Falling into Home Mods: Occupational Therapy’s Role in Keeping Older Adults Safe at Home

Falls are the leading cause of injury-related deaths and the most common cause of nonfatal injuries and hospital admissions for older adults aged 65 and older.1 Other consequences of falls are increased fear of falling, and decreased independence and participation in performance of daily activities. In the past decade, evidence has identified the multifactorial approach, which includes home modification, as the most effective approach in preventing falls in older adults.2 Occupational therapists have the education and unique skill set to perform client-centered home modifications. The purpose of this presentation is to describe the results of an evidenced-based literature review on the distinct contributions and efficacy of occupational therapy in home modifications to reduce fall risk and improve fall efficacy in community-dwelling older adults. Ten articles were critiqued evaluating the effectiveness of occupational therapy guided home modifications in preventing falls in community-dwelling older adults. Databases searched included CINAHL, MEDLINE, PsychINFO, Scopus, Cochrane, and ERIC. Criteria for inclusion were older adults living at home, home modification interventions, falls, fall efficacy, and peer-reviewed articles published between 2003-2013. Included studies were cross critiqued by two readers using the Law Critical Review form and the PRISMA checklist for systematic reviews and meta-analyses.3,4 Results from this review indicate home modifications can be effective in reducing fall risk of community-dwelling older adults. The findings show individuals who are high-risk for falls benefit most from and are more likely to comply with recommended home modifications. However, there is limited evidence indicating home modifications improve fall efficacy. Literature suggests occupational therapists’ ability to perform home modifications that incorporate the interaction between the person, environment and occupation provides promising evidence for the reduction of falls in community-dwelling older adults. While evidence supports occupational therapy’s distinct role in home modification, additional research is needed to further differentiate the effectiveness of occupational therapy guided interventions from other professions, and directly link occupational therapy’s unique skills to decreased fall risk and improved fall efficacy of community-dwelling older adults. References: Centers for Disease Control and Prevention (2012). Falls Among Older Adults: An Overview. Retrieved from http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html Chase, C. A., Mann, K., Wasek, S., & Arbesman, M. (2012). Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults. The American Journal of Occupational Therapy, 66(3), 284-291. Law, M. & MacDermid, J. (2008). Evidence-Based Rehabilitation: A Guide to Practice. Slack, Inc. Liberati, A., Altman, D., Tetzlaff, J., Mulrow, C., Gøtzsche, P., Ioannidis, J., Clarke, M., Devereaux, P.J., Kleijnen & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals Of Internal Medicine, 151(4), W65-94