CHICAGO—A certain type of hip protector studied was not effective in preventing hip fractures, according to an article in the April 16 issue of the Journal of the American Medical Association (JAMA).

Worldwide, the annual number of hip fractures is expected to increase from 1.66 million in 1990 to 6.26 million in 2050, according to background information in the article. This is caused by not only the increasing number of elderly persons, but also an increase in the age-adjusted incidence of hip fracture. The consequences of hip fractures can be severe. During the year after a hip fracture, the death rate is about 17% to 33%; after 1 year, 25% to 33% of patients are severely disabled or cannot walk at all. An intervention developed to try to prevent hip fractures is the hip protector. According to the authors, when a person falls on the hip, the hip protector is designed to absorb and/or shunt away the impact toward the soft tissues to keep the force on the trochanter (a part of the hip bone) below the fracture threshold. Several randomized controlled trials have been performed to examine the effectiveness of external hip protectors in reducing the incidence of hip fractures, but the results are controversial.

Natasja M. van Schoor, MSc, and colleagues from the Vrije Universiteit Medical Center, Amsterdam, the Netherlands, examined the effectiveness of hip protectors in reducing the incidence of hip fractures in an elderly high-risk population. The study was a randomized controlled trial of elderly persons 70 years or older, who had low bone density, and were at high risk for falls.

Eight hundred thirty elderly persons from 45 homes or apartment houses for the elderly and nursing homes in the Amsterdam area were screened for risk of hip fracture. Of these, 561 persons had a high risk for hip fracture and were assigned to the intervention (n=276) or control (n=285) group by individual randomization between March 1999 and March 2001.

Both groups received written information on bone health and risk factors for falls. Those in the intervention group received at least 4 hip protectors (Safehip) of the energy-shunting type. The hip protector consisted of 2 shell-shaped protectors, made of polypropylene, which are sewn into special underpants and cover the greater trochanter. Participants were followed up for an average of 69.6 weeks.

The researchers found: "In the intervention group, 18 hip fractures occurred vs 20 in the control group. Four hip fractures in the intervention group occurred while an individual was wearing a hip protector. At least 4 hip fractures in the intervention group occurred late at night or early in the morning. Both in univariate analysis and in multivariate analysis, no statistically significant difference between the intervention group and control group was found with regard to time to first hip fracture. In addition, the per protocol analysis in compliant participants did not show a statistically significant difference between the groups."

CHICAGO—Providing a universal consent form to patients or the patient's representative, and health care clinicians may increase the frequency with which informed consent is obtained for procedures performed in the intensive care unit, according to an article in the April 16 issue of the Journal of the American Medical Association (JAMA).

According to background information in the article, informed consent is the process by which a patient authorizes medical treatment after discussion with clinicians regarding the nature, indications, benefits, and risks of treatment. The authors write that in the past, physicians did not routinely seek permission from patients and/or proxies (such as the patient's family member or other representative) to provide medical treatment, even when the treatments involved invasive procedures with significant risks.

Nicole B. Davis, BS, and colleagues from the University of Chicago, Chicago, Ill, conducted their study of 270 patients in a 16-bed intensive care unit (ICU) at a university hospital. The study included a baseline period from November 1, 2001, to December 31, 2001 and an intervention period from March 1, 2002, to April 30, 2002.

The authors developed a 3-part intervention process, which included a universal consent form that allowed a patient or proxy to give advanced written permission for 8 commonly performed procedures, including placement of an arterial catheter, a central venous catheter, a pulmonary artery catheter, or a peripherally inserted central catheter placement; lumbar puncture, thoracentesis (surgical puncture through the chest wall with drainage of fluid from the thoracic cavity), paracentesis (surgical puncture through the abdominal wall with drainage or aspiration of fluid from the abdominal cavity), and intubation/mechanical ventilation, in the ICU, if necessary, during the course of treatment. The second part of the intervention was an attachment to the universal consent form describing each procedure along with commonly associated complications. The third part of the intervention targeted the health care clinicians—the physicians, nurses, new resident physicians, and fellows—by providing them with information about the universal consent form.

"Fifty-three percent of procedures were performed after consent had been obtained during the baseline period compared with 90% during the intervention period," the authors report. "During baseline, the majority (71.6%) of consents were provided by proxies. This was also the case during the intervention period in which 65.6% of consents were provided by proxies. Comprehension by consenters of indications for and risks of the procedures was high and not different between the 2 periods."

CHICAGO—Simple screening methods can detect treatable hearing loss in older adults, according to an article in the April 16 issue of the Journal of the American Medical Association (JAMA).

Hearing loss is the third most prevalent chronic condition in older Americans, after hypertension and arthritis, according to information in the article. Between 25% and 40% of the population 65 years or older is hearing impaired. The diminished ability to hear is also linked to depression, social isolation, poor self-esteem, and functional disability. However, hearing loss often goes undiagnosed and untreated.

Bevan Yueh, MD, MPH, of the Veterans Affairs Puget Sound Health Care System, Seattle, Wash, and colleagues performed a literature review of research describing screening and management of hearing loss in older adults in the primary care setting.

The researchers searched several databases for articles and practice guidelines published between 1985 and 2001, reviewed references found in articles identified through their search, and reviewed articles suggested to them by experts in hearing impairment. The researchers identified 1595 articles.

Data from the articles found indicated that there are several tests that reliably detect hearing loss, including the use of an audioscope (an instrument that emits tones to test a person's hearing level, and can be used to examine the eardrum), and a self-administered questionnaire, the Hearing Handicap Inventory for the Elderly–Screening version. The researchers also found that screening for hearing loss is endorsed by most professional organizations, including the US Preventive Services Task Force.

The literature suggested that while most hearing loss in older adults is sensorineural ("nerve deafness" caused by damage to tiny hair cells in the inner ear), ear wax impaction, and chronic otitis media (fluid in the middle ear) may be present in up to 30% of elderly patients with hearing loss and can be treated by the primary care physician.

In randomized trials reviewed, hearing aids improved outcomes for patients with sensorineural hearing loss, but many people prescribed hearing aids do not use them. Early recognition of reversible causes of hearing loss, such as sudden sensorineural hearing loss, is important in improving the chances for recovery.

ROUTINE HEARING SCREENING INDICATED FOR ELDERLY AMERICANS