Comprehensive, higher intensity interventions demonstrated greater efficacy to improve occupational performance. Emerging evidence was also found for the role of occupational therapy in providing effective home modification interventions. Implications for occupational therapy practice, education, and research are discussed.

IMPORTANCE Falls are the leading preventable cause of morbidity, mortality, and premature institutionalization for community-dwelling older adults.OBJECTIVE To test the effectiveness of a behavioral intervention on fall risk among older adults receiving services from an Area Agency on Aging. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial examined a home hazard removal intervention in the community using a race-and sex-stratified randomization design. Older adults receiving services from the Area Agency on Aging in urban St Louis, Missouri, were assigned to a home hazard removal intervention delivered over 2 weeks with a 6-month booster or usual care control. Eligible participants were adults aged 65 years or older who did not have dementia, were at high risk for falling, and resided in the community. Enrollment occurred from January 2015 to

Unpacking the "black box" of the clinical reasoning process has yielded a useful clinical reasoning tool that will allow occupational therapists to deliver complex interventions with fidelity.

BackgroundFalls remain the leading cause of injury, long-term disability, premature institutionalization, and injury-related mortality in the older adult population. Home modifications, when delivered by occupational therapists, can reduce falls among high-risk community-dwelling older adults by 39%. However, home-modification implementation is not standard practice in the United States. The goal of the Home Hazard Removal Program (HARP) study is to implement an evidence-based home modification intervention for older adults designed to reduce the incidence of falls through an aging services network.MethodsWe will conduct a hybrid effectiveness/implementation trial of 300 older adults at risk for a fall who are randomized and followed for 12 months. Participants who are randomized to treatment will receive the home modification intervention provided by an occupational therapist in addition to usual care, defined as continued services from the area agency on aging. We will compare the effectiveness of the program and usual care using survival analysis with the time to the first fall over 12 months as the primary outcome of interest. Secondary outcomes include daily activity performance, fall self-efficacy, and health-related quality of life. Fidelity, dose, adherence, safety, cost, and health care utilization will also be examined in the implementation component of this study.DiscussionThis intervention targets an underserved, difficult to reach population of older adults. The tailored approach of the study intervention is a strength in improving adherence, as each recommendation is individualized to be acceptable to the participant. The effectiveness/implementation design of the study allows for rapid dissemination of results and implementation of the intervention in a United States social services agency.Trial registration Clinicaltrials.gov identifier: NCT02392013. Retrospectively registered on March 5, 2015.

More than 36% of all adults over the age of 65 have experienced a fall, and about half of those falls occur in the home (Cigolle et al., 2015; Rubenstein, 2006). Falls can result in fractures and other injuries, increased mortality, long-term disability, and permanent and premature institutionalisation