Evidence for Completion of Home Modifications for Decrease in Risk of Falls and Preservation of Autonomy

Within the community dwelling population about 1/4-1/3 of persons aged 65-79 fall every year. Persons aged >80 years have about 1/2 fall every year Nikolaus & Bach [1]. More than 1/2 of the persons who have experienced a fall will have multiple episodes a year. Falls can result in loss of independence of activities of daily living (ADLs) Pardessus et al. [2]. Home modifications are utilized by occupational therapists (OTs) to provide environmental changes to remove hazards which can cause falls [3,4]. Effectiveness of home modifications has been debated. Risk for falls is an imbalance between the patient’s autonomy and environmental hazards [2-5]. The purpose of this study was to review current literature on home modifications related to decreasing risk of falls and/or impact on autonomy to support best practice methods. For the purpose of this study, we created a clinical/research PICO question (Population, Intervention, Comparison, and Outcome), a key to evidence-based decision [6]. The PICO formed for our study is as follows:

(P): For community dwelling older adults aged 65 years and older

(I): Does a home modification intervention

(C): No comparison

(O): Decrease risk for falls and/or impact autonomy?

Review of literature and search strategy

A research has been made in the following databases: Ovid, CINAHL, and PubMed. Keywords and Search items used to search articles for our study were home modification, risk of fall, autonomy, older adults, activities of daily living, occupational therapy, randomized controlled trail. By combining the search results, we found articles on home modifications for decrease in risk of falls and preservation of autonomy. Based on the format of PICO question, three most relevant articles were selected for our study. Studies cited in the reference of the three articles along with other articles were also used to collect important information. After all, the strongest evidence-based article was chosen based on level of evidence and significance level to highlight and confirm our results and conclusions.

Table 1:A summary of Reviewed Articles in Relation to our PICO.

The three selected articles were related to the effectiveness of home modifications for decrease in risk of falls and preservation of autonomy. All articles were related to our PICO question. A summary of the three articles in relation to our PICO is presented (Table 1).

Cumming et al. [5] which examined the effectiveness of home modifications for decrease in risk of falls was selected as the strongest evidence-based article. Based on the hierarchy of levels of evidence in evidence-based practice, this study was a level II (Evidence obtained from at least one well designed RCT) [7]. They used a large sample size of 530 subjects. The intervention group (n=264) received home visits from an occupational therapist (OT), provided with a list of recommended home modifications, and further home visits were also provided if needed. Phone calls were made to encourage compliance with modifications, and a completion of monthly falls calendar was conducted. In the control group (n=266), no home visits were provided, and a completion of monthly falls calendar was conducted. In this study, the number of falls between intervention group (226) and control group (324) was not statistically significant. For subjects who experienced >1 fall in follow up period there was a reduction in risk of falling by 19% (p=.05). For subjects with a history of falls, there was a reduction in risk of falling in the intervention group by 36% (p=.001). For subjects with no history of falls the reduction in risk of falling was not significant. Evidence for decrease in risk of falls was supported by Cumming et al. [5]. In addition, evidence for preservation of autonomy was supported by Pardessus et al. [2]. Home modifications can be effective for decreasing the risk of falls and maintaining autonomy amongst community dwelling older adults. Thus, the following plan has been developed in our study and can be executed in clinics to ensure implementation of recommendations on home modifications for individuals with a history of falls who plan to return home (Table 2).

Table 2:A summary of recommendations, plan, and audit tool.

Our review suggested that home modifications are effective and may reduce the risk of falling and preserve autonomy in older adults. Thus, clinical guidelines, recommendations, a plan and audit tool have been created in our study to implement home modifications in clinics. The clinical guidelines for recommended intervention, the plan, and the audit tool recommend therapists to apply home modifications with older adults who are at risk of falls.

No funding was required.

None.

Author declares that there is no conflict of interest.

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2. Pardessus V, Puisieux F, Di Pompeo C, Gaudefroy C, Thevenon A, et al. (2002) Benefits of home visits for fall and autonomy in the elderly: A randomized trial study. American Journal of Physical Medicine & Rehabilitation 81(4): 247-252.
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