There was some limited evidence that home hazard assessment and environmental modification delivered by an occupational therapist may help reduce falls in older people, a major cause of morbidity and mortality. However our study did not find this was the case in community-dwelling older people deemed at higher risk of falling.
Falls in older people are a major cause of morbidity and mortality but there are ways of reducing falls. There was some evidence to suggest that home hazard assessment and environmental modification delivered by an occupational therapist may reduce falls at home among older people likely to be at risk.
We undertook a pragmatic, two-arm modified cohort randomised controlled trial in eight NHS trusts in primary and secondary care in England. In total, 1331 participants were randomised in a 2:1 allocation to either usual care plus a falls prevention leaflet or to receive the home hazard assessment and environmental modification intervention, plus usual care and a falls prevention leaflet. The primary outcome was the number of falls per participant over the 12 months from randomisation. Secondary outcomes included; proportion of fallers and multiple fallers, time to fall, and fear of falling.
Participants were aged 65 years or over, willing to receive a home visit from an occupational therapist, were community-dwelling and had experienced at least one fall in the previous 12 months, or reported a fear of falling.
We did not find any effect on the rate of self-reported falls among a population of older people with an elevated falls risk. Consequently, we do not recommend occupational therapist-led home assessment for patients who have characteristics similar to those of patients included in our study. Scarce occupational therapist resources would be better employed elsewhere.
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York Trials Unit, Department of Health Sciences, University of York, York, UK
Mackay Institute of Research and Innovation, Queensland Health, Mackay Base Hospital, Mackay, QLD, Australia
Division of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
Leicestershire Partnership NHS Trust, Leicester, UK
School of Health Sciences, University of Nottingham, Nottingham, UK
Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
York Teaching Hospital NHS Foundation Trust, York, UK
Institute of Population Health Sciences, Queen Mary University of London, London, UK
The research was funded by NIHR HTA programme (HTA 14/49/149) and a grant of £722,096.59 awarded. The project was started in June 2016 and completed in December 2019
ISRCTN: 22202133.