Assessing Outcomes and Falls-Risk Reduction for Homebound Older Adults Through a Home Evaluation Intervention

PURPOSE: Falls are the leading cause of injury and accidental death in older adults, and an estimated one-third of all falls sustained by older adults involve environmental hazards in the home. A growing base of evidence supports the efficacy of home evaluations conducted by occupational therapists. However, research on the application of these interventions for homebound older adults is limited. The purpose of this pilot study was to examine the outcomes of a home evaluation program for homebound older adults who were referred to occupational therapy by Meals on Wheels (MoW) case managers. This population was identified as a subset of the community at high risk for falls on the basis of age, limited community mobility, chronic multiple health conditions, and low socioeconomic status.

Research questions were as follows: (1) Are the assessment measures used in occupational therapy–based home evaluation research applicable to the homebound population? (2) What are the types and frequencies of (a) home safety and falls risks and (b) major home repairs needed that are identified in a home evaluation intervention conducted with participants? (3) What are the types, frequencies, and cost of adaptive equipment (AE) provided to participants during the home evaluation intervention?

METHOD: This descriptive pilot study was conducted with a sample of 20 participants referred by MoW case managers because they were identified as being at risk for falls (declining function, recent illness, or recent falls). Study participants were homebound, ranged in age from 70 to 92, and had multiple chronic health conditions; 75% lived alone.

Two occupational therapists met with participants (and family members if present) to conduct the home evaluation. Data were collected using a client interview, the SF–8 Health Survey, and the Falls Efficacy Scale. The Person–Environment–Occupation Model was used as a framework for the home evaluation intervention, and the Rebuilding Together home safety checklist was used to conduct the home evaluation. Tracking spreadsheets were developed to code frequencies of home safety risks, home modification needs, and types of AE provided. The home evaluation included education and provision of AE on the basis of client goals and needs. Because of grant support, the home evaluation and AE were provided at no cost to participants or the community partner.

RESULTS: Findings from this pilot study indicate that the homebound population has difficulty completing the assessment measures typically used in home evaluation research, such as the SF–8 Health Survey and the Falls Efficacy Scale (Research Question 1). Data collected revealed five primary types of home safety or falls risks that could be addressed during the home evaluation through education or AE (Research Question 2a) and 16 types of major home repairs needed (Research Question 2b). Thirteen AE items were provided during the course of the study, with a range of 1–11 items provided per client. The retail cost per client of AE ranged from $62.60 to $454.48 (Research Question 3).

CONCLUSION: Although evidence exists regarding the efficacy of occupational therapy home evaluation interventions, limited research has examined the translation of these processes to special populations such as homebound older adults. These populations are important to consider in building evidence because they are at high risk of falls because of multiple factors. Whereas this pilot study suggests that a home evaluation intervention is beneficial for homebound older adults and results in reduction of falls risk, it also demonstrates that typical home evaluation assessments such as the Falls Efficacy Scale may not be applicable to this population. Therefore, further research is needed to measure the outcomes of such an intervention for this special population.

References

Fletcher, P. C., Guthrie, D. M., Berg, K., & Hirdes, J. P. (2010). Risk factors for restriction in activity associated with fear of falling among seniors within the community. Journal of Patient Safety, 6, 187–191. https://doi.org/10.1097/PTS.0b013e3181f1251c

Leland, N. E,, Elliott, S. J., O’Malley, L., & Murphy, S. L. (2012). Occupational therapy in fall prevention: Current evidence and future directions. American Journal of Occupational Therapy, 66, 149–160. https://doi.org/10.5014/ajot.2012.002733

Szanton, S. L., Leff, B., Wolff, J. L., Roberts, L., & Gitlin, L. N. (2016). Home-based care program reduces disability and promotes aging in place. Health Affairs, 35, 1558–1563. https://doi.org/10.1377/hlthaff.2016.0140