Rg. Cumming et al., Home visits by an occupational therapist for assessment and modification of environmental hazards: A randomized trial of falls prevention, J AM GER SO, 47(12), 1999, pp. 1397-1402
Citations number
21
Categorie Soggetti
Public Health & Health Care Science","General & Internal Medicine
OBJECTIVE: To determine whether occupational therapist home visits targeted
at environmental hazards reduce the risk of falls.
DESIGN: A randomized controlled trial.
SETTING: Private dwellings in the community in Sydney, Australia.
PARTICIPANTS: A total of 530 subjects (mean age 77 years), recruited primar
ily before discharge from selected hospital wards.
INTERVENTION: A home visit by an experienced occupational therapist, who as
sessed the home for environmental hazards and facilitated any necessary hom
e modifications.
MEASUREMENTS: The primary study outcome was falls, ascertained over a 12-mo
nth follow-up period using a monthly falls calendar.
RESULTS: Thirty six percent of subjects in the intervention group had at le
ast one fall during follow-up, compared with 45% of controls (P = .050). Th
e intervention was effective only among subjects (n = 206) who reported hav
ing had one or more falls during the year before recruitment into the study
; in this group, the relative risk of at least one fall during follow-up wa
s 0.64 (95% confidence interval, 0.50-0.83). Similar results were obtained
when falls data were analyzed using survival analysis techniques (proportio
nal and multiplicative hazards models) and fall rates (mean number of falls
per person per year). About 50% of the recommended home modifications were
in place at a 12-month follow-up visit.
CONCLUSIONS: Home visits by occupational therapists can prevent falls among
older people who are at increased risk of falling. However, the effect may
not be caused by home modifications alone. Home visits by occupational the
rapists may also lead to changes in behavior that enable older people to li
ve more safely in both the home and the external environment.