Carla A. Chase, Kathryn Mann, Sarah Wasek, Marian Arbesman; Systematic Review of the Effect of Home Modification and Fall Prevention Programs on Falls and the Performance of Community-Dwelling Older Adults. Am J Occup Ther 2012;66(3):284–291. https://doi.org/10.5014/ajot.2012.005017
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This systematic review explored the impact of fall prevention programs and home modifications on falls and the performance of community-dwelling older adults. It was conducted as part of the American Occupational Therapy Association’s Evidence-Based Practice Project. Thirty-three articles were analyzed and synthesized. The strongest results were found for multifactorial programs that included home evaluations and home modifications, physical activity or exercise, education, vision and medication checks, or assistive technology to prevent falls. Positive outcomes included a decreased rate of functional decline, a decrease in fear of falling, and an increase in physical factors such as balance and strength. The strength of the evidence for physical activity and home modification programs provided individually was moderate. Implications for practice, education, and research are also discussed.
Specifying a population that would specifically benefit from a given type of intervention may be important; for example, one study found that people over age 80 and those considered frail responded particularly well to fall reduction interventions (Robertson et al., 2001).
Although the amount of research in the area of fall prevention through various physical activity or exercise programs is fairly large and growing, more research is needed that explores the impact of home modifications on fall prevention and performance in all areas of occupation.
Home modification studies have often missed the opportunity to measure outcomes related to maintained or increased ability to complete ADLs or IADLs and to analyze performance in a variety of environments and contexts. Using standardized outcome measures for functional status and safety in the home such as the Canadian Occupational Performance Measure (Law et al., 1994), the In-Home Occupational Therapy Evaluation (Stark, Somerville, & Morris, 2010), and the Safety Assessment of Function and the Environment for Rehabilitation (Chiu, Oliver, Marshall, & Letts, 2002) can provide a more consistent way to examine change by assessing the wide range of environments in which older adults participate, including the home and community.
In general, a client-centered intervention plan that includes a mix of exercise, education, home modifications, and assistive technology is supported by the best evidence for fall prevention and occupational performance in community-dwelling older adults.
Regardless of the setting in which one practices, occupational therapy practitioners can incorporate fall prevention and home modification strategies throughout the occupational therapy process, from evaluation to intervention planning and implementation and outcome review.
The evidence discussed here reinforces the role of occupational therapists on the home and community team and the importance of client-centered care with a mix of interventions to provide the best fit.
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