• hip protectors;
  • adherence;
  • certified nursing assistant;
  • nursing home;
  • hip fracture

OBJECTIVES: To identify resident- and caregiver-related factors that influence hip protector (HP) usage.

DESIGN: Prospective observational cohort study over 6 weeks.

SETTING: A 409-bed nursing home located in New York City.

PARTICIPANTS: Fifty-two residents and 60 certified nursing assistants (CNAs).

INTERVENTION: Free HPs were provided to residents enrolled in the study.

MEASUREMENTS: HP adherence (number of hours HPs were worn/shift); HP users (subjects who used HPs for more than 1 hour during any 8-hour shift as recorded by CNAs in week 6 or who used HPs at checks performed by research staff in week 6 and intended future use); CNAs' scores on a questionnaire quantifying osteoporosis knowledge, opinions on HPs, job satisfaction, and health locus of control.

RESULTS: Sixty-eight percent of residents were HP users. Factors independently associated with this outcome included male sex, age, Parkinson's disease, family involvement, impaired cognition, dependent ambulation, and CNAs' sense that chance affects health outcomes. In multivariate models, anxiety, resistive behaviors, ambulation, and fall history in residents and CNAs' perceptions of HPs and their sense of how chance or other staff determine health outcomes predicted HP adherence.

CONCLUSION: Resident-related factors and CNAs' sense of external controls predicted HP users and HP adherence. CNAs' understanding of osteoporosis and HP affected only HP adherence. Most resident-related factors were not remediable but might help to target likely HP users. To improve HP adherence, educational programs should be designed to improve CNAs' understanding of osteoporosis and HP. Larger studies are needed to confirm these findings.