Home hazard assessment and environmental modification to prevent falls in older people: the OTIS trial

Sarah Cockayne,Sarah E Lamb,Alison Pighills,Simon Gilbody,Shelley Crossland,Jenny Mccaffery,Lyn Robinson-Smith,Sara Rodgers,Catherine Hewitt,Sophie Boyes,Caroline Fairhurst,Sarah Ronaldson,Ann Cochrane,Katie Whiteside,Avril Drummond,Clare Relton,David Torgerson,Joy Adamson,Arabella Scantlebury

doi:10.12688/f1000research.52313.1

Abstract

Background: Falls in older people are a major cause of morbidity and mortality. There is some evidence to suggest that home hazard assessment and environmental modification delivered by an occupational therapist may reduce falls. The objective of this study was to evaluate the effectiveness of this intervention, relative to usual care. Methods: A pragmatic, two-arm modified cohort randomised controlled trial in eight NHS trusts in primary and secondary care in England. In total, 1331 community-dwelling adults aged 65 years and over with a history of falls or fear of falling were randomised in a 2:1 allocation to either usual care plus a falls prevention leaflet (n=901) or to receive the home hazard assessment and environmental modification intervention, plus usual care and a falls prevention leaflet (n=430). The primary outcome was the number of falls per participant over the 12 months from randomisation. Secondary outcomes included: proportion of fallers and multiple fallers, time to fall, and fear of falling. Results: All 1331 randomised participants (mean age 80 years, 872 [65.5%] female) were included in the primary analysis. There was a small increase in the rate of falls in the intervention group relative to usual care (adjusted incidence rate ratio 1.17, 95% CI 0.99 to 1.38; p=0.07). A similar proportion of participants in the intervention (57.0%) and usual care group (56.2%) reported at least one fall over 12 months. There were no differences in any of the other secondary outcomes and no serious, related adverse events were reported. Conclusions: Home hazard assessment and environmental modification delivered by an occupational therapist did not reduce falls in community-dwelling older people deemed at higher risk of falling recruited to this trial.

Highlights

Falls in community-dwelling older people are a major source of morbidity and cost to society.[1,2] A third of people over the age of 65 years fall each year, and those over 75 years are more likely to experience repeated falls
There was a small increase in the rate of falls in the intervention group relative to usual care
Home hazard assessment and environmental modification delivered by an occupational therapist did not reduce falls in community-dwelling older people deemed at higher risk of falling recruited to this trial

Summary

Introduction

Falls in community-dwelling older people are a major source of morbidity and cost to society.[1,2] A third of people over the age of 65 years fall each year, and those over 75 years are more likely to experience repeated falls. This issue will increase, given the ageing population. In order to find out if these preliminary findings could be confirmed and if home hazard assessment and environmental modification is cost-effective, we undertook OTIS (the Occupational Therapist Intervention Study).[8,9]. The objective of this study was to evaluate the effectiveness of this intervention, relative to usual care

Objectives

Methods

Results