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Environmental Assessment and Modification to Prevent Falls in Older People
Author(s) -
Pighills Alison C.,
Torgerson David J.,
Sheldon Trevor A.,
Drummond Avril E.,
Bland J. Martin
Publication year - 2011
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2010.03221.x
Subject(s) - medicine , fear of falling , confidence interval , randomized controlled trial , occupational safety and health , poison control , injury prevention , rate ratio , gerontology , falling (accident) , suicide prevention , fall prevention , physical therapy , quality of life (healthcare) , demography , environmental health , surgery , nursing , pathology , sociology
OBJECTIVES: To assess the effectiveness of an environmental falls prevention intervention delivered by qualified occupational therapists or unqualified trained assessors. DESIGN: A pilot three‐armed randomized controlled trial. SETTING: Airedale National Health Service Trust catchment, North and West Yorkshire, England. PARTICIPANTS: Two hundred thirty‐eight community‐dwelling adults aged 70 and older with a history of falls in the previous year. INTERVENTION: Assessment and modification of the home environment of people at greater risk of falls. MEASUREMENTS: Fear of falling was the primary outcome measure, and an analysis of covariance was conducted on the area under the curve at 12 months. As a secondary outcome, falls were analysed using negative binomial regression. Quality of life and independence in activities of daily living (ADLs) were also measured. RESULTS: The intervention had no effect on fear of falling ( P =.63). The occupational therapy group had significantly fewer falls than controls 12 months after the assessment (incidence rate ratio (IRR)=0.54, 95% confidence interval (CI)=0.36–0.83, P =.005). There was no significant effect on falls in the trained assessor group (IRR=0.78, 95% CI=0.51–1.21, P =.34). CONCLUSION: Environmental assessment had no effect on fear of falling. Environmental assessment prescribed by an occupational therapist significantly reduced the number of falls in high‐risk individuals whereas that prescribed by a trained assessor did not. Further research in other settings is needed to confirm this, to explore the mechanisms, and to estimate cost‐effectiveness.