Environmental interventions for preventing falls in older people living in the community

Clemson, Lindy; Stark, Susan; Pighills, Alison; Fairhall, Nicola; Lamb, Sarah E; Ali, Jinnat; Sherrington, Catherine

doi:10.1002/14651858.cd013258.pub2

Cited by 33 publications

(23 citation statements)

References 109 publications

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“…The treatment group removed an average of 5.5 hazards, implemented an average of 4.0 home modifications, and as a result, experienced a 38% reduction in their rate of falls. This is consistent with previous findings indicating that high-quality home hazard removal programs are effective in reducing falls for older adults (Clemson et al, 2023; Keglovits et al, 2020). These programs must be delivered by an OT and include assessment of an individual and their environment, an intervention plan to remediate barriers, implementation of the plan, and training on the newly implemented strategies.…”

Section: Discussionsupporting

confidence: 93%

“…In addition to high participation and retention, HARP participants implemented the majority of the recommended home hazard removal strategies (90%) and demonstrated long-term adherence to most of the strategies (92%). Like previous studies, using motivational interviewing and tailoring the intervention resulted in high acceptance, adherence, and behavior change (Clemson et al, 2023;Palacio et al, 2016;Stark, Landsbaum, et al, 2009). Almost half (44%) of HARP participants in the treatment group continued to independently implement strategies using the skills learned during the initial treatment sessions even after formal treatment was completed.…”

Section: Discussionmentioning

confidence: 63%

“…The main limitation of this study was the lack of heterogeneity in the study population, similar to other fall prevention intervention studies (Clemson et al, 2023). While 56% of the participants in this study were Black, the majority were female and were educated at a high-school level.…”

Section: Discussionmentioning

confidence: 95%

“…Over half of falls occur in the home, and about one third of falls are associated with environmental hazards (Nachreiner et al, 2007;Talbot et al, 2005). Recent evidence confirms that home hazard removal interventions delivered by an occupational therapist (OT) reduce falls in the home (Clemson et al, 2023;Keglovits et al, 2020). Most recently, the Home Hazard Removal Program (HARP), developed by the authors, demonstrated effectiveness in reducing falls for communitydwelling older adults (Stark, Keglovits, et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

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A Process Evaluation of a Fall Prevention Intervention Using the RE-AIM Framework

Somerville

Yan

Stark

2023

OTJR: Occupational Therapy Journal of Research

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Background: Home hazard removal programs are effective in reducing falls among older adults, but delivery in the United States is limited. Objectives: We completed a process evaluation of the Home Hazard Removal Program (HARP), an intervention delivered by occupational therapists. Methods: Using the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), we examined outcomes using descriptive statistics and frequency distribution. We examined differences between covariates using Pearson correlation coefficients and two-sample t tests. Results: 79.1% of eligible older adults participated (reach); they experienced a 38% reduction in fall rates (effectiveness). Ninety percent of recommended strategies were completed (adoption), 99% of intervention elements were delivered (implementation), and 91% of strategies were still used at 12 months (maintenance). Participants received an average of 258.6 minutes of occupational therapy. An average of US$765.83 was spent per participant to deliver the intervention. Conclusions: HARP has good reach, effectiveness, adherence, implementation, and maintenance and is a low-cost intervention.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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A Process Evaluation of a Fall Prevention Intervention Using the RE-AIM Framework

Somerville

Yan

Stark

2023

OTJR: Occupational Therapy Journal of Research

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“…That review, by Lindy Clemson and colleagues found that several common-sense strategies appear to prevent dangerous injuries. (See Clemson et al, 2023. )…”

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confidence: 99%

Preventing Injurious Falls: A Few Interventions Stand Out

2023

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Decades of research have failed to produce credible evidence that any drug therapy is effective and safe in the treatment of acute low back pain, if a stunning new review and network meta-analysis is correct. (See definition of network meta-analysis below.) This is a stunning conclusion because it conflicts with the dominant view across medicine. Numerous international evidence-based guidelines based on more traditional head-to-head clinical trials and meta-analyses have concluded that several common medications provide modest relief of acute back pain.The massive new network meta-analysis by Michael Wewege, MSc, of the University of New South Wales and colleagues departed from that view in dramatic fashion. "The comparative effectiveness and safety of analgesic medicines for acute non-specific low back pain are uncertain," they concluded. (See Wewege et al., 2023) If the new review is accurate, research to date doesn't provide any conclusive guidance for healthcare providers, patients, and the general public.Or as senior author James McAuley, PhD commented in an accompanying statement, "Despite more than 60 years of research, we are still uncertain whether any analgesic medicine provides meaningful pain relief for people with low back pain. We recommend that doctors and patients take a cautious approach to managing acute low back pain with analgesic medicines until higher quality trials of head-to-head comparisons are available."Another coauthor lamented the quality of the evidence. "It is quite shocking that the evidence base for the effectiveness and safety of some of the most commonly used drugs for such a common condition is so fragile and incomplete. Our findings clearly indicate the need for larger, rigorous trials that can genuinely inform better clinical decisions," according to

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Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults

Colón-Emeric,

McDermott,

Lee

et al. 2024

JAMA

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ImportanceFalls are reported by more than 14 million US adults aged 65 years or older annually and can result in substantial morbidity, mortality, and health care expenditures.ObservationsFalls result from age-related physiologic changes compounded by multiple intrinsic and extrinsic risk factors. Major modifiable risk factors among community-dwelling older adults include gait and balance disorders, orthostatic hypotension, sensory impairment, medications, and environmental hazards. Guidelines recommend that individuals who report a fall in the prior year, have concerns about falling, or have gait speed less than 0.8 to 1 m/s should receive fall prevention interventions. In a meta-analysis of 59 randomized clinical trials (RCTs) in average-risk to high-risk populations, exercise interventions to reduce falls were associated with 655 falls per 1000 patient-years in intervention groups vs 850 falls per 1000 patient-years in nonexercise control groups (rate ratio [RR] for falls, 0.77; 95% CI, 0.71-0.83; risk ratio for number of people who fall, 0.85; 95% CI, 0.81-0.89; risk difference, 7.2%; 95% CI, 5.2%-9.1%), with most trials assessing balance and functional exercises. In a meta-analysis of 43 RCTs of interventions that systematically assessed and addressed multiple risk factors among individuals at high risk, multifactorial interventions were associated with 1784 falls per 1000 patient-years in intervention groups vs 2317 falls per 1000 patient-years in control groups (RR, 0.77; 95% CI, 0.67-0.87) without a significant difference in the number of individuals who fell. Other interventions associated with decreased falls in meta-analysis of RCTs and quasi-randomized trials include surgery to remove cataracts (8 studies with 1834 patients; risk ratio [RR], 0.68; 95% CI, 0.48-0.96), multicomponent podiatry interventions (3 studies with 1358 patients; RR, 0.77; 95% CI, 0.61-0.99), and environmental modifications for individuals at high risk (12 studies with 5293 patients; RR, 0.74; 95% CI, 0.61-0.91). Meta-analysis of RCTs of programs to stop medications associated with falls have not found a significant reduction, although deprescribing is a component of many successful multifactorial interventions.Conclusions and RelevanceMore than 25% of older adults fall each year, and falls are the leading cause of injury-related death in persons aged 65 years or older. Functional exercises to improve leg strength and balance are recommended for fall prevention in average-risk to high-risk populations. Multifactorial risk reduction based on a systematic clinical assessment for modifiable risk factors may reduce fall rates among those at high risk.

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Environmental interventions for preventing falls in older people living in the community

Cited by 33 publications

References 109 publications

A Process Evaluation of a Fall Prevention Intervention Using the RE-AIM Framework

A Process Evaluation of a Fall Prevention Intervention Using the RE-AIM Framework

Preventing Injurious Falls: A Few Interventions Stand Out

Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults

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