Do home adaptation interventions help to reduce emergency fall admissions? A national longitudinal data-linkage study of 657,536 older adults living in Wales (UK) between 2010 and 2017

Abstract

Background falls are common in older people, but evidence for the effectiveness of preventative home adaptations is limited. Aim determine whether a national home adaptation service, Care&Repair Cymru (C&RC), identified individuals at risk of falls occurring at home and reduced the likelihood of falls. Study Design retrospective longitudinal controlled non-randomised intervention cohort study. Setting our cohort consisted of 657,536 individuals aged 60+ living in Wales (UK) between 1 January 2010 and 31 December 2017. About 123,729 individuals received a home adaptation service. Methods we created a dataset with up to 41 quarterly observations per person. For each quarter, we observed if a fall occurred at home that resulted in either an emergency department or an emergency hospital admission. We analysed the data using multilevel logistic regression. Results compared to the control group, C&RC clients had higher odds of falling, with an odds ratio (OR [95% confidence interval]) of 1.93 [1.87, 2.00]. Falls odds was higher for females (1.44 [1.42, 1.46]), older age (1.07 [1.07, 1.07]), increased frailty (mild 1.57 [1.55, 1.60], moderate 2.31 [2.26, 2.35], severe 3.05 [2.96, 3.13]), and deprivation (most deprived compared to least: 1.16 [1.13, 1.19]). Client fall odds decreased post-intervention; OR 0.97 [0.96, 0.97] per quarter. Regional variation existed for falls (5.8%), with most variation at the individual level (31.3%). Conclusions C&RC identified people more likely to have an emergency fall admission occurring at home, and their service reduced the odds of falling post-intervention. Service provisioning should meet the needs of an individual and need varies by personal and regional circumstance.

Understanding the Home Environment as a Factor in Mitigating Fall Risk among Community-Dwelling Frail Older People: A Systematic Review

“…1 shows the characteristics of the 14 studies. Seven (50%) were nonintervention [25][26][27][28][29][30][31] and seven (50%) were intervention studies [32][33][34][35][36][37][38]. Te 14 studies were conducted in various regions (four each in the US, Asia, and Europe), and the countries where both nonintervention and intervention Home environment safety assessment tool assessed living room (carpet and foor), furniture (bed, chair, and sofa), light (light is bright), bathroom (handrail and antislip mat), kitchen (location of frequently used objects), stairs (safety handrails and outline of the edge), and mobility (shoes and slippers).…”

“…However, seven studies did not clearly describe the community settings. Trough this analysis, it was confrmed that Fried's criteria [25,26,29], visiting healthcare survey [31,38], a frailty scale [28], and an electronic frailty index [33] were used to measure frailty. Furthermore, decline in activities of daily living, need for walking aids or home help service, impairments in mobility or having an increased risk of falling, immobility, and chronic disease were recognized as characteristics of frail participants.…”

The “fight” for adaptations: exploring the drivers and barriers to implementing home and environment modifications that support healthy ageing

“…Despite the demonstrable importance of health in adaptations outcomes, it is an area that remains underexplored. While the cost of material and labour in adaptations provision (Curtis & Beecham, 2018;Keall et al, 2015) and its effectiveness in reducing hours of care (Carnemolla & Bridge, 2019), care home admissions and emergency falls (Hollinghurst et al, 2020(Hollinghurst et al, , 2022, or treatment on fall injuries (Keall et al, 2017) can be accurately measured, the health benefits are harder to quantify. The lack of understanding of this theme thus complicates thinking about adaptations in cost-benefit terms and as a system in itself.…”

“…All of these impacts can contribute to savings of monetary and/or labour costs to the health and social care sectors (e.g. Carnemolla & Bridge, 2019;Hollinghurst et al, 2020Hollinghurst et al, ,2022Keall et al, 2015;Keall et al, 2017;Salkeld et al, 2000).…”

How to tackle the global challenge of falls?

“…Environmental modifications of an older person’s physical home for fall hazards need to consider their capacities and behaviours in this context [ 2 ]. The importance of home adaptations was demonstrated by a recent retrospective longitudinal controlled non-randomised intervention cohort study [ 8 ]. In this study, by Hollinghurst et al ., 657,536 individuals older adults living in Wales were included and home adaptions reduced the odds of falling post-intervention [ 8 ].…”