preventing Hip Fractures
in Elderly People: Systematic Review. BMJ: March 2, 2006
Effectiveness of Hip Protectors for Preventing Hip Fractures
in Elderly People: Systematic Review. BMJ: March 2, 2006
Parker MJ, et al, concluded that hip protectors represent an Ineffective intervention for elders living at home, while their Effectiveness in preventing hip fractures in Institutional setting may be regarded as Uncertain..
Parker MJ, et al, concluded that hip protectors represent an Ineffective intervention for elders living at home, while their Effectiveness in preventing hip fractures in Institutional setting may be regarded as Uncertain..
ื. ืจืืืืืกืืกืงืื. ืืจืคืื ืงื, ,ืก. ื'ืืื , ื. ืื ืืฉืจืื
ื. ืจืืืืืกืืกืงืื. ืืจืคืื ืงื, , ืก. ื'ืืื , ื. ืื ืืฉืจืื
ืืขืืืืช ืืืื ื ืืจืืืื ืืื ืืขืช ืฉืืจื ืืจื ืืงืฉืืฉืื ืขื ืฉืืืืืืืขืืืืช ืืืื ื ืืจืืืื ืืื ืืขืช ืฉืืจื ืืจื ืืงืฉืืฉืื ืขื ืฉืืืืื
-ืืืจืื ืืืฉืืื ืืจืคืืื ืืจืืืืจืืชืฉืื ืคืจืืก-ืื ื
-ืืืจืื ืืืฉืืื ืืจืคืืื ืืจืืืืจืืชืฉืื ืคืจืืก-ืื ื
ืืืฆืขื ืืืืงืช ืืืืช ืืจืืคื ืืืื ืชืืขืื ืืืืืง ืืืฆืขื ืืืืงืช ืืืืช ืืจืืคื ืืืื ืชืืขืื ืืืืืง 20012001ืืื ืืืจ ืืื ืืืจ ืืืขืงื, ืืืขืงื,
ืืื ืืืืคื ืื ื ืฆืคืชื ื ืคืืื ืืืืืงืืช ืืชืฉืืฉื ืื ืคืฉ. ืืื ืืืืคื ืื ื ืฆืคืชื ื ืคืืื ืืืืืงืืช ืืชืฉืืฉื ืื ืคืฉ. ืืืฆืข ืืื ืืืืคื ืืืืืฉ ืืื (ืงืืืฆืช ืืืฆืข ืืื ืืืืคื ืืืืืฉ ืืื (ืงืืืฆืช 20042004 ืืื ืืื ืืืจ ืืื ืืื ืืืจ
ืืืืงืจ). ืืืืงืจ). ืืงืืืฆืช ืืืืงืืจืช ืฉืืฉื ืืืืคืืื ืฉืื ืืืฉื ืืื : ืืงืืืฆืช ืืืืงืืจืช ืฉืืฉื ืืืืคืืื ืฉืื ืืืฉื ืืื :
ืืฉืืืืฉ ืืฉืืืืฉHIP SAVERSHIP SAVERS ืืคื ื ืืื ืกืช ืืคื ื ืืื ืกืช 20042004 * ืืคื ื ืื ืืืจ * ืืคื ื ืื ืืืจ ืขืงื ืกืืจืื ืืืืืคื ืื ืืคืืืจืืคืกื ืืืืืฉ ืขืงื ืกืืจืื ืืืืืคื ืื ืืคืืืจืืคืกื ืืืืืฉ 20042004ืืืจื ืื ืืืจ ืืืจื ืื ืืืจ * *
ืืื.ืืื. ืฉืืืืืช ืืฉืืจืื ืืืกืืช ืืืกืคืจ ืื ืคืืืืชืฉืืืืืช ืืฉืืจืื ืืืกืืช ืืืกืคืจ ืื ืคืืืืช ืืจืืฉ ืชืื ื ื ืืืืืง ืืจืืฉ ืชืื ื ื ืืืืืง , ,
(ืืกืคืจ ืื ืคืืืืช ืืื ืืกืคืจ ืืืืืื ื ืงืืข ืืืฉืชื ื ืืืืชื (ืืกืคืจ ืื ืคืืืืช ืืื ืืกืคืจ ืืืืืื ื ืงืืข ืืืฉืชื ื ืืืืชื ืชืืื).ืชืืื).
20042004 ืืืืง ืืืืืืื ื ืคืืืืช ืืฉืืจืื ืืฉืืืฉื ืืื ืืืจื ืื ืืืจ ืืืืง ืืืืืืื ื ืคืืืืช ืืฉืืจืื ืืฉืืืฉื ืืื ืืืจื ืื ืืืจ ื ืืืื ืืงืืืฆืช ืืืืงืจ, ืื ืืืชื ืืืืื ืืคื ื ืชืืจืื ืื ืืจื ื ืืืื ืืงืืืฆืช ืืืืงืจ, ืื ืืืชื ืืืืื ืืคื ื ืชืืจืื ืื ืืจื
ืืืื ืก ืืฉืืืืฉ ืืืื - ื ืืืื ืืืืง ืืงืืืฆืช ืืืืงืืจืช. ืืืื ืก ืืฉืืืืฉ ืืืื - ื ืืืื ืืืืง ืืงืืืฆืช ืืืืงืืจืช.
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืฉ ื ื ื ืช ื ื ื ื ื ืืฉ ื ื ื ืช ื ื ื ื ื ื
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืฉ ื ื ื ืช ื ื ื ื ื ืืฉ ื ื ื ืช ื ื ื ื ื ื
ืืืืคืืื ืฉืชืืืืช ืืืืื ืืฆืคืืื ืคืืืช ืืฉืฉื ืืืืคืืื ืฉืชืืืืช ืืืืื ืืฆืคืืื ืคืืืช ืืฉืฉื
ืืืืฉืื.ืืืืฉืื.
.ืืืืคืืื ืืฆืคืืืื ืืืคืื ืกืืขืืืืื ืชืื ืฉืฉื ืืืืฉืื. ืืืืคืืื ืืฆืคืืืื ืืืคืื ืกืืขืืืืื ืชืื ืฉืฉื ืืืืฉืื
ืื ืืชืื ืืชืืฆืืืช ืื ื ืืืื ืืืืื ืฉื ืคืืจื ืชืื ืฉืืฉื ืื ืืชืื ืืชืืฆืืืช ืื ื ืืืื ืืืืื ืฉื ืคืืจื ืชืื ืฉืืฉื
ืืืืฉืื ืืชืืืืช ืืืขืงื (ืืงืืืฆืืช ืืืืงืจ ืืืืฉืื ืืชืืืืช ืืืขืงื (ืืงืืืฆืืช ืืืืงืจ
ืืืืืงืืจืช). ืืืืืงืืจืช).
ืื ืืชืื ืืชืืฆืืืช, ืื ื ืืืื ืืงืืืฆืช ืืืืงืจ ืื ืืชืื ืืชืืฆืืืช, ืื ื ืืืื ืืงืืืฆืช ืืืืงืจ
ืืืืคืืื ืฉืืืฉื ืืืื ื ืืจื ืคืืืช ืืืืืฉืืื ืืื ืื ืืืืคืืื ืฉืืืฉื ืืืื ื ืืจื ืคืืืช ืืืืืฉืืื ืืื ืื
ืืืืฉืื (ืืงืืืฆืืช ืืืืฉืื (ืืงืืืฆืืช 33ืืืืคืืื ืฉืืื ืืืขืงื ืคืืืช ื - ืืืืคืืื ืฉืืื ืืืขืงื ืคืืืช ื -
ืืืืงืจ ืืืืืงืืจืช).ืืืืงืจ ืืืืืงืืจืช).
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืฉ ื ื ื ืช ื ื ื ื ื ืืฉ ื ื ื ืช ื ื ื ื ื ื
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืฉ ื ื ื ืช ื ื ื ื ื ืืฉ ื ื ื ืช ื ื ื ื ื ื
EXCLUSION CRITERIAEXCLUSION CRITERIAEXCLUSION CRITERIAEXCLUSION CRITERIA
www.hipsavers.com
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืฉ ื ื ื ืช ื ื ื ื ื ืืฉ ื ื ื ืช ื ื ื ื ื ืืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืฉ ื ื ื ืช ื ื ื ื ื ืืฉ ื ื ื ืช ื ื ื ื ื ื
HIP SAVER - CHARACTERISTICSHIP SAVER - CHARACTERISTICSHIP SAVER - CHARACTERISTICSHIP SAVER - CHARACTERISTICS
โโThird Generation...โThird Generation...โ Nursing home typeNursing home type Worn over the underwear Worn over the underwear Both firm and elasticBoth firm and elastic Quite resistantQuite resistant
toto wear and tearwear and tear
in the washing machinein the washing machine.
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืฉ ื ื ื ืช ื ื ื ื ื ืืฉ ื ื ื ืช ื ื ื ื ื ืืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืฉ ื ื ื ืช ื ื ื ื ื ืืฉ ื ื ื ืช ื ื ื ื ื ื
HIP SAVER - CHARACTERISTICSHIP SAVER - CHARACTERISTICSHIP SAVER - CHARACTERISTICSHIP SAVER - CHARACTERISTICS Two sets of hip Savers Two sets of hip Savers
availableavailable Personally fit for each Personally fit for each
patient patient While the patient is While the patient is
wearing one set, wearing one set,
the other is cleaned the other is cleaned
in the departmentโs in the departmentโs
washing machine.washing machine.
ืืืกืจ ืืืขื ืืช ื ืงืืข ืืกืืจืื ืืชืืฉื ืฉื ืืืกืจ ืืืขื ืืช ื ืงืืข ืืกืืจืื ืืชืืฉื ืฉื
ืืืืืคื ืืืืืฉ ืืช ืืื ืืืจืืืื ืืืจืืช ืืืืืคื ืืืืืฉ ืืช ืืื ืืืจืืืื ืืืจืืช
ื ืืกืืื ืืช ืืืืจืื ืฉื ืืฆืืืช ืืฉื ืฉืืืข ื ืืกืืื ืืช ืืืืจืื ืฉื ืืฆืืืช ืืฉื ืฉืืืข
ืืืื. ืืืื.
ืืืขื ืืช ืชืฉืืฉื ืื ืคืฉ ืืืืืฉืช ืืืื ื ืืจืืืื ืืืขื ืืช ืชืฉืืฉื ืื ืคืฉ ืืืืืฉืช ืืืื ื ืืจืืืื
ืืืื. ืืืื.8080 ื - ื - 5555ื ืขื ืืื ื ืขื ืืื
ืืืขื ืืช ืื ืืืืชื ืชืืืื ืืืืืืืฆืื ืฉื ืืืขื ืืช ืื ืืืืชื ืชืืืื ืืืืืืืฆืื ืฉื
ืืฆืืืช.ืืฆืืืช.
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืชืช ื ืฆ ื ื ืชืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืชืช ื ืฆ ื ื ืช
ืืืจืื) ืืืจืื)7676 ื ืฉืื, ื ืฉืื, 152152(( ืชืืงื ืชืฉืืฉื ื ืคืฉ ืชืืงื ืชืฉืืฉื ื ืคืฉ 228228ื ืกืงืจื ื ืกืงืจื
..20062006 ืืกืคืืืืจ ืืกืคืืืืจ 20012001ืฉืืืฉืคืื ื"ืฉืื" ืืื ืื ืืืจ ืฉืืืฉืคืื ื"ืฉืื" ืืื ืื ืืืจ
149149) ื ืคืื ืืคืืืช ืคืขื ืืืช ) ื ืคืื ืืคืืืช ืคืขื ืืืช 66.5%66.5% ืืืืืืคืืื ( ืืืืืืคืืื (
ืืืืื ืืฉืคืืื (ืืื ืืืื ืืฉืืขืืชื ืืื ืืืื ืื). ืืืืื ืืฉืคืืื (ืืื ืืืื ืืฉืืขืืชื ืืื ืืืื ืื).
- ืืืืื, ืื ืคืืืืช ืืืฉืืจืื ื ืืืื ืชืืืื ืืืืื, ืื ืคืืืืช ืืืฉืืจืื ื ืืืื ืชืืืื 5353 ื - ื
ืืฉืืืื ืืืืืฉ ืืื ืืฉืืืื ืืืืืฉ ืืื 20042004ืืงืืืฆืช ืืืืงืืจืช, ืืืื ืืืจ ืืงืืืฆืช ืืืืงืืจืช, ืืืื ืืืจ
ื ืืืื ืืืชื ืืืืื ืืงืืืฆืช ืืืืงืจ ื ืืืื ืืืชื ืืืืื ืืงืืืฆืช ืืืืงืจ
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืชืช ื ืฆ ื ื ืชืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืชืช ื ืฆ ื ื ืช
ืืืืจ ืืคืขืืช ืืืืืื ืืืืกืจ ืืืืื ื ืืชืจื ืืงืืืฆืช ืืืืจ ืืคืขืืช ืืืืืื ืืืืกืจ ืืืืื ื ืืชืจื ืืงืืืฆืช ืืืืคืืื ืฉืืืฉื ืืืื ื ืืจืืืื ืืคืืืช ืืืืคืืื ืฉืืืฉื ืืืื ื ืืจืืืื ืืคืืืช 107107ืืืืงืจ ืืืืงืจ
ื ืืืงืื ืฉืื ืืืฉื ื ืืืงืื ืฉืื ืืืฉื 153153ืืืืฉืืื ืืืงืืืฆืช ืืืืงืืจืช ืืืืฉืืื ืืืงืืืฆืช ืืืืงืืจืช ืืื. ืืื.
107107 ืืืืืคืืื ืืงืืืฆืช ืืืืงืจ ืืื ืืืขืงื ืืืืืคืืื ืืงืืืฆืช ืืืืงืจ ืืื ืืืขืงื ืืืืฉืื. ืืืืฉืื.19451945 ืขื ืืืื ืชืงืืคื ืืืืืช ืฉื ืขื ืืืื ืชืงืืคื ืืืืืช ืฉื
153153 ืฉื ืืืื ืืงืืืฆืช ืืืืงืืจืช ืืื ืืืขืงื ืฉื ืืืื ืืงืืืฆืช ืืืืงืืจืช ืืื ืืืขืงื . ืืืืฉืื ืืืืฉืื30953095 ืืื ืืืื ื ืืจืืืื ืืฉื ืืื ืืืื ื ืืจืืืื ืืฉื
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืชืช ื ืฆ ื ื ืชืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืชืช ื ืฆ ื ื ืช
ืืืืืคืืื ืฉืฉืืืฉื ืืืืืคืืื ืฉืฉืืืฉื 5353- - ืืื ืืืชืืฉื ื ืืื ืืืชืืฉื ื ืืืขืฉื ืืืืงืืจืช ืฉื ืขืฆืื, ืืืขืฉื ืืืืงืืจืช ืฉื ืขืฆืื,
ืื ื ืืฆื ืืืื ืืฉืืขืืชื ืืื ืงืืืฆืืช ืื ื ืืฆื ืืืื ืืฉืืขืืชื ืืื ืงืืืฆืืช ืืืืงืจ ืืงืืืฆืช ืืืืงืืจืช ืืืืื ืช ืืื, ืืื, ืืืืงืจ ืืงืืืฆืช ืืืืงืืจืช ืืืืื ืช ืืื, ืืื,
ืืืืืช ืจืงืข, ืืืฆืื ืืืขืืื ืืืืืช ืจืงืข, ืืืฆืื ืืืขืืื ืืคืืช.ืืชืจืืชืจ
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืชืช ื ืฆ ื ื ืชืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืชืช ื ืฆ ื ื ืช
Mean Age: Study group 82Mean Age: Study group 82.8.8 (SD=9(SD=9.6.6),),
Contrrol groupContrrol group 8811..44 (SD=9.(SD=9.66))
Females: Study group 69% Controls Females: Study group 69% Controls 67%67%
ืืืจืืข ืืืื, ืืคืืื, ืืืืช ืืืจืืข ืืืื, ืืคืืื, ืืืืช ืคืจืงืื ืกืื, ืืชืจ ืืืฅ ืื ืคืจืงืื ืกืื, ืืชืจ ืืืฅ ืื
ืคืจืคืืจ ืคืจืืืืืจืื, ืืคืจืขืช ืงืฆื ืคืจืคืืจ ืคืจืืืืืจืื, ืืคืจืขืช ืงืฆื ืื ืื ืกืคืืงืช ืื ืืฉืืขืืชืืืช, ืื ืื ืกืคืืงืช ืื ืืฉืืขืืชืืืช, ืืืืช ืื ืืืืืืช, ืกืืืจืช, ืืืื ืืืืช ืื ืืืืืืช, ืกืืืจืช, ืืืื ืืจืื ืืช ืืฉืืขืืชืืช ืฉื ืืจืืื ืื ืืจืื ืืช ืืฉืืขืืชืืช ืฉื ืืจืืื ืื
ืืืืื, ืขืืืืจืื, ืืืจืฉืืช, ืืืืื, ืขืืืืจืื, ืืืจืฉืืช, ืกืืืืืคืจื ืื, ืฉืืจ ืืฆืืืืจ ืืืจื.ืกืืืืืคืจื ืื, ืฉืืจ ืืฆืืืืจ ืืืจื.
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืชืช ื ืฆ ื ื ืชืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืชืช ื ืฆ ื ื ืชืืืืืช ืจืงืข ืืืืืื ืื ื ืืฆื ืืืื ืืฉืืขืืชื ืืื ืืงืืืฆืืช:
ืืืืืช ืจืงืข ืืืืืื ืื ื ืืฆื ืืืื ืืฉืืขืืชื ืืื ืืงืืืฆืืช:
ื% ืืืืืืืืื ื% ืืืืืืืืื1010ืื ืืื ืฉื ืคืืืช ื - ืื ืืื ืฉื ืคืืืช ื -
ื% ื33%ืจืืช ืืืืืืื ืืกืจืื ื ืืืื ื - ืจืืช ืืืืืืื ืืกืจืื ื ืืืื ื - 55 ืื ืืืืฆื ืคืืืืช < ืื ืืืืฆื ืคืืืืช < B12B12 < 200 < 200ืจืืช ืจืืช
ื ืืืืช ืชืจืืคืืช ืืืชืจ ื"ื, ืกืืืจืช, ื ืืืืช ืชืจืืคืืช ืืืชืจ ื"ื, ืกืืืจืช, ื ืืืจืืื, ืืฉืชื ืื, ืืืืช ืคืจืงืื ืกืื, ื ืืืจืืื, ืืฉืชื ืื, ืืืืช ืคืจืงืื ืกืื, ื ืืืื ืคืกืืืืื, ื ืืืื ืืืืืื ืืชืืฉืืจื ื ืืืื ืคืกืืืืื, ื ืืืื ืืืืืื ืืชืืฉืืจื
(ืฉืืื ื ืื ืืืืืืืคืื ืื).(ืฉืืื ื ืื ืืืืืืืคืื ืื).ืฉืื ื ืฉืื ื
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืชืช ื ืฆ ื ื ืชืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืชืช ื ืฆ ื ื ืชืืืืื ื ืืกืคืื ืืืืืื ืืื ืืืื ืืฉืืขืืชื ืืื
ืืงืืืฆืืช:ืืืืื ื ืืกืคืื ืืืืืื ืืื ืืืื ืืฉืืขืืชื ืืื
ืืงืืืฆืืช:
ืืืืื, ื ืืฆืื ืืจืืื ืืฉืืขืืชืืช ืืฉืืืืืช ืืืืื, ื ืืฆืื ืืจืืื ืืฉืืขืืชืืช ืืฉืืืืืช ืืฉืืจืื ืืืกืืช ืื ืคืืืืช ืืงืืืฆืช ืืืืงืจ ืืฉืืจืื ืืืกืืช ืื ืคืืืืช ืืงืืืฆืช ืืืืงืจ
ืฉืืืฉื ืืื.ืฉืืืฉื ืืื.
).). p<0.007p<0.007 ฯฯ22(1)(1)=7.16=7.16ืืืืื ืืืืืง (ืืืืื ืืืืืง (
ืขื ืืื ืขื ืืื 0.1660.166ืคื ืคื ืืกืืืื ืืฉืืจ ืงืืืืกืืืื ืืฉืืจ ืงืื ืืฉืืจ ืืื ืืื, ืืฉืืจ ืืื ืืื, ืืืฉืืืื ืืกืืืืืืืฉืืืื ืืกืืืื
CI95(0.037-0.736) OR=0.16CI95(0.037-0.736) OR=0.16
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืช ืข ื ืง ืจ ื ื ืชืช ื ืฆ ื ื ืช ืข ื ืง ืจ ื ื ืชืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืช ืข ื ืง ืจ ื ื ืชืช ื ืฆ ื ื ืช ืข ื ืง ืจ ื ื ืชืื ื ืืฆื ืืืื ืืืืื ืช ืฉืืืืืช ืื ืคืืืืช
ืืื ืืืืคืืื ืฉืืืฉื ืืืื ื ืืืจืืืื ืืงืืืฆืช ืืืืงืืจืช.
ืื ื ืืฆื ืืืื ืืืืื ืช ืฉืืืืืช ืื ืคืืืืช ืืื ืืืืคืืื ืฉืืืฉื ืืืื ื ืืืจืืืื
ืืงืืืฆืช ืืืืงืืจืช.
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืช ืข ื ืง ืจ ื ื ืชืช ื ืฆ ื ื ืช ืข ื ืง ืจ ื ื ืชืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืช ื ืฆ ื ื ืช ืข ื ืง ืจ ื ื ืชืช ื ืฆ ื ื ืช ืข ื ืง ืจ ื ื ืชFALLS * BREAK Crosstabulation
310 14 32495.7% 4.3% 100.0%53.7% 87.5% 54.6%
267 2 26999.3% .7% 100.0%46.3% 12.5% 45.4%
577 16 59397.3% 2.7% 100.0%
100.0% 100.0% 100.0%
Count% within FALLS% within BREAKCount% within FALLS% within BREAKCount% within FALLS% within BREAK
without saver
with saver
FALLS
Total
no yesBREAK
Total
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ื ืก ืง ื ื ืชื ืก ืง ื ื ืชืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ื ืก ืง ื ื ืชื ืก ืง ื ื ืชืืืืื ืฉืืืืื ืขื ืชืคืงืื ืชืงืื ืืืืืงืืช
: ืชืฉืืฉื ื ืคืฉ
ืืืขื ืืช ืืืืืฉืช ืืืื ื ืืจืืืื ื ืขื ืืื ืืืขื ืืช ืืืืืฉืช ืืืื ื ืืจืืืื ื ืขื ืืื
ืืืื ืืชืืืื ืืขืืงืจ ืืืื ืืชืืืื ืืขืืงืจ 8080 ื - ื - 5555
..ืืืืืืืฆืื ืฉื ืืฆืืืชืืืืืืืฆืื ืฉื ืืฆืืืช
ืืื ื ืืืืืจืื ืฉืืืืืช ืืื ื ืืืืืจืื ืฉืืืืืช ืืืื ื ืืจืืืืืืืื ื ืืจืืืื
ืื ืคืืืืช ืืืื ื ืงืฉืืจืื ืืชืืคืขืืช ืื ืคืืืืช ืืืื ื ืงืฉืืจืื ืืชืืคืขืืช
ืช.ืืืืื ืืฉืืขืืืืืืืื ืืฉืืขืืื
ืืืืืงืืช ืืชืฉืืฉื ื ืคืฉ -ืืืืฉื ืงืืืขื ืืืืืงืืช ืืชืฉืืฉื ื ืคืฉ -ืืืืฉื ืงืืืขื ืฉื ืืืื ื ืืจืืืื ืืืืื ืืืฆืขื ืืขืื ืฉื ืืืื ื ืืจืืืื ืืืืื ืืืฆืขื ืืขืื
ืืืคืืชืช ืืฉืืจืื ืืฆืืืืจ ืืืจื.ืืืคืืชืช ืืฉืืจืื ืืฆืืืืจ ืืืจื.
ืฉืืืืฉ ืืืืจ ืืืืฆืขื ืื ืืขืชื ืื ืฉืืืืฉ ืืืืจ ืืืืฆืขื ืื ืืขืชื ืื ืืชืืจืื ืืกืืคื ืฉื ืืืจ ืืกืืืื ืืชืืจืื ืืกืืคื ืฉื ืืืจ ืืกืืืื
ืืืคืืช ืืชืืืชื, ืชืืืืื ืงืฉื ืืืคืืช ืืชืืืชื, ืชืืืืื ืงืฉื ืืกืื ืืืืืคื ืืืฉืคืืชื, ืืืงืืื ืืกืื ืืืืืคื ืืืฉืคืืชื, ืืืงืืื ืืืงืื ืืฉืืขืืชืืช ืื ืื ืืืืืื.ืืืงืื ืืฉืืขืืชืืช ืื ืื ืืืืืื.
ืืืื ืืืืืืฅ ืขื ืืืื ื ืืจืืืื ืืืื ืืืืืืฅ ืขื ืืืื ื ืืจืืืื ืืืืื ืฉืืืืื ืืืฃ ืืงืฉืืฉืื ืืืืื ืฉืืืืื ืืืฃ ืืงืฉืืฉืื
ืชืฉืืฉืื - ืื ืืงืืืืืชืฉืืฉืื - ืื ืืงืืืื
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉื ืก ืง ื ื ืชื ืก ืง ื ื ืช
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉื ืก ืง ื ื ืชื ืก ืง ื ื ืช
Garfinkel D, Radomisalski Z, Jamal S, Ben Israel J.
High efficacy for hip protectors in the Prevention of hip fractures among
elderly people with dementia.
J AM MED DIR ASSOC 9: 313 - 318, 2008.
Garfinkel D, Radomisalski Z, Jamal S, Ben Israel J.
High efficacy for hip protectors in the Prevention of hip fractures among
elderly people with dementia.
J AM MED DIR ASSOC 9: 313 - 318, 2008.
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ
ืืขืืืืช ืืืื ื ืืจืืืื ืืชืฉืืฉื ื ืคืฉ