Reducing home hazards may not actually prevent falls - addressing intrinsic factors will
Removing hazards not very effective for fall prevention in the home.
Although home hazard removal is a popular fall prevention approach to fall prevention in the elderly, studies show that it’s not nearly as effective as people think. Home hazard removal interventions often include installing grab bars in bathrooms, adding slip-resistant surfaces to bathtubs and other slick surfaces, removing loose floor rugs and mats, removing floor-lying cords, and improving lighting.
One study [1] in Miami, FL found that although environmental hazards were present in the homes of nearly every older adult who fell, most of these supposed hazards were not actually associated with an increased risk of injurious fall. The study consisted of 270 people age 65+ who had recently sought medical treatment for a fall. The follow-up included a home hazard assessment. When the researchers specified the room in which the injury occurred and looked at the possible relationship between a noted hazard and the fall, they found that the hazards were often not related to the fall.
Another study [2] found no consistent association between home hazards and falls. They followed 1088 people living in New Haven, CT who were age 72+. Researchers evaluated the participants’ homes for 13 common trip or slip hazards, and then followed up with the participants every month for the next 3 years to track their falls.
A third study [3] in St. Louis, Missouri found that a home hazard intervention did not reduce the number of people who fell. In both the group of people who had a home hazard removal fall prevention intervention and the group that did not have the fall prevention intervention, about 50% of people experienced a fall in the next 12 months. However, the people in the home hazard removal program did fall less often. At 12 months, they had experienced 1.5 falls per person while the control group had 2.3 falls per person.
Unlike the previous two studies, this third study did not look at whether the falls occurred inside the home and whether or not they were plausibly related to home hazards. So, we don’t necessarily know whether the reduction of home hazards was the cause of the lower rate of falling in the intervention group. The home hazard removal program also did not make a difference in independence in daily activities, in the older adults’ concerns about doing activities without falling, or in their overall quality of life. This study involved 310 adults age 65+ who were receiving services from the Area Agency on Aging. Half of the people in the study were randomly selected to receive a home hazard removal intervention with a 6-month follow-up, and the other half just continued received the typical Area Agency on Aging programming.
Intrinsic health factors cause falls.
The researchers in the New Haven study advised that rather than focusing on home hazard removal, the limited resources for fall prevention should instead focus on modifying intrinsic health factors, because evidence is strongest that intrinsic health factors cause falls. Intrinsic factors include health conditions like arthritis, stroke, foot problems, medications, impairments in cognition, muscle strength, balance, gait, and vision. Interventions that target these intrinsic factors have been shown to be effective in comparison to interventions that target extrinsic factors like home hazards for fall prevention in the elderly.
Good balance is key to fall prevention in the home, and outside too.
People who have good balance and muscle strength will be better able to avoid falling when they encounter a trip or slip hazard inside or outside. Those who have poor balance can work on improving their balance in physical therapy or a targeted exercise course.
The ZIBRIO Stability Scale is a quick and easy tool to measure balance and fall risk and identify people who are in need of intervention for this important intrinsic fall risk factor.
Sources:
[1] Sattin, R.W., Rodriguez, J.G., DeVito, C.A., Wingo, P.A. (1998). Home Environmental Hazards and the Risk of Fall Injury Events Among Community-Dwelling Older Persons. Journal of the American Geriatrics Society, 46: 669-676. https://doi-org.ezproxy.lib.purdue.edu/10.1111/j.1532-5415.1998.tb03799.x
[2] Gill, T. M., Williams, C. S., & Tinetti, M. E. (2000). Environmental Hazards and the Risk of Nonsyncopal Falls in the Homes of Community-Living Older Persons. Medical Care, 38(12), 1174–1183. http://www.jstor.org/stable/3767995
[3] Stark S, Keglovits M, Somerville E, et al. (2021). Home Hazard Removal to Reduce Falls Among Community-Dwelling Older Adults: A Randomized Clinical Trial. JAMA Netw Open, 4(8):e2122044. doi:10.1001/jamanetworkopen.2021.22044