Preventing falls in older people: Impact of an intervention to reduce environmental hazards in the home

OBJECTIVES: To evaluate the impact of an intervention to reduce fall hazard s in the homes of older people. DESIGN: The intervention was administered to the 570 subjects in the experi mental arm of a randomized controlled trial, with follow-up of subjects for 1 year. SETTING: Community-based seniors living in Perth, Australia. PARTICIPANTS: People age 70 and older. INTERVENTION: Registered nurses delivered the intervention. It consisted of a home hazard assessment, an educational strategy on general fall hazard r eduction and ways to reduce identified home hazards, and the free installat ion of safety devices: grab rails, nonslip stripping on steps, and double-s ided tape for floor rugs and mats. All intervention subjects received the h ome hazard assessment, and 96% received the educational strategy. Grab rail s were installed in 77% of homes, rugs were stabilized in 8%, and nonslip s tep stripping was installed in 36%. MEASUREMENTS: Hazard prevalence was assessed at baseline in all homes and 1 1 months later in a random sample of 51 homes. Action taken in response to the intervention was assessed by a self-completed postal questionnaire comp leted 11 months after the intervention. RESULTS: All homes had at least one fall hazard. The most prevalent were fl oor rugs and mats (mean of 14 per home), stepovers (Stepovers are structura l changes to the height of the floor that were designed to be stepped over rather than stepped upon, for example, the lip of a shower or a bath side.) (mean of seven per home), steps (mean of four per home), and trailing cord s (mean of two per home). The intervention was associated with a small but significant reduction in four of the five most prevalent hazards. The mean number of unsafe rugs and mats was reduced by 1.57 per house (95% confidenc e interval (Cl) = 0.91-2.24); the mean number of unsafe steps was reduced b y 0.61 per house (95% Cl = 0.28-0.94); the mean number of rooms with traili ng cords was reduced by 0.43 per house (95% Cl = 0.10-0.76); and the mean n umber of unsafe chairs was reduced by 0.10 per house (95% CI 0.02-0.18). Safety devices were installed in 81.9% of homes. Advice on modifying specif ic hazards identified on the home hazard assessment resulted in over 50% of subjects removing hazards of floor rugs and mats, trailing cords, and obst acles. The general education message prompted less activity to reduce these hazards than did the advice on identified hazards. CONCLUSIONS: Fall hazards are ubiquitous in the homes of older people. The intervention resulted in a small reduction in the mean number of hazards pe r house, with many study subjects taking action but removing only a few haz ards. The impact of the intervention in achieving self-reported action to r educe hazards was high.