Abstract
Worldwide, injuries due to falls in the home impose a substantial burden and merit considerable effort to find effective prevention measures. The current study is one of very few randomized controlled trials that assess the effectiveness of home modification for preventing falls. It is the first carried out with a minority or indigenous community and focused on reducing inequities. Just over 250 households in Aotearoa, New Zealand, with Māori occupants were recruited in two strata, 150 from the Wellington region and 100 from the Taranaki region. These were randomly allocated to equally sized treatment and control groups within the respective regions, the treatment group receiving a package of home modifications designed to prevent falls at the start of the study, and the control group receiving the package at the end of the study. Injury data came from the Accident Compensation Corporation, a state-owned no-fault injury insurer. This provided coverage of virtually all unintentional injuries requiring medical treatment. Matched injury claims were made available for analysis once all identifying fields had been removed. These data will be pooled with data for Māori households from the already-conducted Home Injury Prevention Intervention (HIPI) study, which tested an identical intervention on the general population. In the analysis, the primary outcome measure will be fall injury rates over time, comparing treatment and control households, adjusting for the stratum and prior falls in the household. A secondary measure will be the rates of specific injuries, which are most likely to be prevented by the package of modifications tested. We anticipate that the findings will provide robust evidence for effective injury prevention measures that can reduce an important contributor to health inequities for indigenous populations such as the Māori.
Highlights
1.4% of disability-adjusted life years (DALYs) due to disease and injury in 2010 were from fall injuries, which were the third most important injury type following road injury and self-harm [1]
Between 2014 and 2018, in a population of 5 million there were more than 24,000 hospitalizations annually for unintentional fall injuries [3] and according to data provided by the Accident Compensation Corporation (ACC), between 2011 and 2018, there were an average of
The Home Injury Prevention Intervention (HIPI) randomized controlled trial, found a reduction in home fall injury rates of 26% [5], the study was not powered to look at specific groups, such as the Maori, the indigenous people of Aotearoa, New Zealand
Summary
1.4% of disability-adjusted life years (DALYs) due to disease and injury in 2010 were from fall injuries, which were the third most important injury type following road injury and self-harm [1]. In New Zealand, falls accounted for 2.9% of DALYs, which was only slightly less than road injuries (3.1%) [2]. Given the importance of the home as a setting for falls, the home environment is a potential focus of prevention efforts to install safety features or to remove hazards. Randomized controlled trials focused on the safety benefits of home modification are rare. The Home Injury Prevention Intervention (HIPI) randomized controlled trial, found a reduction in home fall injury rates of 26% (95% CI 6–42%) [5], the study was not powered to look at specific groups, such as the Maori, the indigenous people of Aotearoa, New Zealand. As Maori suffer from poorer health on average than other New Zealanders, measures that may potentially reduce health inequalities, such as home modification to reduce fall risk, need to be identified. The trial was designed to generate evidence for intervention that could be rolled out as a national programme
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