Understanding the Home Environment as a Factor in Mitigating Fall Risk among Community-Dwelling Frail Older People: A Systematic Review

Abstract

The home environment is increasingly emphasized as a key factor in home falls among frail older people. In this study, we aimed at exploring and synthesizing empirical studies that considered the environmental factors of home falls among frail older people. We performed a systematic review to draw comprehensive conclusions regarding these environmental factors by searching MEDLINE, CINAHL, Embase, and Cochrane Library, as well as gray literature databases. Intervention and nonintervention studies that specifically reported home environmental factors related to falls in community-dwelling frail older people aged 65 years and over were selected. Of the 8374 studies initially retrieved, seven intervention and seven nonintervention studies were included in the analysis. In seven of the 14 studies, environmental hazards were evaluated using relevant assessment tools. Interventions were provided for the bathroom/toilet, bedroom, living room, and for slipping and tripping, identified as frequent fall locations and situations, respectively, through nonintervention studies. The most common intervention was to provide advice/counseling and disseminate information to enhance knowledge after visiting the home and evaluating the home environmental factors that could affect falls. In the majority of the studies, the intervention was of a multicomponent nature, and in only two intervention studies was there practical modification of the home environment to lower the fall risk. In all the four studies with statistically significant results, the intervention was provided by a multidisciplinary team. Through this review, we identified environmental factors for home falls, helping clinicians and health professionals gain a better understanding of the situation to prevent recurrence in frail older people who have experienced falls. The findings indicate that comprehensive standardized environmental evaluations should be conducted considering older people’s functional characteristics and needs and that the intervention process requires the participation of older people with a multidisciplinary team.