Health and Social Care in the Community, 30(1), 2022, pp.253-263.
Publisher:
Wiley
Falls impose substantial health and economic burdens on older adults. Over half of falls in older adults occur at home, with many involving bathroom areas. Limited information is available on the presence of bathroom modifications for those who experience them. Therefore, this study examined factors associated with bathroom modifications among older adults with at least one fall in the United beneficiaries with ≥1 fall, 55.5% had bathroom modifications and 50.1% had repeated falls (≥2 falls). Approximately 40.2% of those with repeated falls had no bathroom modifications. In the adjusted model, non-Hispanic Blacks (odds ratio [OR] = 0.38; p < 0.001) and Hispanics (OR = 0.64; p = 0.039) had lower odds of having bathroom modifications than non-Hispanic Whites. Fear of falling and activities of daily living limitations had incremental impacts on having bathroom modifications. This study highlights the need to improve disparities in bathroom modifications for non-Hispanic Black and Hispanic Medicare beneficiaries, including those with repeated falls. With the aging population and growing number of older minorities in the United States, reducing these disparities is vital for fall prevention efforts
(Edited publisher abstract)
Falls impose substantial health and economic burdens on older adults. Over half of falls in older adults occur at home, with many involving bathroom areas. Limited information is available on the presence of bathroom modifications for those who experience them. Therefore, this study examined factors associated with bathroom modifications among older adults with at least one fall in the United States. This study analysed the nationally representative 2016 Medicare Current Beneficiary Survey Public Use File of Medicare beneficiaries aged ≥65 years with ≥1 fall (n = 2,404). A survey-weighted logistic model was used to examine associations between bathroom modifications and factors including socio-demographic characteristics, health-related conditions, and fear of falling. Among Medicare beneficiaries with ≥1 fall, 55.5% had bathroom modifications and 50.1% had repeated falls (≥2 falls). Approximately 40.2% of those with repeated falls had no bathroom modifications. In the adjusted model, non-Hispanic Blacks (odds ratio [OR] = 0.38; p < 0.001) and Hispanics (OR = 0.64; p = 0.039) had lower odds of having bathroom modifications than non-Hispanic Whites. Fear of falling and activities of daily living limitations had incremental impacts on having bathroom modifications. This study highlights the need to improve disparities in bathroom modifications for non-Hispanic Black and Hispanic Medicare beneficiaries, including those with repeated falls. With the aging population and growing number of older minorities in the United States, reducing these disparities is vital for fall prevention efforts and aging-in-place.
(Edited publisher abstract)
Subject terms:
home adaptations, home care, older people, falls, independent living, inequalities;
This research explores the experience of twenty people aged between 50-70 living in homes that do not meet their needs. Despite being recruited to the study on the basis that their home did not meet their needs, participants broadly felt positively about where they lived. The research found that issues within the home were not always recognised due to strong feelings of attachment to their current property; a reluctance to think about possible negative future scenarios in their homes; and limited awareness of the impact of issues. On further exploration, participants described significant problems and hazards in their homes, with many identified as issues that would likely get worse as they aged. The impacts of living with these problems were wide-ranging and significant: affecting personal finances, social connections, mental and physical health. issues were grouped into three overarching themes: difficulties staying warm and dry at home; problems when moving around a home; concerns around the safety and security of a home and the local area. The report makes three key recommendations for supporting people to live in a home that meets their needs: solutions to poor quality homes need to be tailored by tenure type; there is a need for greater financial support options, particularly for homeowners; interventions should take account of the role of individual attitudes and identity in making repairs or renovations to a home.
(Edited publisher abstract)
This research explores the experience of twenty people aged between 50-70 living in homes that do not meet their needs. Despite being recruited to the study on the basis that their home did not meet their needs, participants broadly felt positively about where they lived. The research found that issues within the home were not always recognised due to strong feelings of attachment to their current property; a reluctance to think about possible negative future scenarios in their homes; and limited awareness of the impact of issues. On further exploration, participants described significant problems and hazards in their homes, with many identified as issues that would likely get worse as they aged. The impacts of living with these problems were wide-ranging and significant: affecting personal finances, social connections, mental and physical health. issues were grouped into three overarching themes: difficulties staying warm and dry at home; problems when moving around a home; concerns around the safety and security of a home and the local area. The report makes three key recommendations for supporting people to live in a home that meets their needs: solutions to poor quality homes need to be tailored by tenure type; there is a need for greater financial support options, particularly for homeowners; interventions should take account of the role of individual attitudes and identity in making repairs or renovations to a home.
(Edited publisher abstract)
Subject terms:
older people, home adaptations, home improvements, housing conditions, independent living, falls, user views;
... they faced. Many people in their 50s and 60s are living in poor-quality homes that are detrimental to their health and mental wellbeing. Common problems include excessive damp, an inability to heat homes properly and poor design and disrepair, which leaves people at greater risk of falls and other injuries as they grow older. Emotional attachment often prevents people from being realistic about the problems
(Edited publisher abstract)
Findings of a research study to explore the problems older people experience in their homes and the impact of these problems on their physical and mental health; and the barriers that prevent them from carrying out repairs and adaptations. Twenty participants aged 50 to 70 took part in two interviews and contributed a two-week online diary in which they explored their homes and the problems they faced. Many people in their 50s and 60s are living in poor-quality homes that are detrimental to their health and mental wellbeing. Common problems include excessive damp, an inability to heat homes properly and poor design and disrepair, which leaves people at greater risk of falls and other injuries as they grow older. Emotional attachment often prevents people from being realistic about the problems that exist in their homes and the negative impact on their quality of life, now and in the future. The study finds that people in this age group can be reluctant to think ahead and often don’t feel ‘old enough’ to undertake home improvements now, which would aid them to live healthily and independently for longer. Where people do recognise a need for repairs or changes to their homes, they can face a range of barriers, chiefly a lack of finances and financing options. In addition, they often don’t know where to find support and information about making home improvements or trustworthy tradespeople to carry out the works. This can lead to people putting off necessary improvements and choosing short-term unsustainable fixes over long-term changes. Tenure affects people’s options around making home improvements. Renters can feel unable to carry out necessary repairs due to their relationship with and reliance on landlords.
(Edited publisher abstract)
Subject terms:
older people, housing conditions, home improvements, falls, independent living, home adaptations, user views;
Background: falls are common in older people, but evidence for the effectiveness of preventative home adaptations is limited. Aim: determine whether a national home adaptation service, Care&Repair Cymru (C&RC), identified individuals at risk of falls occurring at home and reduced the likelihood of falls. Study Design: retrospective longitudinal controlled non-randomised intervention cohort study. admission. We analysed the data using multilevel logistic regression. Results: compared to the control group, C&RC clients had higher odds of falling, with an odds ratio (OR [95% confidence interval]) of 1.93 [1.87, 2.00]. Falls odds was higher for females (1.44 [1.42, 1.46]), older age (1.07 [1.07, 1.07]), increased frailty (mild 1.57 [1.55, 1.60], moderate 2.31 [2.26, 2.35], severe 3.05 [2.96, 3.13]), and deprivation (most deprived compared to least: 1.16 [1.13, 1.19]). Client fall odds decreased post-intervention; OR 0.97 [0.96, 0.97] per quarter. Regional variation existed for falls (5.8%), with most variation at the individual level (31.3%). Conclusions: C&RC identified people more likely to have an emergency fall admission occurring at home, and their service reduced the odds of falling
(Edited publisher abstract)
Background: falls are common in older people, but evidence for the effectiveness of preventative home adaptations is limited. Aim: determine whether a national home adaptation service, Care&Repair Cymru (C&RC), identified individuals at risk of falls occurring at home and reduced the likelihood of falls. Study Design: retrospective longitudinal controlled non-randomised intervention cohort study. Setting: our cohort consisted of 657,536 individuals aged 60+ living in Wales (UK) between 1 January 2010 and 31 December 2017. About 123,729 individuals received a home adaptation service. Methods: we created a dataset with up to 41 quarterly observations per person. For each quarter, we observed if a fall occurred at home that resulted in either an emergency department or an emergency hospital admission. We analysed the data using multilevel logistic regression. Results: compared to the control group, C&RC clients had higher odds of falling, with an odds ratio (OR [95% confidence interval]) of 1.93 [1.87, 2.00]. Falls odds was higher for females (1.44 [1.42, 1.46]), older age (1.07 [1.07, 1.07]), increased frailty (mild 1.57 [1.55, 1.60], moderate 2.31 [2.26, 2.35], severe 3.05 [2.96, 3.13]), and deprivation (most deprived compared to least: 1.16 [1.13, 1.19]). Client fall odds decreased post-intervention; OR 0.97 [0.96, 0.97] per quarter. Regional variation existed for falls (5.8%), with most variation at the individual level (31.3%). Conclusions: C&RC identified people more likely to have an emergency fall admission occurring at home, and their service reduced the odds of falling post-intervention. Service provisioning should meet the needs of an individual and need varies by personal and regional circumstance.
(Edited publisher abstract)
Subject terms:
assistive technology, home adaptations, falls, prevention, hospital admission, longitudinal studies, older people, emergency health services;
Journal of Enabling Technologies, 14(4), 2020, pp.253-271.
Publisher:
Emerald
Purpose: Older adults are at a high risk of falling. The consequences of falls are worse when the person is unable to get up afterward. Thus, an intelligent video monitoring system (IVS) was developed to detect falls and send alerts to a respondent. This study aims to explore the implementation of the IVS at home. Design/methodology/approach: A multiple case study was conducted with four dyads:
(Edited publisher abstract)
Purpose: Older adults are at a high risk of falling. The consequences of falls are worse when the person is unable to get up afterward. Thus, an intelligent video monitoring system (IVS) was developed to detect falls and send alerts to a respondent. This study aims to explore the implementation of the IVS at home. Design/methodology/approach: A multiple case study was conducted with four dyads: older adults and informal caregivers. The IVS was implemented for two months at home. Perceptions of the IVS and technical variables were documented. Interviews were thematically analyzed, and technical data were descriptively analyzed. Findings: The rate of false alarms was 0.35 per day. Participants had positive opinions of the IVS and mentioned its ease of use. They also made suggestions for improvement. Originality/value: This study showed the feasibility of a two-month implementation of this IVS. Its development should be continued and tested with a larger experimental group.
(Edited publisher abstract)
Subject terms:
older people, digital technology, information technology, monitoring, falls, videos, assistive technology, home adaptations, housing, case studies;
... of death, injury and decline among older adults is falls in the home, often a result of inadequate adaptation and maintenance. In addition, the quality of the built environment is associated with mental and physical health outcomes. The evidence suggests that interventions to improve housing quality, both in and outside of the home can be a highly cost-effective means of improving health outcomes. Every £1 spent on improving warmth in homes occupied by ‘vulnerable’ households can result in £4 of health benefits, while £1 spent on home improvement services to reduce falls is estimated to lead to savings of £7.50 to the health and care sector.
(Edited publisher abstract)
This report summarises what existing research tells us about the role and impact of poor-quality housing on health, particularly in the context of the COVID-19 pandemic. Of the 23.5 million homes in England, 18% are in a ‘non-decent’ condition. The report offers an insight into the current context of poor housing, identifies the key pathways in which poor-quality housing can impact health and considers the implications of the coronavirus in this relationship. The final section of the report reviews various housing interventions that have been found to improve health and prevent ill-health. The review found that poor-quality housing has a profound impact on health and the COVID-19 pandemic has exposed and amplified housing-related health inequalities. Groups in the population who are more likely to live in poor housing are often the same groups who are vulnerable to COVID-19 and other health conditions, including older people, people with existing health conditions, those with lower incomes and people from ethnic minority groups. Living in a cold, damp home and overcrowded housing, which is more common among ethnic minority groups, pose a significant health risk. One of the major causes of death, injury and decline among older adults is falls in the home, often a result of inadequate adaptation and maintenance. In addition, the quality of the built environment is associated with mental and physical health outcomes. The evidence suggests that interventions to improve housing quality, both in and outside of the home can be a highly cost-effective means of improving health outcomes. Every £1 spent on improving warmth in homes occupied by ‘vulnerable’ households can result in £4 of health benefits, while £1 spent on home improvement services to reduce falls is estimated to lead to savings of £7.50 to the health and care sector.
(Edited publisher abstract)
Subject terms:
Covid-19, housing, housing conditions, poverty, health inequalities, inequalities, mental health, black and minority ethnic people, falls, home adaptations;
Background: Despite the considerable injury burden attributable to falls at home among the general population, few effective safety interventions have been identified. This study tested the safety benefits of home modifications, including handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, edging for outside steps, and slip-resistant surfacing for outside by electronic coin toss to either immediate home modifications (treatment group) or a 3-year wait before modifications (control group). Household members in the treatment group could not be masked to their assigned status because modifications were made to their homes. The primary outcome was the rate of falls at home per person per year that needed medical treatment, which was derived from administrative data for insurance claims. Coders who were unaware of the random allocation analysed text descriptions of injuries and coded injuries as all falls and injuries most likely to be affected by the home modifications tested. To account for clustering at the household level, this stanalysed all injuries from falls at home per person-year with a negative binomial generalised linear model with generalised 1085–1263), the crude rate of fall injuries per person per year was 0·061 in the treatment group and 0·072 in the control group (relative rate 0·86, 95% CI 0·66–1·12). The crude rate of injuries specific to the intervention per person per year was 0·018 in the treatment group and 0·028 in the control group (0·66, 0·43–1·00). A 26% reduction in the rate of injuries caused by falls at home per year exposed to the intervention was estimated in people allocated to the treatment group compared with those assigned to the control group, after adjustment for age, previous falls, sex, and ethnic origin (relative rate 0·74, 95% CI 0·58–0·94). Injuries specific to the home-modification intervention were cut by 39% per year exposed (0·61, 0·41–0·91). Interpretation: The findings suggest that low-cost home modifications
(Edited publisher abstract)
Background: Despite the considerable injury burden attributable to falls at home among the general population, few effective safety interventions have been identified. This study tested the safety benefits of home modifications, including handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, edging for outside steps, and slip-resistant surfacing for outside areas such as decks and porches. Methods: This study is a single-blind, cluster-randomised controlled trial of households from the Taranaki region of New Zealand. To be eligible, participants had to live in an owner-occupied dwelling constructed before 1980 and at least one member of every household had to be in receipt of state benefits or subsidies. This study randomly assigned households by electronic coin toss to either immediate home modifications (treatment group) or a 3-year wait before modifications (control group). Household members in the treatment group could not be masked to their assigned status because modifications were made to their homes. The primary outcome was the rate of falls at home per person per year that needed medical treatment, which was derived from administrative data for insurance claims. Coders who were unaware of the random allocation analysed text descriptions of injuries and coded injuries as all falls and injuries most likely to be affected by the home modifications tested. To account for clustering at the household level, this stanalysed all injuries from falls at home per person-year with a negative binomial generalised linear model with generalised estimating equations. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000779279. Findings: Of 842 households recruited, 436 (n=950 individual occupants) were randomly assigned to the treatment group and 406 (n=898 occupants) were allocated to the control group. After a median observation period of 1148 days (IQR 1085–1263), the crude rate of fall injuries per person per year was 0·061 in the treatment group and 0·072 in the control group (relative rate 0·86, 95% CI 0·66–1·12). The crude rate of injuries specific to the intervention per person per year was 0·018 in the treatment group and 0·028 in the control group (0·66, 0·43–1·00). A 26% reduction in the rate of injuries caused by falls at home per year exposed to the intervention was estimated in people allocated to the treatment group compared with those assigned to the control group, after adjustment for age, previous falls, sex, and ethnic origin (relative rate 0·74, 95% CI 0·58–0·94). Injuries specific to the home-modification intervention were cut by 39% per year exposed (0·61, 0·41–0·91). Interpretation: The findings suggest that low-cost home modifications and repairs can be a means to reduce injury in the general population. Further research is needed to identify the effectiveness of particular modifications from the package tested.
(Edited publisher abstract)
Subject terms:
falls, evaluation, prevention, intervention, randomised controlled trials, injuries, home adaptations, outcomes;
This report presents results of a tool developed by York Health Economics Consortium to assess the potential return on investment (ROI) of falls prevention programmes targeted at older people living in the community. The tool pulls together evidence on the effectiveness and associated costs for four programmes where there was evidence of cost-effectiveness: Otago home exercise, Falls Management
(Edited publisher abstract)
This report presents results of a tool developed by York Health Economics Consortium to assess the potential return on investment (ROI) of falls prevention programmes targeted at older people living in the community. The tool pulls together evidence on the effectiveness and associated costs for four programmes where there was evidence of cost-effectiveness: Otago home exercise, Falls Management Exercise group programme, Tai Chi group exercise, and home assessment and modification. Based on an example analysis, all four interventions were found to be cost-effective, thus producing a positive societal ROI. One out of four interventions was also found to have a positive financial ROI (ie cost savings outweigh the cost of implementation). An accompanying Excel sheet allows for results to be tailored to the local situation based on the knowledge of the user.
(Edited publisher abstract)
Subject terms:
older people, falls, prevention, evaluation, cost effectiveness, quality of life, physical exercise, home adaptations;
Updated NICE quality standard which sets out best practice for health and social care professionals in preventing falls in older people and assessing older people after a fall. The standard covers older people who are living in the community or staying in hospital. It includes eight quality statements, which cover: identifying older people at risk; multifactorial risk assessment and intervention; checking for injury after an inpatient fall; moving people safely after a fall; strength and balance training, and home hazard assessment and intervention. It highlights the value of health and social care practitioners asking questions about falls during routine appointments to identify older people most at risk and the importance of offering multifactoral falls risk assessment to help to prevent falls,
(Edited publisher abstract)
Updated NICE quality standard which sets out best practice for health and social care professionals in preventing falls in older people and assessing older people after a fall. The standard covers older people who are living in the community or staying in hospital. It includes eight quality statements, which cover: identifying older people at risk; multifactorial risk assessment and intervention; checking for injury after an inpatient fall; moving people safely after a fall; strength and balance training, and home hazard assessment and intervention. It highlights the value of health and social care practitioners asking questions about falls during routine appointments to identify older people most at risk and the importance of offering multifactoral falls risk assessment to help to prevent falls, disability and loss of independence. It updates the previous quality standard which was published in 2015.
(Edited publisher abstract)
Subject terms:
risk assessment, older people, intervention, home adaptations, falls, assessment, injuries, patients, prevention, quality assurance;
Background: older adults are known to have increased falls rates and functional decline following hospital discharge, with substantial economic healthcare costs. This systematic review aimed to synthesise the evidence for effective falls prevention interventions in older adults recently discharged from hospital. Methods: literature searches of six databases of quantitative studies conducted from 1990 to June 2017, reporting falls outcomes of falls prevention interventions for community-dwelling older adults discharged from hospital were included. Study quality was assessed using a standardised JBI critical appraisal tool (MAStARI) and data pooled using Rev-Man Review Manager® Results: sixteen studies (total sample size N = 3,290, from eight countries, mean age 77) comprising 12 interventions met inclusion criteria. Findings: home hazard modification interventions delivered to those with a previous falls history (1 study), was effective in reducing the number of falls (RR 0.63, 95%CI 0.43, 0.93, Low GRADE evidence). Home exercise interventions (3 studies) significantly increased the proportion of fallers (OR 1.74, 95%CI 1.17, 2.60, Moderate GRADE evidence), and did not significantly reduce falls rate (RR 1.27, 95%CI 0.99, 1.62, Very Low GRADE evidence) or falls injury rate (RR 1.16, 95%CI, 0.83,1.63, Low GRADE evidence). Nutritional supplementation for malnourished older adults (1 study) significantly reduced the proportion of fallers (HR 0.41, 95% CI 0.19, 0.86, Low GRADE evidence). Conclusion: the recommended falls prevention interventions for older adults recently discharged from hospital are to provide home hazard minimisation particularly if they have a recent previous falls history and consider nutritional supplementation if they are malnourished.
(Edited publisher abstract)
Background: older adults are known to have increased falls rates and functional decline following hospital discharge, with substantial economic healthcare costs. This systematic review aimed to synthesise the evidence for effective falls prevention interventions in older adults recently discharged from hospital. Methods: literature searches of six databases of quantitative studies conducted from 1990 to June 2017, reporting falls outcomes of falls prevention interventions for community-dwelling older adults discharged from hospital were included. Study quality was assessed using a standardised JBI critical appraisal tool (MAStARI) and data pooled using Rev-Man Review Manager® Results: sixteen studies (total sample size N = 3,290, from eight countries, mean age 77) comprising 12 interventions met inclusion criteria. Findings: home hazard modification interventions delivered to those with a previous falls history (1 study), was effective in reducing the number of falls (RR 0.63, 95%CI 0.43, 0.93, Low GRADE evidence). Home exercise interventions (3 studies) significantly increased the proportion of fallers (OR 1.74, 95%CI 1.17, 2.60, Moderate GRADE evidence), and did not significantly reduce falls rate (RR 1.27, 95%CI 0.99, 1.62, Very Low GRADE evidence) or falls injury rate (RR 1.16, 95%CI, 0.83,1.63, Low GRADE evidence). Nutritional supplementation for malnourished older adults (1 study) significantly reduced the proportion of fallers (HR 0.41, 95% CI 0.19, 0.86, Low GRADE evidence). Conclusion: the recommended falls prevention interventions for older adults recently discharged from hospital are to provide home hazard minimisation particularly if they have a recent previous falls history and consider nutritional supplementation if they are malnourished.
(Edited publisher abstract)
Subject terms:
falls, very old people, older people, systematic reviews, intervention, evaluation, outcomes, hospital discharge, home adaptations, physical exercise, nutrition;