Abstract
Falls are the leading preventable cause of morbidity, mortality, and premature institutionalization for community-dwelling older adults. To test the effectiveness of a behavioral intervention on fall risk among older adults receiving services from an Area Agency on Aging. This 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 September 2016; 12-month follow-up occurred from February 2016 to October 2017. Data were analyzed from February 2019 to July 2021. The intervention was a home hazard removal program delivered by an occupational therapist in the home that included a comprehensive clinical assessment and a tailored hazard removal plan. Usual care control consisted of annual assessments and community referral. The primary outcome was the hazard of a fall over 12 months. Prespecified secondary outcomes included the rate of falls over 12 months, daily activity performance, falls self-efficacy, and self-reported quality of life. A total of 310 participants (mean [SD] age, 75 [7.4] years; 229 [74%] women; 161 Black participants [52%]) were randomized, with 155 participants assigned to the intervention and 155 participants assigned to usual care. Retention was 127 participants (82%) in the intervention group and 126 participants (81%) in the control group. There was no difference for our primary outcome of fall hazard (hazard ratio, 0.90; 95% CI, 0.66-1.27). There was a 38% reduction in the rate of falling in the intervention group compared with the control group (relative risk, 0.62; 95% CI, 0.40-0.95; P = .03). At 12 months, the rate of falls per person-year was 1.5 (95% CI, 1.32-1.75) in the intervention group and 2.3 (95% CI, 2.08-2.60) in the control group. There was no difference in daily activity performance (adjusted difference, -0.20; 95% CI, -0.95 to 0.55; P = .60), falls self-efficacy (adjusted difference, -0.12; 95% CI, -1.25 to 1.01; P = .84), or quality of life (adjusted difference, 0.84; 95% CI, -0.95 to 2.64; P = .35). This randomized clinical trial found that a brief home hazard removal program did not reduce the hazard of falls among community-dwelling older adults at high risk for falling. The intervention was effective in achieving a reduced rate of falls, a prespecified secondary outcome. This effectiveness study has the potential for delivery through the national aging services network. ClinicalTrials.gov Identifier: NCT02392013.
Highlights
Falls remain the leading cause of injury, long-term disability, premature institutionalization, and injury-related mortality in the older adult population.[1,2,3,4,5] Falls are the most common cause of traumatic brain injury and fracture for older adults[6] and can result in serious complications, such as functional dependence and fear of falling.[7,8] Every 20 minutes, an older adult dies from the consequences of a fall.[9]
A total of 310 participants were randomized, with 155 participants assigned to the intervention and 155 participants assigned to usual care
There was no difference for our primary outcome of fall hazard
Summary
Falls remain the leading cause of injury, long-term disability, premature institutionalization, and injury-related mortality in the older adult population.[1,2,3,4,5] Falls are the most common cause of traumatic brain injury and fracture for older adults[6] and can result in serious complications, such as functional dependence and fear of falling.[7,8] Every 20 minutes, an older adult dies from the consequences of a fall.[9]. Home hazard removal has been shown to reduce falls by 39% among people at high risk of falls in studies conducted in Europe and Australia.[14,15,16] Interventions can include installation of grab bars, slip-resistant surfacing, and improved lighting. Home hazard removal interventions are strongly recommended by the American and British Geriatrics Societies to prevent falls[17] but are not standard practice in the US, and the effectiveness of such programs in the US is unknown. The most recent US Preventive Services Task Force recommendations for interventions to prevent falls excluded home hazard removal, citing a lack of evidence.[18]
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