Abstract and Introduction
Background: Many falls in older people occur at home, and home hazards (HOHA) are often involved. Fear of falling (FOF) is a frequent and serious consequence of falls. This study aimed to analyze the effectiveness of an autonomous reduction of HOHA on FOF.
Methods: In this single-blinded, prospective cohort study design, the inclusion criteria were female sex, age ≥60 years, no known dementia, community-dwelling, and written informed consent. Using a 54-item room-by-room checklist, the participants identified and autonomously reduced as many HOHA as possible, within 14 days. The FOF was measured using a dichotomous scale (D-FOF) and the Falls Efficacy Scale International (FES-I). Logistic regression models were used to identify the predictors of a substantial reduction of HOHA (≥50%) and FOF (≥25%).
Results: A total of 782 women fulfilled the inclusion criteria, and 431 (60.5%) returned the complete checklist on time. The mean age was 72.5 [SD 7.1] years. 43.8% of participants reduced ≥50% of the HOHA. The D-FOF (odds ratio 22.4 [95% confidence interval 11.0–45.3]), age ≥ 75 years (14.1 [7.5–26.4]), polypharmacy (3.0 [1.4–6.5]), and assumed improvability of housing conditions (2.4 [1.3–4.3]) were identified as predictors for substantially reducing HOHA with an area under the curve of 0.91. The initial FES-I score decreased from 24.5 to 19.5. Prior to the intervention, 53.1% showed a high FOF (>22 FES-I scores). Of these, 70.7% participants reduced their high FOF to low FOF. 29.2% of all participants reduced FOF ≥25% postinterventionally, associated with a substantial reduction in HOHA (3.5 [2.2–5.7]) as the strongest independent factor in the multiple logistic regression analysis.
Conclusion: The use of a self-administered checklist led to a substantial reduction of HOHA and subsequently to a clinically relevant reduction of FOF in older community-dwelling women. Autonomous competence of older people should be considered when developing fall prevention strategies.
Over the past three decades, falls in older people have become a focus of research owing to their frequency and far-reaching individual and socioeconomic consequences. Approximately, one in three people older than 65 years of age fall once a year. Most of these falls occur at home.[14,32] Women have a higher risk of falling than men. Physiological aging processes and comorbidities can worsen the outcome of falls. For instance, after a fall-related hip fracture, 60% do not regain their previous mobility; several people become dependent on nursing care, and 30% die within the first year after the fall. Women are 2.2 times more likely to suffer a fall-related fracture and display a hospitalization rate 1.8 times higher than men, resulting in higher costs. Still, even minor injuries or near-falls can affect a person's confidence in his/her own abilities. A long-term consequence is fear of falling (FOF). FOF is defined as "a lasting concern about falling that leads to an individual avoiding activities that she/he remains capable of performing." More than half of the older population suffers from FOF,[27,30,41] which can be both a consequence of a previous fall[5,19] and a risk factor for future falls or can occur independently of falls.[27,41] Therefore, falls and FOF mutually reinforce each other and can lead to frailty through activity avoidance,[9,41] mobility restriction, limitations in the living space, and a severe reduction in the quality of life.[20,29,30]
Many risk factors for falls also apply to FOF, such as older age, female sex, gait and balance impairments, functional impairments, and polypharmacy.[10,29,41] However, the home environment also plays a significant role in the risk of falls, especially for people with disabilities. Home hazards (HOHA) are defined as "aspects of the physical environment, including objects, space, and the elements in and about the house that pose a risk or danger of causing the person to fall and, therefore, risk injury." They are common among older people, but several HOHA are modifiable.
Based on known risk factors, fall prevention concepts and methods for reducing FOF[18,21,28,42] have been developed. Many prevention strategies focus on multilevel interventions using external resources, such as home checks by occupational therapists. Gillespie et al. demonstrated in a meta-analysis that HOHA adjustment significantly reduced both the fall risk and the fall rate, especially in high-risk groups concurrent with occupational therapy monitoring. Other studies demonstrated that home safety improvement reduced fall-related injuries in older people by 39% and in people with visual impairment by 41%. Furthermore, demographic developments strengthen the need for simple, individualized, and effective fall prevention strategies. However, the effectiveness of self-administered checklists for the autonomous reduction of HOHA and their influence on FOF is unknown.
J Am Geriatr Soc. 2022;70(6):1754-1763. © 2022 Blackwell Publishing