As physiotherapists working in aged care, we are frequently asked to give an opinion on the use of hip protectors. Resident falls are always distressing, and staff and families are keen to do “something”.
Hip protectors are an external shell that either slots into, or is sewn into, specially designed underwear and provides a crash pad directly over the most vulnerable aspect of the hip. As people often fall sideways, this is designed to absorb some of the shock and decrease the risk of fracture. They may be hard (spreads the force) or soft (absorbs the force).
The very newly released Best Practice Guidelines for Australian Residential Aged Care services recommend that aged care facilities “consider the use of hip protectors for older people to reduce the risk of fall-related hip fractures”. On the other side, one facility was advised that hip protectors increase the risk of pelvic fractures. So, what does the evidence suggest?
Fortunately, a recently published systematic review provides us with clear guidance, looking at all current meta-analysis articles on the efficacy of hip protectors. Its key findings are:
- For older people living in communities (own homes) there isn’t evidence that hip protectors can reduce hip fractures. This is possibly due to decreased adherence compared to living in care where a care giver may be dressing the resident.
- A comparison study showed that hard hip protectors were able to decrease the force to a clinically significant level – but there is no comparison study of the efficacy of hard versus soft hip protectors
- One study showed that hip protectors can attenuate stresses by 40%, but if moved by half a cm then this is reduced to less that 20%.
One piece of opinion that has been put forward is that hip protectors may increase the risk of a pelvic fracture. However, an NZ Doctor Review of the 2014 Cochrane Review reports that this risk is slight (1 more per 1000 people), versus the decreased chance of hip fracture (11 fewer per 1000 people).
Returning to the most recently published guide for those in Aged Residential Care the key practice points recommended are…
- ARC facilities should prioritise the use of hip protectors to those residents who fall frequently, have osteoporosis or low body mass index.
- Provided information to residents and their whānau to support shared and informed decision making
- Provide training to the staff and resident on application and positioning of hip protectors
- If hip protectors are used then frequently check that they are been worn, are in the right position, aren’t causing pressure damage, and do not prevent independent toileting.
Hip protectors may form part of a multifactorial falls reduction approach. As with all aspects of care this should be individually assessed and prescribed, be multidisciplinary and include the resident and whānau in the decision making and be carefully monitored.
For more information on the most up to date evidence for preventing falls in Aged Residential Care you can contact On the Go Physio. In person in-services or online webinars can be provided to ARC facilities throughout the country.
References
Preventing falls and harm from falls in Older People. Best Practice Guidelines for Australian Residential Aged Care Services. Published 2025 by The Australian Commission on Safety and Quality in Health Care. Falls Guidelines for Australian Residential Aged Care Services | Australian Commission on Safety and Quality in Health Care
Does hip protector prevent falls and hip fractures? An umbrella review of meta-anlyses. Published 2024, BMC Geriatrics. Author Qingchen, Da et al. https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-024-05122-x
Limited benefit from hip protectors. New Zealand Doctor 2nd July 2015. Author Brian McAvoy. https://www.nzdoctor.co.nz/vault/pearls/limited-benefit-hip-protectors