Interventions targeting the assessment and modification of dangers in the homes of the elderly have demonstrated efficacy for reducing risks (Feder, Cryer et al., 2000; American Geriatrics Society et al., 2001; Gillespie, Gillespie et al., 2003). In-home actions also allow for the participation of the elderly and those close to them in fall risk prevention. With this intervention, care providers may observe the elderly in their daily home activities, which provides valuable information on their real capacities and allows for detecting other risk factors (balance impairment, risk-taking, fear of falling, etc.).
Coordinated with medical healthcare, professional assessment of the home, when accompanied by modification of the detected environmental risks and follow-up of these modifications, is an effective strategy for the reduction of falls in the elderly who present fall risk factors.
Disability assessment in the home, combined with an educative approach to risk factors and referral to health professionals as resources for information, seems to hold promise as a strategy for reducing the risk of falling. Thus, this is recommended despite a currently unestablished level of evidence
The assessment of factors that the home dweller feels are bothersome for carrying out activities of daily living (e.g., bad lighting, difficult to use furnishings, hard to access storage spaces) is a promising strategy, as these factors are significantly associated with a risk of falling in the home.
Support and assistance, when requested by the elderly person, should be provided for assessment organization and any ensuing modifications of the home environment. A study found that the elderly actually implemented less than half of recommended home security measures.
– act on the cognitive determinants of behavioral change, such as knowledge, beliefs, the perception of benefits of actions and the feeling of personal vulnerability, through an educative approach
– plan for a follow-up of recommendations; – ease access to resources and technical aids. Several assessment tools for fall risks in the home have been developed for use by the elderly themselves, for example
The Safe Living Guide–A guide to home safety for seniors: This illustrated brochure addresses safety in several topics. The first section, “Keeping your home safe”, comprises a series of checklists for addressing home dangers and tips for organizing the home and activities to increase safety. The brochure also contains information on aging and injuries and gives advice on physical activity and medication, among others.
Bruno and Alice: A love story in twelve parts about seniors and safety: This illustrated brochure presents twelve measures for preventing accidents, including falls. The measures concern mainly home organization and risktaking (http://www.phacaspc.gc.ca/seniorsaines/pubs/bruno_and_alice/foreword_e. html or http://www.phac-aspc.gc.ca/seniorsaines/pubs/bruno_and_alice/pdf/Bruno_ Alice_e.pdf)
You can prevent falls: By having a safe home and lifestyle! (http://www.phac-aspc. gc.ca/seniors-aines/pubs/Falls_Prevention/ fallsprevtn2_e.html
– Prévenir les chutes à domicile : quelques conseils utiles25 (Bégin et al., 1994): This Frenchlanguage tool provides advice on preventing falls in the home. Available from the CLSC of Joliette; Direction de la santé publique/ Régie régionale de la santé et des services sociaux of Lanaudière. CLSC of Joliette, 1994, 7 pages
La prévention des accidents domestiques : faire attention chez soi, c’est faire attention à soi26: This French-language, web-based resource gives general injury prevention advice, including for falls (other subjects are burns, intoxications, etc.). In the second half, “Votre sécurité à la maison (…)”27, the main home dangers are presented and advice is given to reduce them. http://www. prevention.ch/faireattentionchezsoi.html [July 2008].
It is not recommended to assess the homes of the at-risk elderly without providing follow-through actions (documented recommendations or direct intervention) intended to correct the identified problems. Studies have repeatedly found that assessment of home risks alone does not reduce the risk of falling, probably because few people implement the recommendations.