Home Hazard Removal to Reduce Falls Among Community-Dwelling Older Adults

Abstract

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

World guidelines for falls prevention and management for older adults: a global initiative

“…The greatest reductions are seen when the intervention is delivered to those at highest risk of falling [ 77 , 124 , 127 , 174 , 175 ].…”

The Effect of Tailored Home Hazard Removal on Falls Among Community-Dwelling Older Adults

“…In a randomized clinical trial, Stark and colleagues found that removal of home hazards and tailored self-management strategies decreased fall rate among older adults at risk for falls. There were no differences in time to first fall or other prespecified outcomes of daily activity performance, falls efficacy, or self-reported quality of life.…”

“…Other multicomponent fall programs have used a person- and purpose-directed approach to setting goals with the expertise of an occupational therapist, nurse, and maintenance and repair professional to intervene on the person and their lived environment, resulting in reduced disability and increased falls efficacy . The study by Stark et al adds to this body of evidence that intervening with the home and the person could be an important strategy and the actual provision of services seems to have a stronger impact on falls than referral alone for services.…”

“…However, the home hazard removal intervention used by Stark et al focused on reducing risk for falls based on how an older adult uses their environment and did not include other individual-level risks. For example, the occupational therapist may discover that an older adult is grabbing onto the soap dish climbing into the tub without addressing the dizziness or leg weakness that might also cause a fall.…”

“…That said, there are many innovative features of this study . In addition to the home environment intervention, Stark and colleagues enhanced the criterion standard falls calendar method of fall measurement by deploying a personalized calendar that includes each participant’s birthday, anniversaries, and holidays they celebrate. This can enhance recall accuracy and actual use of the calendar.…”