Accidents Screening Tool Research Articles

Study Protocol of Implementation and Evaluation of Aging Home Modification Intervention Program (AhMIP) for Iranian Community-Dwelling Older Adults

Introduction With the rapid increase in the older population in Iran, the housing needs of this age group are also changing. The residential environment plays an important role in the ability of older adults to perform daily activities. This study will be conducted to implement and evaluate a home modification intervention program to support older adults. Method This paper describes the protocol for a triangulation mixed methods design study with three substudies. The first substudy is a cross-sectional study to be conducted on 422 community-dwelling older adults to assess their current status at home, functional abilities, fear of falling, and quality of life. In the second substudy, a randomized clinical intervention trial will be conducted on 116 older adults (58 intervention group and 58 control group) with the intervention of home modifications based on the results of the Home Falls and Accidents Screening Tool. The third substudy is a qualitative study with an in-depth, semi-structured interview approach to find out about older adults’ experienecs regarding AhMIP. Conclusion The quantitative and qualitative findings of this study can be useful in designing intervention programs to improve the living environment of older Iranian adults and promote their quality of life.

An Online, Self-Report Version of the Home Falls and Accidents Screening Tool (HOME FAST-SR) to Identify Fall-Related Hazards in the Homes of Older People

To identify the characteristics of the users of the HOME FAST-SR, to explore the common home hazards identified and to determine the opinions of older people about the usefulness of the HOME FAST-SR. Data from completed HOME FAST-SR submissions were downloaded from the website hosting the tool, and data from participants who consented to provide additional anonymized information about themselves were included for analysis (n = 250). A further link to an electronic survey was used to gather data about participants’ experience of using the HOME FAST-SR (n = 27). Data were downloaded into SPSS and analyzed. Participants had a mean of 11.37 hazards which is in the high-risk category for falls. A total of 12 hazards were identified by more than half of the participants, most of which were modifiable. Participants indicated they agreed that HOME FAST-SR was useable across the criteria, and 57.9% of participants rated the HOME FAST-SR at 4 stars and a further 21.1% rated it at 5 stars. The online HOME FAST-SR is a useable tool that provides older people with an evaluation of their home hazards and information about how to modify these hazards. It also provides a way to make home hazard evaluation more accessible for older people living in the community.

The Effect of Fall-Prevention Multimedia Training on the Fear of Falling, Home Safety, and the Quality of Life in Older Adults: A Randomized, Parallel, Controlled Trial

Background: Falling is a common aging-associated problem. Over one-third of older adults have experienced at least one episode of falling, and its prevalence increases with age. Objectives: This study was conducted to determine the effect of fall-prevention multimedia training on the fear of falling, home safety, and the quality of life in older adults presenting to a designated healthcare center. Methods: Design: Parallel, double-blind, randomized, controlled trial. Setting: The orthopedic outpatient clinic of Dena Hospital in Shiraz, Fars province, Iran. Participants: 100 older adults, including 50 randomly allocated to the intervention group (multimedia training) and 50 to the control group (standard teaching) by permuted block randomization. Measurements: For data collection, a demographic information form, the fear of falling inventory, the home falls and accidents screening tool (HOME FAST), and LEIPAD (an instrument for assessing the quality of life in older adults) were completed before and three months after the intervention. The level of significance was set at 0.05. Results: The comparison of the pre-and post-intervention scores of the three assessed outcomes between the study groups showed a significant difference between the mean scores of home safety before and after the intervention (P < 0.001) in the intervention group; however, there were no significant differences in the scores of fear of falling (P = 0.30) and quality of life (P = 0.32). In the control group, there were no statistically significant differences in the mean scores of the three outcomes before and after the intervention. Calculating the standardized mean difference revealed the significant effect of the intervention on home safety (Cohen’s d = 0.84, 95% CI: 0.43 - 1.3). Conclusions: Given the potential effectiveness of multimedia training in the improvement of older adults’ fear of falling and quality of life, especially concerning home safety, this type of training should be emphasized in future educational programs.

The Vietnamese version of the Home Falls and Accidents Screening Tool (HOME FAST) - A preliminary study of validity and inter-rater reliability.

The Vietnamese Home Falls and Accidents Screening Tool (HOME FAST) was developed to measure the number of home hazards present in the homes of older Vietnamese people and the risk of falls. The HOME FAST and the HOME FAST manual were translated into Vietnamese by an independent translator and underwent backward translation by local health professionals into English to evaluate the accuracy of the translation. A panel of 14 Vietnamese health professionals evaluated the validity of the HOME FAST translation and rated the clarity and cultural relevance of each item. Ratings were evaluated using the content validity index (CVI). Reliability in ratings of the HOME FAST was evaluated using intra-class correlations (ICC), and ratings took place within the homes of two older Vietnamese people by six assessors. In all, 22 out of 25 Vietnamese HOME FAST items were considered to have met content validity standards using the CVI. The ICC for home visit one was 0.94 (95% CI 0.87-0.97) and for home visit two was ICC 0.95 (95% CI 0.91-0.98) indicating high reliability. Bathroom items showed the most inconsistency in ratings indicating cultural differences in bathing activities. Descriptors of HOME FAST items will be reviewed for use in Vietnam to account for cultural and environmental differences. A larger pilot study is planned with older people living in the community in Vietnam to include calendar ascertainment of falls to determine if home hazards are associated with falling.

History of falls, mild cognitive impairment, and the presence of home environmental hazards among community-dwelling older persons in District V, Manila

Introduction: It is important to investigate factors that may increase the fall risk in the geriatric population. This study aimed to determine the relationship between: 1) mild cognitive impairments (MCI) and history of falls; 2) home environmental hazards (HEH) and history of falls; and 3) MCI and HEHs among older adults. Methods: Community-dwelling older persons of District V, Manila were random sampled to participate in this cross-sectional correlational study. The Home Falls and Accidents Screening Tool for Health Professionals (HOMEFAST-HP) and Fall History Questionnaire were used to collect information on the presence of HEH and history of falls, respectively. Chi-Square test was used to determine the relationships between variables. Results: Thirty-seven (37) older adults, with a mean age of 69.8 + 8.1 years (range = 60-95), 84% female, participated. Majority (78.4%) have MCI. Seven (18.9%) have a history of falls. However, no significant association (p=0.12) exists between MCI and history of falls. About 68.2% of fallers were noted to have HEH, with improper bed (p=.04), inaccessible kitchen items (p=.02) and unidentifiable step edges (pp=.04) and improper bed (p=.01) as HEH reached significant association with MCI. Discussion: In this study, MCI is not associated with the history of falls. HEH are more common in MCI and fallers, particularly the inaccessible kitchen items, improper bed, loose mats, and unidentifiable edges of steps. Home modifications to address these identified HEH may decrease the fall risk of Filipino older adults with and without MCI. Further investigation using a bigger sample size across different dwelling situations should be considered.

Cross-Cultural Adaptation and Reliability of the Home Falls and Accidents Screening Tool (HOME FAST) in Assessing Fall-Risk Home Hazards for Stroke Using Technologies over a Conventional Home Visit.

Objective This study is aimed at translating the Home Falls and Accidents Screening Tool (HOME FAST) into the three main languages spoken in Malaysia and investigating its reliability through an alternative technology-based evaluation. Methods Translation into three languages and cross-cultural adaptation of the HOME FAST was conducted via the five steps adopted from the Mapi Institute. For interrater reliability, occupational therapists who attended a face-to-face home hazard workshop were recruited. Each therapist rated the HOME FAST by using the provided combination of videos and photographs of stroke survivors manoeuvring in their home. For test-retest reliability, the same occupational therapists were invited to rate the same combination of photographs and videos again. Reliability was analysed using Gwet's AC1 and Bland and Altman's plot to describe agreement. Results The translation challenges were minimal and rectifiable. A Bahasa Melayu, Mandarin, and Tamil versions of the HOME FAST were developed. Overall interrater reliability for both video (AC1 = 0.91) and photograph (AC1 = 0.91) were good. The test-retest reliability yielded similar outcome (video: overall AC1 = 0.92 and photograph: overall AC1 = 0.93). Conclusion Using alternative technology (video and photograph) to do a home hazard assessment was feasible. However, the asynchronous nature of these methods has limitations in clarifying certain aspects in the home. Moving forward, potential investigation on other technologies such as telehealth for synchronous and real-time interaction is warranted.

The Effects of a Home-Based Combined Motor Control and Ergonomic Program on Functional Ability and Fear of Falling: A Randomized Controlled Trial.

ObjectivesPhysical exercise is a key intervention for improving functional ability and preventing falls in older people. However, the implemented interventions targeted balance, gait, and muscle strength, while little is known regarding motor control exercises in this population. Therefore, this study aimed to investigate the effects of a 12-week home-based motor control exercise program combined with an ergonomic home modification (the McHeELP program).Patients and methodsFifty-two older people (aged ≥65 years), who had experienced at least one fall incident in the past 12 months, were randomly assigned into two groups; the McHeELP group (McHeELP-G) (n=26) that received the McHeELP program and the control group (CG) (n=26). Physical performance measures (PPMs) and patient-reported outcomes (PROs) were used to evaluate participants. At baseline, 3rd month (post-intervention), and again at 6th month (follow up), balance control was assessed using the Tandem stance test (Tandem) and the Functional Reach Test (FRT). Functionality was assessed by the 4 meters walking test (4MWT), Timed Up and Go (TUG) test, 30 seconds-Sit to stand test and the Greek version of Lower Extremity Functional Scale (LEFS-Greek). The Greek version of the Falls Self-efficacy International scale (FES-I_GREEK) was used for the evaluation of "fear-of-falling" (FOF). The home falls and accidents screening tool (HOMEFAST) is used to identify home hazards. Two-way mixed ANOVA model, independent samples t-test, One-factor Repeated Measures ANOVA model and ANCOVA model were used for the statistical analysis of the data.ResultsHomogeneity was found between McHeELP-G and CG regarding the demographic and clinical characteristics, and no statistically significant difference was found at baseline measurements of PROs and PPMs, except HOMEFAST (p=0.031). Post-intervention (3rd month), the comparison of the absolute values between groups revealed that the McHeELP-G achieved statistically significant better balance control (longer Tandem stance test and higher values of FRT), better functionality [faster gait speed (4MWT), shorter TUG performance time, and a higher number of repetitions at 30 seconds-Sit to stand] (all p-values <0.05), while no difference was found for LEFS-Greek score (p=0.095), compared to CG. In addition, McHeELP-G reported lesser FOF than CG [lower FES-I_GREEK score (p=0.041)], and fewer home-hazards [lower HOMEFAST score (p=0.041)]. At follow up measurement (6th month), all PPMs scores of McHeELP-G, regarding balance control and functionality, were remained statistically significant (all p-values <0.005), and the FES-I_GREEK score (p=0.034), while no difference was found between groups for LEFS-Greek score (p=0.146) and HOMEFAST score (p=0.185). Sensitivity analysis (from baseline to 3rd and 6th month) revealed similar findings to the "comparison of the absolute values between groups" analysis. The within-group changes from baseline to 3rd month of McHeELP-G were statistically significant improved for all PPMs and PROs (all p-values <0.05), while in CG, statistical significant difference was found for TUG, FRT-right, and HOMEFAST (p<0.05). Those within-group changes were also preserved until 6th month.ConclusionsThe study's findings provide encouraging evidence that McHeELP program may increase functional ability and decrease FOF of older people. However, further research is required for a thorough understanding of the effect of McHeELP program.

Motor Control and Ergonomic Intervention Home-Based Program: A Pilot Trial Performed in the Framework of the Motor Control Home Ergonomics Elderlies' Prevention of Falls (McHeELP) Project.

ObjectivesFalls are a serious problem that can reduce living autonomy and health-related quality of life of older adults. A decrease in the muscular strength of the lower limbs and the deterioration of balance or motor performance deficits may lead to falls. "Motor Control Home Ergonomics Elderlies' Prevention of Falls" (McHeELP) is a novel motor control exercise program combined with ergonomic arrangements of the home environment. This pilot trial is conducted in order to examine the feasibility and acceptability of the McHeELP program, the selection of the most appropriate outcome measures, and the exact sample size calculation that should be used for the randomized controlled trial (RCT) with Clinical Trial Identifier: ISRCTN15936467.Patients and methodsTwenty older adults (aged ≥65 years) who had experienced at least one fall-incident in the past 12 months have participated in the trial; they were randomized in a 1:1 ratio to the McHeELP group (McHeELP-G) and the Control group (CG). The McHeELP-G received a personalized therapeutic motor control and learning exercise program performed three times per week for 12 weeks. Regarding McHeELP - home modification, a booklet that contained basic advice and tips on the modification for their inside and outside home environment was provided to the participants. Objective and self-reported outcome measures, collected at baseline and post-intervention (end of the third month), included functional, fear of falling, and quality of life measurements.ResultsThe McHeELP intervention was very feasible and acceptable to the participants, and the adherence was excellent (100%). The majority of outcome measures seemed appropriate and significant differences were also revealed between the two groups. Specifically, post-intervention statistically significant improvement was found in the 4 meters walking test, Timed Up and Go test, Sit to Stand test, Tandem Stance test, Functional Reach test, Foot tapping test, EuroQoL-5D-5L - visual analog scale (VAS), Lower Extremity Functional Scale, Falls Self-Efficacy International Scale, and Home Falls and Accidents Screening Tool (HOMEFAST) questionnaire of McHeELP-G (all p-values ≤0.002). No statistically significant difference was observed in the mobility, self-care, usual activities, pain/discomfort subscales of Euro QoL-5D-5L (all p-values >0.05), except the anxiety/depression subscale of McHeELP-G (p=0.008). Moreover, no statistically significant improvement was found regarding McHeELP participants' knee flexion/extension restriction and ankle dorsiflexion/plantar-flexion restrictions. Regarding CG, no statistically significant difference was found (p>0.05), except the Tandem Stance test (p=0.003) and HOMEFAST (p<0.001). Referring to the future McHeELP RCT, it was estimated that a sample size of 25 evaluable patients per group is required.ConclusionsThis pilot trial's findings suggest that it is feasible to deliver an RCT of the McHeLP program to this population. Exercise programs that are easy to administer need to be developed and implemented to reduce the burden of falls in older adults.

Home Hazards With Fear of Falling: Findings From the Baseline Study of the Malaysian Elders Longitudinal Research (MELoR).

Background: Fear of falling (FoF) is a common issue among older people, impacting on psychological health, functional performance and mortality. Many factors associated with fear of falling have been investigated but little is known about the role of home hazards. Home hazards can be due to unsafe environmental and functional features. This study is aims to evaluate the association between home hazards with fear of falling among community-dwelling individuals aged 55 years and over.Methods: Baseline data with 1,489 older individuals from the Malaysian Elders Longitudinal Research (MELoR) study were analyzed. Home visits for interview and observations in the home were conducted with the participants. FoF was established with a single-item question and home hazards with the Home Falls and Accidents Screening Tool (HOME FAST).Results: The majority (76.4%) of older participants experienced FoF. The history of falls was not associated with FoF (p = 0.868), but FoF was associated with participants limiting their daily activities (p < 0.001). Home hazards were less likely (p = 0.023) and functional issues were more likely (p < 0.001) to be associated with a high degree of FoF. However, both home hazards domains were not associated with activity restriction due to FoF.Conclusions: Education about home hazards from the perspective of person-environment interaction may encourage home hazards management and reduce FoF which should be evaluated in future studies.

Predictive validity of three home fall hazard assessment tools for older adults in Thailand.

This study aimed to examine the predictive validity of two internationally well-known instruments, the Modified Home Falls and Accidents Screening Tool (Modified HOME FAST) and the Modified Home Falls and Accidents Screening Tool-Self Report (Modified HOME FAST-SR), and the newly developed Thai Home Falls Hazard Assessment Tool (Thai-HFHAT) (69 items) in predicting falls among older Thai adults. It also aimed to examine the predictive validity of the two abbreviated versions (44 and 27 items) of the Thai-HFHAT, which were developed post hoc to accommodate older adults’ limited literacy and poor vision and to facilitate the identification of high-impact home fall hazards that are prevalent in the Thailand context. A prospective cohort study was conducted among 450 participants aged 60 years and above who were assessed by the aforementioned tools at baseline, for which data on fall incidence were then collected during the one-year follow-up. The Cox proportional hazard model was applied to estimate hazard ratios (HRs); then, Harrell’s C-statistics and receiver operating characteristic (ROC) analyses were conducted to identify the best cutoff point, sensitivity and specificity for each instrument. The results showed that the fall hazard rate was 2.04 times per 1,000 person-days. Taking into account both the predictive validity and applicability, the Thai-HFHAT (44 items) was found to be the most suitable screening tool due to its highest sensitivity and specificity (93% and 72%) at the cutoff score of 18. In conclusion, our study showed that these internationally validated home fall hazard assessment tools were quite applicable for Thailand, but further tailoring the tools into a specific local context yielded even more highly valid tools in predicting fall risk among older Thai adults. Although these findings were well reproducible by inferring from the internal validation results, further external validation in the independent population is necessary.

Adaptation of Home Falls and Accidents Screening Tool (HOME FAST) as a Fall Risk Screening Tool for the Elderly in First Level Health Facilities at Purworejo Regency

Background: The Home Falls and Accidents Screening Tool (HOME FAST) is used for early detection of unsafe environmental conditions at home and risk factors for falls in the elderly. However, in Indonesia there are no data on the adaptation of this instrument. Objective: To determine if the HOME FAST adaptation can be used as a screening tool for the risk of falling in the elderly in the First Level Health Facilities/Fasilitas Kesehatan Tingkat Pertama (FKTP) of Purworejo Regency. Methods: This research was a quantitative study with a cross-sectional design. Subjects were elderly with age over 65 years in the Puskesmas Loano working area that met the inclusion and exclusion criteria. Results: After the adaptation of the HOME FAST instrument was completed, a validity test was performed and a r table result of 0.361 was obtained, indicating all questions were valid. Reliability testing using the Cronbach Alpha formula obtained 0.8461. Subjects were 300 respondents with a distribution of 135 men (45%) and 165 women (55%). The results of the bivariate analysis found three factors that were statistically significantly related, namely gender, age, and the total score of the HOME FAST adaptation instrument. Gender was statistically significantly correlated with a history of falls p = 0.045 (95% CI 2.14-2.56) with RP 1.57 while age was significant with p = 0.046 with (95% CI: 2.85-3.46), and the risk of unsafe total HOME FAST scoring with p = 0.024. From the 2x2 table calculations, the sensitivity of the HOME FAST adaptation scoring method was low with 46% and the specificity of 67%. Conclusion: The adaptation of HOME FAST has a sensitivity of 46% and a specificity of 67%. The prevalence of adaptation results from HOME FAST risk of falling was 36.66%, with the number of safe houses were 190 housing units and 110 unsafe houses.

The HOME FAST BRAZIL self-report version: translation and transcultural adaptation into Brazilian Portuguese

ObjectiveTo translate and cross-culturally adapt the Home Falls and Accidents Screening Tool Self-report into Brazilian Portuguese and to correlate with the history of falls.MethodsThe translation and transcultural adaptation process followed international parameters. The Home Falls and Accidents Screening Tool Brazil Self-report, the Mini-Mental State Examination and the history of falls were applied to 10 elderly in the pre-test and to 41 in the final. Demographic and anthropometric data were also evaluated. Spearman correlation coefficient was performed.ResultsThe participants considered the questionnaire easy to understand and did not report any doubts to answer the final version. There was significant correlation between: Home Falls and Accidents Screening Tool Brazil Self-report score and number of falls (ρ = 0.31, p = 0.02) and the lighting and bathroom domains with presence of falls at home (ρ = 0.44, p = 0.00 and ρ = 0.33, p = 0.02, respectively). The questionnaire indicated fall’s risk scoring, 10(±2).ConclusionThe Home Falls and Accidents Screening Tool Brazil Self-report showed to be comprehensible and feasible tool for self-assessment of domiciliary falls risk in Brazilian older people. The scores indicated fall’s risk and were associated with the history of falls.

The Brazilian version of the Home Falls and Accidents Screening Tool (HOME FAST): translation, cross-cultural adaptation, validation and reliability

Abstract Objective: to translate and cross-culturally adapt the Home Falls and Accidents Screening Tool - HOME FAST into Brazilian Portuguese and to evaluate its construct validity and intra-and inter-rater reliability. Method: a cross-sectional study was carried out that included older people aged 60 years or older. Translation and cross-cultural adaptation were carried out in the following stages: 1. Translation, 2. Synthesis, 3. Back translation, 4. Expert panel (review and pre-final version), 5. Pre-testing, 6. Analysis by the expert panel and the final version of the instrument. The Berg Balance Scale - BBS was used to test construct validity (Spearman correlation coefficient). Additionally, intra-and inter-rater reliability analysis was conducted using the Intraclass Correlation Coefficient (ICC) and the Bland-Altman plot. Results were considered significant at p&lt;0.05. Results: the HOME FAST-Brazil was applied to 53 older people with a mean age of 71(5) years; 79% (42) of whom were female and 21% (11) of whom were male. The translation and cross-cultural adaptation process resulted in similar versions among translations. The correlation of the total score of HOME FAST-Brazil with the BBS was ρ=-0.241, p=0.041. The reliability rate was ICC=0.99 and 0.92 (intra-and inter-rater, respectively). Conclusion: The HOME FAST-Brazil, translated and cross-culturally adapted to Brazilian Portuguese, was shown to have construct validity and excellent intra-and inter-rater reliability.

113 An Online Platform for the Home Falls and Accidents Screening Tool (Home Fast)

Abstract The Home Falls and Accidents Screening Tool (HOME FAST) is a well validated and researched tool designed to identify risk of falls in home environments for older people. The reach of the tool is limited by its availability only in paper-based form. This paper will outline the process involved in making the HOME FAST available online for health professionals, older people and their carers, and its utility in providing links to recommendations to modify home hazards, referring on to appropriate health professionals, generating reports, and communicating results with general practitioners. An online platform is being designed for both the health professional and self-report versions of the HOME FAST which will be available for use on smartphones, tablets and computers. The program will indicate high, moderate and low falls risk. The platform will be tested by groups of health professionals, and older people throughout NSW. Once approved the online platform will be made generally available and demographic data will be collected about the person the HOME FAST is used with and common hazards they face. Older people have been recruited through NSW council community groups and senior’s expos to trial the online HOME FAST and provide feedback through surveys, interviews and focus groups. Health professionals are being recruited through professional networks. We anticipate collection of useful data about the home environmental risks present in the homes of older people as well as the uptake and adoption of the online HOME FAST and its potential to be used routinely in health professional practice. Findings will inform primary falls prevention in the community, how older people view the advice that is given through the on-line resources and how the home environment can be implicated in falls risk for older people living in the community.

Scoring the home falls and accidents screening tool for health professionals (HOME FAST‐HP): Evidence from one epidemiological study

Falls in older people are a major public health concern. To target falls prevention interventions, screening tools need to be able to identify older people at greater risk of falling. This study aimed to investigate the screening capacity of the Home Falls and Accidents Screening Tool for health professionals (HOME FAST-HP), and to identify the best cut-off score to identify older people at higher risk of falls using the HOME FAST-HP. The study used cross-sectional data from a random sample of 650 women from the 1921 to 1926 cohort of the Australian Longitudinal Study of Women's Health (ALSWH). Selected women were sent a postal survey including the HOME FAST-HP, falls history, and other health factors. Scores on the home fast were calculated and the cut-point for optimal sensitivity and specificity of the HOME FAST-HP in relation to falls was assessed using a Receiver Operating Characteristic curve. A total of 567 older women participated (response rate 87%). The mean age of participants was 77.5yrs (95% CI 77.31-77.70). A total of 153 participants (27%) reported a fall in the previous six months. The mean number of hazards using the HOME FAST-HP was 9.74 (95% CI 9.48-10.01), range 2-22. Non-fallers had a mean of 9.6 hazards (95% CI 9.32-9.91) and fallers had a mean of 10.63 hazards (95% CI 10.08-11.19) which was a significant difference (t=3.41, P=0.001). The area under the receiver operator curve (AUC) was 0.58 (95% CI 0.53-0.64). A HOME FAST-HP cut-off score of 9 was associated with the optimal sensitivity for falls (73.9%), with specificity (37.9%), and positive predictive value was 30.6% and negative predictive value was 79.7%. The HOME FAST-HP can be used as a screening tool to identify fallers with a cut-off score of nine indicating a higher risk of falling.

Factors associated with home hazards: Findings from the Malaysian Elders Longitudinal Research study.

Previous studies have investigated home hazards as a risk factor for falls without considering factors associated with the presence of home hazards. The present study aimed to determine patterns of home hazards among urban community-dwelling older Malaysians, and to identify factors contributing to home hazards. Cross-sectional data from the initial wave of the Malaysian Elders Longitudinal Research study were used. Basic demographics were obtained from the Global Questionnaire. Basic and instrumental activities of daily living were measured using the Katz and Lawton-Brody scales, and home hazards were identified using the Home Falls and Accidents Screening Tool. Participants were also asked if they had fallen in the previous 12 months. Data were analyzed from 1489 participants. Hazards were frequently identified (>30%) in the toilet and bathroom areas (no grab rail, no non-slip mat, distant toilet), slippery floors, no bedside light access and inappropriate footwear. Lower educational attainment, traditional housing, Chinese ethnicity, greater number of home occupants, lower monthly expenditure, poor vision and younger age were the factors independently associated with home hazards. This study provides evidence that home hazards are a product of the interaction of the individual's function within their home environment. Hazards are also influenced by local sociocultural and environmental factors. The relationship between home hazards and falls appears complex and deserves further evaluation. Geriatr Gerontol Int 2018; 18: 387-395.

The interrater and test-retest reliability of the Home Falls and Accidents Screening Tool (HOME FAST) in Malaysia: Using raters with a range of professional backgrounds.

Falls can be a devastating issue for older people living in the community, including those living in Malaysia. Health professionals and community members have a responsibility to ensure that older people have a safe home environment to reduce the risk of falls. Using a standardised screening tool is beneficial to intervene early with this group. The Home Falls and Accidents Screening Tool (HOME FAST) should be considered for this purpose; however, its use in Malaysia has not been studied. Therefore, the aim of this study was to evaluate the interrater and test-retest reliability of the HOME FAST with multiple professionals in the Malaysian context. A cross-sectional design was used to evaluate interrater reliability where the HOME FAST was used simultaneously in the homes of older people by 2 raters and a prospective design was used to evaluate test-retest reliability with a separate group of older people at different times in their homes. Both studies took place in an urban area of Kuala Lumpur. Professionals from 9 professional backgrounds participated as raters in this study, and a group of 51 community older people were recruited for the interrater reliability study and another group of 30 for the test-retest reliability study. The overall agreement was moderate for interrater reliability and good for test-retest reliability. The HOME FAST was consistently rated by different professionals, and no bias was found among the multiple raters. The HOME FAST can be used with confidence by a variety of professionals across different settings. The HOME FAST can become a universal tool to screen for home hazards related to falls.

The Clinimetric Properties of Instruments Measuring Home Hazards for Older People at Risk of Falling: A Systematic Review

Home hazards are associated with falls among older people living in the community. However, evaluating home hazards is a complex process as environmental factors vary according to geography, culture, and architectural design. As a result, many health practitioners commonly use nonstandardized assessment methods that may lead to inaccurate findings. Thus, the aim of this systematic review was to identify standardized instruments for evaluating home hazards related to falls and evaluate the clinimetric properties of these instruments for use by health practitioners. A systematic search was conducted in the Medline, CINAHL, AgeLine, Web of Science databases, and the University of Sydney Library CrossSearch Engine. Study screening, assessment, and quality ratings were conducted independently. Thirty-six studies were identified describing 19 instruments and three assessment techniques. The clinimetric properties varied between instruments. The Home Falls and Accidents Screening Tool, Home Safety Self-Assessment Tool, In-Home Occupational Performance Evaluation, and Westmead Home Safety Assessment were the instruments with high potential for evaluating home hazards associated with falls. Health practitioners can choose the most appropriate instruments for their practice, as a range of standardized instruments with established clinimetric properties are available.

Pilot study to investigate the feasibility of the Home Falls and Accidents Screening Tool (HOME FAST) to identify older Malaysian people at risk of falls

ObjectiveThe relationship between home hazards and falls in older Malaysian people is not yet fully understood. No tools to evaluate the Malaysian home environment currently exist. Therefore, this study aimed...

Evaluation of the clinical utility of the Home Falls and Accidents Screening Tool (HOME FAST)

Purpose: The HOME FAST was developed and trialled in Australia as a screening tool designed to be used by any health professional to identify older people at increased risk of falls and to facilitate referral for more detailed assessment and intervention. This study aimed to evaluate the clinical utility of the HOME FAST from the perspective of users.Method: A mixed-methods approach using survey data (n = 32), focus group data (n = 46) and interview data (n = 5) from occupational therapists, physiotherapists, community nurses and other health professionals working in hospitals, community services and private practice, located in the UK, Canada and Australia. Data were integrated using a matrix of quantitative and qualitative data that aligned the findings with established theoretical constructs of clinical utility.Results: Findings across the data sources provide evidence of the clinical utility of the HOME FAST, and these findings align with theoretical constructs about how a tool such as the HOME FAST is adopted in practice.Conclusion: The HOME FAST can be used in a variety of international setting in developed countries and by different health professionals as a screening tool. A manual would assist in the consistent application of the HOME FAST.Implications for RehabilitationHazards in the home environment are a key contributor to falls risk for older peopleThe Home Falls and Accidents Screening Tool (HOME FAST) was designed for any health professional to screen older people at increased risk of falling because of home hazards.Even with psychometric evidence of the reliability and validity of a tool, it is critical that the tool can be easily adopted by clinicians (clinical utility), otherwise its applicability to practice and research is limited.An international mixed-method study has provided evidence of the clinical utility of the HOME FAST.