Home Hazards Research Articles

‘I just don’t want them to be my patient again’: an exploratory mixed-methods study examining provider home safety concerns for adolescents with acquired brain injuries in the US Midwest

ObjectiveAdolescents with acquired brain injuries are at risk for additional injuries after hospital discharge. We asked healthcare providers to identify and prioritise urgent hazards in the home setting for this...

Investigating the Inter-Rater Reliability and Usability of Telehealth for Home Hazard Falls-Risk Assessment After Stroke

Introduction: Stroke survivors are more likely to fall at home. A home hazard assessment may be beneficial to reduce the risk of falling; however, it is resourceful and time-intensive. This study examines the inter-rater reliability and usability of telehealth for a hazard assessment to address the risk of falls. Materials and Methods: Two occupational therapists accessed the telehealth platform from different locations and simultaneously rated participants’ home environment using the home falls and accident screening Tool. Stroke survivors and their caregivers answered the telehealth usability questionnaire. Results: A total of 36 stroke survivors and 31 caregivers participated in the study. Gwet’s AC1 was used for agreement analysis. The overall AC1 value for the inter-rater reliability was 0.93 (95% confidence interval [CI], 0.66%, 1.00%). There was a moderate correlation between the raters (r=0.57, P=0.000). Bland and Altman graph plot showed a mean difference of -0.61 and 97.2% of the difference score fell within the limits of agreement (95% CI, -5.67%, 4.39%). The overall mean score of the telehealth usability questionnaire was 5.62 out of 7. Conclusion: Telehealth technology is a potential medium that provides an opportunity for synchronous practitioner-client interaction in evaluating home hazards. Some challenges were noted during the telehealth sessions, thus requiring a brief protocol to navigate the system.

Using tele-paramedicine to conduct in-home fall risk reduction after emergency department discharge: Preliminary data.

Older adults discharged from our emergency department (ED) do not receive comprehensive fall risk evaluations. We conducted a quality improvement project using an existing Community Tele-Paramedicine (CTP) program to perform in-home fall risk assessment and mitigation after ED discharge. High falls-risk patients, as defined by STEADI score >4, were referred for a CTP home visit by community paramedics supervised virtually by emergency physicians. Home hazards assessment, Timed Up and Go test (TUG), medication reconciliation, and psychosocial evaluation were used to develop fall risk mitigation plans. Outcomes assessed at 30 days post ED-discharge included: completed CTP visits, falls, ED revisits, hospital admissions, and referrals. Between November 2022 and June 2023, 104 (65%) patients were discharged and referred to CTP. The mean age of enrolled patients was 80 years, 66% were female, 63% White, 79% on Medicare or Medicaid, most lived with a family member (50%) or alone (38%). Sixty-one (59%) patients received an initial CTP visit, 48 (79%) a follow-up visit, and 12 (11%) declined a visit. Abnormal TUG tests (74%), home hazards (67%), high-risk medications (36%), or need for outpatient follow-up (49%) or additional home services (41%) were frequently identified. At 30 days, only one of the CTP patients reported a fall, one patient had a fall-related ED visit, and one patient was admitted secondary to a fall. A quality improvement initiative using CTP to perform fall risk reduction after ED discharge identified areas of risk mitigation in the home where most falls take place. Further controlled studies are needed to assess the impact of CTP on clinical outcomes important to patients and health systems.

The Safe Home Care Intervention Study: Implementation Methods and Effectiveness Evaluation.

Home care (HC) aides experience numerous safety hazards in clients' homes; many hazards also put clients at risk. We hypothesized that safety coaching led by nurse managers (NMs) during their initial HC needs assessment could prompt clients to improve safety conditions in their homes. Following a 2-arm proof-of-concept intervention study design, intervention NMs used motivational interviewing (MI), facilitated by a safety handbook and video, to coach clients on home safety improvements. Control arm NMs performed intake assessments with no changes to usual practices. Intervention effectiveness was assessed by NMs and aides. Three HC agencies and two elder services contributed 35 intervention and 23 control homes. NMs coached 97% of clients and reported that 94% were engaged; 63% implemented improvements. NMs' and aides' assessments were consistent; homes with clients reported by NMs as resistant to safety changes had higher aides' hazard scores. Client coaching can be effective for improving HC safety.

Home safety hazards associated with unintentional poisoning among children aged 0-5 years in Mongolia: A case-control study.

To examine the association between home safety hazards and unintentional poisoning in children in Mongolia. We conducted a case-control study using structured questionnaires to investigate safety behaviours, safety equipment use, and home hazards in households with or without children aged 0-5 years who had suffered from poisoning at home (i.e., cases and controls). We recruited 190 cases (105 medicinal and 84 non-medicinal poisonings, and one each) at the National Center for Maternal and Child Health and 379 controls in the communities between 1 March and 30 October 2021. There were large differences between cases' and controls' households in safety behaviours and home hazards: the failure to store all medicines out of reach of children (68% of cases vs. 25% of controls), the failure to store all medicines safely (out of reach, locked or non-existent) (61% vs. 22%), the failure to put all medicines away immediately after use (77% vs. 43%), the presence of things that a child could climb on to reach high surfaces (82% vs. 67%), the presence of medicines transferred into different containers (28% vs. 9%) and the presence of household products transferred into different containers (28% vs. 16%). These home safety hazards were strongly associated with poisoning after controlling for confounders. Children's risk of unintentional poisoning was strongly associated with the unsafe storage of potentially poisonous agents by caregivers and home hazards. Since unsafe storage is widespread, a fail-safe approach such as child-resistant closure of medicines and household products should be considered.

A neurologist’s perspective of approach to falls in the elderly

Abstract Falls constitute an important public health problem that impact the quality of life of an individual. Falls contribute to disability, especially among older adults and elderly individuals. Recurrent fallers are those who fall one or more times per year. The purpose of this article is to provide a detailed systemic qualitative review of the recent definition of falls, their mechanism, risk factors, classification; falls in neurodegenerative disorders; and their approach and management. Sources of literature were drawn from peer-reviewed original and systematic review articles published until January 2024 in the PubMed database using the following key words: falls, elderly, definition, management, etiology, neurodegenerative diseases, epilepsy and fall, dementia and fall, and prevention and diagnostic tests for postural instability and falls. This review summarizes the current understanding of falls and provides a pragmatic and clinically focused approach to their management. Falls are usually multifactorial. Neurodegenerative disorders such as cognitive decline and parkinsonism lead to increased risk of falling. There are several tools to assess the risk of early falls. A multidisciplinary approach is needed in the management of falls. The main goal is encouraging physical activity, home hazard modification, management of postural hypotension, and underlying neurodegenerative diseases.

OLDER ADULT FALLS IN THE COMMUNITY: DOES UNSAFE HOME ENVIRONMENT HAVE A RISK ROLE?

Abstract Hazardous environmental conditions are frequent in older adult homes and are linked to a majority of the older adult falls in the community. However it is unclear whether it is the presence/absence of home hazards per se, or the interaction between unsafe home conditions and physical functioning that is of salience to older adults’ fall risk. To address this gap, we conduct a mediation analysis using the Karlson–Holm–Breen methodology to estimate: 1) whether home disorder (peeling/flaking paint, pests: cockroaches/rodents, broken furniture/lamp, unsafe flooring/tripping hazards, room clutter) and unsafe bathroom features (absence of bathtub/shower stall, grab bar, seat in shower/tub, raised toilet) adversely associated with subsequent fall risk of older adults, and 2) what proportion of those influences were mediated through limitations in daily and instrumental activities of daily living (ADL/IADL). Using a nationally representative large sample of Medicare beneficiaries (≥65 years) living in the community who were respondents in the 2018-2019 National Health and Aging Trends Study (NHATS; n=2,599), we examined baseline home environment in 2018 and its relation with subsequent falls in 2019, after controlling for covariates. Results indicate while home disorder had both a direct (adjusted Odds Ratio [aOR]: 1.11, 95% Confidence Interval [CI]:1.01,1.22) and an indirect (aOR: 1.01; 95% CI: 1.00,1.02) effect on subsequent falls through limitations in ADL and IADL, unsafe bathroom features did not significantly predict subsequent fall risk of older adults. Given these findings, addressing home disorder through policy/housing assistance initiatives and educational programs highlighting home environmental safety would be essential.

BRINGING COMMUNITY-BASED FALLS PREVENTION PROGRAM TO IMPROVE GLOBAL HEALTH (BRIGHT)

Abstract Older adults in low- and middle-income countries (LMICs) experience a disparate burden of non-communicable diseases (NCDs) and barriers to accessing health care. Unintentional injuries are among the major NCDs, and falls are the second leading cause of these injuries and deaths. Falls were reported in up to 50% of older people living in Asia, including Thailand. There is a lack of community-based multifactorial fall prevention interventions that target both older adults and the primary care systems. We aimed to culturally adapt the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) for Thai older adults and explore the feasibility, appropriateness, and acceptability of using STEADI by trained community health workers (CHWs) and care managers (CMs). STEADI consists of three steps: screening, assessing, and intervening. In Step a, CHWs screened fall risk using three key questions and found that all of participants had fall risk, then CHWs screened with a Stay Independent questionnaire (range 0-14) and found that 100% have high fall risk (total scores 9.7± 2.4). In Step b, CMs assessed risk factors and CHWs assessed home hazards. They found that 50% had poor balance, 70% took 4+ medications, 75% fell on the walkway, and 70% had no bathroom modifications. In Step c, individual participants received fall prevention interventions and participants attended all sessions. Our results indicated that STEADI delivered by CHWs and CMs is feasible and acceptable for older adults. The mean scores of acceptability, appropriateness, and feasibility were 19.20,18.80, and 18.60 out of 20 totals, respectively.

Current practices of physiotherapists in Switzerland regarding fall risk-assessment for community-dwelling older adults: A national cross-sectional survey.

Falls can strongly impact older people's quality of life, health, and lifestyle. Multifactorial assessment can determine an individual's risk of falling as the first step for fall prevention intervention. Physiotherapists have an essential role to play in assessing fall risk by older adults living in the community. In the absence of published data on this topic in Switzerland, this study investigated the current practices of physiotherapists to determine whether those are in line with recommendations. An anonymous cross-sectional survey was undertaken among physiotherapists practising in Switzerland between the 21st of November and the 31st of December 2020. A priori and exploratory hypotheses were tested. Responses to open-ended questions were grouped into themes for analysis. A total of 938 questionnaires from all three language regions of Switzerland was analysed. Participants worked in different settings, with a higher representation of private practice self-employees (56%). Standardised fall risk assessments or instruments were used by 580 (62%) participants, while 235 (25%) preferred subjective assessment of fall risk only. Differences in fall risk assessment were observed according to the workplace setting (adjusted OR 1.93, 95% CI 1.37 to 2.7) and education level (trend test, p<0.001). The standardised assessments most frequently employed were the Berg Balance Scale (58%), the Timed-Up-and-Go (57%) and the Tinetti Balance Assessment tool (47%). Risk factors for falls were frequently queried, particularly history of falls (88%), home hazards (84%), and functional ability (81%). Technical resources (40%), knowledge (30%), and time (22%) were common barriers to implement a systematic fall risk assessment. This study provides an overview of the current practices of physiotherapists in Switzerland in fall risk assessment. There is still room to optimise the standardisation and systematisation of this assessment to implement a best practice strategy and prevent avoidable falls.

Common home hazards among healthy older aged adults and potential modifications required for age-friendly housing.

The creation of age-friendly home environments enables middle-aged and older aged people to live independently at home while adapting to age-related changes. Little is currently known about existing home hazards that may potentially hinder healthy older people as they age. Prospective cohort study of healthy adults who received an age-friendly home environment assessment conducted by an occupational therapist. Adults aged 60 and over, without significant disability, living in homes within metropolitan Adelaide, South Australia were recruited through community advertising. Sixty age-friendly home environment assessments were conducted. Common areas where potential hazards were identified, and modifications recommended were bathrooms, toilets and backyards. Gardens were commonly identified as potentially requiring modifications in the future. Participants were more likely to consider moving to new housing if additional modifications were needed to their homes. Affordable and accessible age-friendly housing is required to support an ageing population. Education on age-friendly housing for healthy middle and older aged people is required enabling proactive planning rather than awaiting health crises.

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.

Reliability of the 44-question Home Fall Hazard Assessment Tool and demographic characteristics associated with home hazards among the Thai elderly

Background: The 44-question Thai Home Fall Hazard Assessment Tool (Thai-HFHAT) was developed to assist healthcare professionals in identifying the risk of falls among community-dwelling older adults from their home environment. However, the reliability of this tool has not been studied. This study aimed to examine the reliability of the 44-question Thai-HFHAT and determine the demographic characteristics associated with home hazards. Methods: A descriptive cross-sectional study design was used to evaluate inter-rater reliability. The participants in this study were 51 older people from various types of Thai houses: a one-story elevated house, a one-story non-elevated house, and a house with two or more floors, 51 caregivers of older patients, and 5 village health volunteers (VHV). A prospective design was used to evaluate test-retest reliability with older people at different times in their homes. All participants answered 44 Thai-HFHAT questions to determine inter-rater and test-retest reliabilities. The reliabilities were analyzed using an intra-class correlation coefficient (ICC). Demographic characteristics including sex, occupation, and education were used to identify the factors affecting home hazards, and linear regression was used to analyze. Results: The ICC of inter-rater reliability of the 44-question Thai-HFHAT was 0.74 (95% CI: 0.57-0.84) and the test-retest reliability was 0.80 (95% CI: 0.64-0.88) for the older adults, 0.80 (95% CI: 0.65-0.89) for the caregivers and 0.70 (95% CI: 0.477-0.83) for the VHV. In demographic variables, personal business career and education level (grades 1-3) had significant relations with the total number of home hazards in the 44-questions Thai-HFHAT. Conclusions: The 44-question Thai-HFHAT is suitable for home hazard assessment among older adults in Thailand. Further studies are needed to investigate changes in the house environment after using the 44-question Thai-HFHAT to determine which changes can reduce fall risk.

A Process Evaluation of a Fall Prevention Intervention Using the RE-AIM Framework.

Home hazard removal programs are effective in reducing falls among older adults, but delivery in the United States is limited. We completed a process evaluation of the Home Hazard Removal Program (HARP), an intervention delivered by occupational therapists. Using the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance), we examined outcomes using descriptive statistics and frequency distribution. We examined differences between covariates using Pearson correlation coefficients and two-sample t tests. 79.1% of eligible older adults participated (reach); they experienced a 38% reduction in fall rates (effectiveness). Ninety percent of recommended strategies were completed (adoption), 99% of intervention elements were delivered (implementation), and 91% of strategies were still used at 12 months (maintenance). Participants received an average of 258.6 minutes of occupational therapy. An average of US$765.83 was spent per participant to deliver the intervention. HARP has good reach, effectiveness, adherence, implementation, and maintenance and is a low-cost intervention.

Reliability of the 44-question Home Fall Hazard Assessment Tool and demographic characteristics associated with home hazards among the Thai elderly.

Background: The 44-question Thai Home Fall Hazard Assessment Tool (Thai-HFHAT) was developed to assist healthcare professionals in identifying the risk of falls among community-dwelling older adults from their home environment. However, the reliability of this tool has not been studied. This study aimed to examine the reliability of the 44-question Thai-HFHAT and determine the demographic characteristics associated with home hazards. Methods: A descriptive cross-sectional study design was used to evaluate inter-rater reliability. The participants in this study were 51 older people from various types of Thai houses: a one-story elevated house, a one-story non-elevated house, and a house with two or more floors, 51 caregivers of older patients, and 5 village health volunteers (VHV). A prospective design was used to evaluate test-retest reliability with older people at different times in their homes. All participants answered 44 Thai-HFHAT questions to determine inter-rater and test-retest reliabilities. The reliabilities were analyzed using an intra-class correlation coefficient (ICC). Demographic characteristics including sex, occupation, and education were used to identify the factors affecting home hazards, and linear regression was used to analyze. Results: The ICC of inter-rater reliability of the 44-question Thai-HFHAT was 0.74 (95% CI: 0.57-0.84) and the test-retest reliability was 0.80 (95% CI: 0.64-0.88) for the older adults, 0.80 (95% CI: 0.65-0.89) for the caregivers and 0.70 (95% CI: 0.477-0.83) for the VHV. In demographic variables, personal business career and education level (grades 1-3) had significant relations with the total number of home hazards in the 44-questions Thai-HFHAT. Conclusions: The 44-question Thai-HFHAT is suitable for home hazard assessment among older adults in Thailand. Further studies are needed to investigate changes in the house environment after using the 44-question Thai-HFHAT to determine which changes can reduce fall risk.

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.

Reliability of the 44-question Home Fall Hazard Assessment Tool and personal characteristics associated with home hazards among the Thai elderly

Background: The 44-question Thai Home Fall Hazard Assessment Tool (Thai-HFHAT) was developed to assist healthcare professionals in identifying the risk of falls among community-dwelling elderly from their home environment. However, the reliability of this tool has not been studied. This study aimed to examine the reliability of the 44-question Thai-HFHAT and determine the personal characteristics associated with home hazards. Methods: A descriptive cross-sectional study design was used to evaluate interrater reliability. The participants in this study were 51 elderly people from various types of Thai houses: a one-story elevated house, a one-story non-elevated house, and a house with two or more floors, 51 caregivers of elderly patients, and 5 village health volunteers (VHV). A prospective design was used to evaluate test-retest reliability with older people at different times in their homes. All participants answered 44 Thai-HFHAT questions to determine inter-rater and test-retest reliabilities. The reliabilities were analyzed using an intra-class correlation coefficient (ICC). Personal characteristics including sex, occupation, and education were used to identify the factors affecting home hazards, and linear regression was used to analyze. Results: The ICC of inter-rater reliability of the 44-question Thai-HFHAT was 0.74 (95% CI: 0.57-0.84) and the test-retest reliability was 0.80 (95% CI: 0.64-0.88) for the elderly, 0.80 (95% CI: 0.65-0.89) for the caregivers and 0.70 (95% CI: 0.477-0.83) for the VHV. Personal business career and education level grades 1-3 are less than 0.05, which showed these factors had a significant relationship with the 44-question Thai-HFHAT score as the dependent variable. Conclusions: The 44-question Thai-HFHAT is suitable for home hazard assessment among the elderly in Thailand. Further studies are needed to investigate changes in the house environment after using the 44-question Thai-HFHAT to determine which changes can reduce fall risk.

Smart Plug 2.0: A Solid-State Smart Plug Device Preventing Fire and Shock Hazards

Electrical faults cause fire or shock hazards in homes and offices. Flexible power cords are particularly susceptible to metal or insulation degradation that may lead to a variety of electrical faults. This article introduces a new Smart Plug 2.0 device which offers all-in-one protection against short-circuit, overload, arc, and ground faults in addition to the wireless power control and monitor function of conventional smart plug devices. It offers microsecond-scale time resolution to detect and respond to a fault condition, and significantly reduces the electrothermal stress on household electrical wires and loads. A new arc fault detection method is developed using machine learning models based on load current <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">di/dt</i> events. Comparing to other solid-state circuit breaker designs which typically respond to overcurrent conditions only, Smart Plug 2.0 integrates additional protective functions into the same hardware structure with minimal cost penalty. A 120 V/10 A solid-state Smart Plug 2.0 prototype using power <sc xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">moseft</small> s is designed and tested. It has experimentally demonstrated the comprehensive protection features against all types of electrical faults.

Older Adults' Experiences, Worries and Preventive Measures Regarding Home Hazards: A Survey on Home Safety in Sweden.

Home safety is important for preventing injuries and accidents among older adults living at home. Feeling safe at home is also essential for older adults' well-being. Thus, this study aimed to explore older adults' perceptions of safety in their homes by examining their experiences, worries and preventive measures in relation to a range of potential home-based health and safety hazards. The study was a national cross-sectional telephone survey of 400 randomly selected adults over 70 years of age living at home in ordinary housing in Sweden. Participants were asked for their experience of, worry about, and preventive measures taken regarding fifteen home hazards. Data were also collected on background variables including age, health, and cohabitation status. Falls and stab/cut injuries were the most experienced hazards and worry was highest for burglary and falls, while preventive measures were most common for fire and burglary. While older adults' experience and worry regarding home hazards were associated with preventive measures, these associations were not strong and other factors were associated with preventive behaviour. Further identification of the main determinants of older adults' preventive behaviour can contribute to policy for effectively reducing home accidents.

A validity study to consult on a protocol of a home hazard management program for falls prevention among community dwelling stroke survivors.

A fall after a stroke is common but the consequences can be devastating not only for the stroke survivors, but also for caregivers, healthcare, and the society. However, research on falls prevention among the stroke population are limited, particularly on home hazards assessment and home modifications, demanding for a study to be conducted. The aim of the study is to validate the protocol and content of a home hazard management program guided by the Person-Environment-Occupation (PEO) Model for falls prevention among community dwelling stroke survivors. Researchers developed their own questionnaire for content validation which consist of 23 items that covers two domains, namely justification for telehealth home hazard management practice and the protocol's overall methodology. Occupational therapists with at least one year of experience in conducting a home hazard assessment were consulted for the content validation of a two-group clinical controlled trial protocol utilizing a home hazard assessment, home modifications and education over the usual care. Written consent was obtained prior to the study. The occupational therapists were given a Google Form link to review the protocol and intervention based on the questionnaire and rated each item using a four-point Likert scale for relevance and feasibility. Open-ended feedback was also recorded on the google form. Content Validity Index (CVI), Modified Kappa Index and Cronbach's Alpha was calculated for the content validity and reliability analysis. A total of sixteen occupational therapists participated in the study. 43.7% of participants had a master's degree, 93.7% worked in the government sector and 56.2% had six years and more experience on conducting home hazard assessments. Content validity of the protocol is satisfactory for relevancy and feasibility (CVI = 0.84, ranging from 0.5 to 1.00), and for the reliability (α = 0.94 (relevance) and α = 0.97 (feasibility), respectively. The Modified Kappa ranged from 0.38 to 1.00 for all items. Feedback was also received regarding the design and procedure of the study protocol which included participant's selection criteria, sample size, equipment provided, cost, location, and care for the participants during the intervention. Introducing a home hazard management program to prevent falls among the stroke population is viewed relevant and feasible. Practical suggestions from the consultation panel were adopted, and minor adjustments were required to strengthen the protocol's overall methodology. This study established a rigorous and robust experimental protocol for future undertaking.

Reliability of the 44-question Home Fall Hazard Assessment Tool and personal characteristics associated with home hazards among the Thai elderly

Background: The 44-question Thai Home Fall Hazard Assessment Tool (Thai-HFHAT) was developed to assist healthcare professionals in identifying the risk of falls among community-dwelling elderly from their home environment. However, the reliability of this tool has not been studied. This study aimed to examine reliability of the 44-question Thai-HFHAT and determine the person characteristics associated with home hazards. Methods: A descriptive cross-sectional study design was used for this research. The participants in this study were 51 elderly people from various types of Thai houses: a one-story elevated house, a one-story non-elevated house, and a house with two or more floors, 51 caregivers of elderly patients and 5 village health volunteers (VHV). All participants answered 44 Thai-HFHAT questions to determine inter-rater and test-retest reliabilities. The reliabilities were analyzed using an intra-class correlation coefficient (ICC). Personal characteristics including sex, occupation, and education were used to identify the factors affecting home hazard and linear regression was used to analyze. Results: The ICC of inter-rater reliability of the 44-question Thai-HFHAT was 0.74 (95% CI: 0.57-0.84) and the test-retest reliability was 0.80 (95% CI: 0.64-0.88) for the elderly, 0.80 (95% CI: 0.65-0.89) for the caregivers and 0.70 (95% CI: 0.477-0.83) for the VHV. Personal business career and education level grade 1-3 are less than 0.05, which showed these factors had a significant relationship with the 44-question Thai-HFHAT score as dependent variable. Conclusions: The 44-question Thai-HFHAT is suitable for the home hazards assessment among the elderly in Thailand. Further studies are needed to investigate changes in the house environment after using the 44-question Thai-HFHAT to determine which changes can reduce the risk of fall.