Date Presented 03/28/20
OTs provide safety recommendations and encourage active participation in the home. This study determines the effect of participation in home repairs on falls in older Mexican Americans. Results of the analysis indicated performing recent home repairs was associated with decreased likelihood of the respondents having fallen within the last 12 months. Interventions targeting increased participation and safety with instrumental activities of daily living are needed.
Primary Author and Speaker: Mandi Sonnenfeld
Additional Authors and Speakers: Julianna Dean
Contributing Authors: Dylan Dean, Soham Al Snih
PURPOSE: The purpose of this analysis was to examine the relationship between recent home maintenance or repair activities and fall occurrence in the Hispanic Established Population for the Epidemiological Study of the Elderly (HEPESE) dataset (2005–2006). Our research question is as follows: “In the older adult Mexican American population living in the Southwestern United States, is there a significant association between reported participation in recent home repairs and reports of having fallen in the past 12 months?” Every 19 minutes, an older adult dies after a fall (NCOA, 2019). Falls are a significant health problem that cause a decrease in independence for older adults (Burns, Stevens, & Lee, 2016). This research is vital because there is a gap in the literature regarding the association of falls with home repairs, which is the leading setting for injury occurrence in the United States (Bergen, Chen, Warner, et al., 2008). This research addresses a salient issue in occupational therapy because occupational therapists (OTs) provide recommendations for safety and participation in activities, such as home repairs, following injury or disability.
DESIGN: The study design was a retrospective cross-sectional analysis of the first wave of the frailty dataset—a subsample of the HEPESE conducted in 2005–2006. The participants (n=932) were community dwellers of Mexican-American nativity status, aged 75 and older who resided in Arizona, California, Colorado, New Mexico, and Texas. The criteria and methods used to select participants for the study included no missing data for response to falls, home repairs, age, gender, marital status, nativity, comorbidities, and Short Physical Performance Battery (SPPB) score.
METHODS: Participants were interviewed at home in their language of preference (Spanish or English). The primary independent variable was engagement in home repairs (yes/no). Each participant was asked, “During the past 7 days, did you engage in any of the following activities: home repairs like painting, wallpapering, electrical work, etc.” The primary dependent variable was falls (yes/no) within the past 12 months. A fall was defined by the HEPESE codebook as “unintentionally coming to a rest on the ground, floor, or other lower level, whether or not you were injured (we are not talking about falls where you came to rest on a chair or a bed).” Covariates included socio-demographic characteristics (age, gender, marital status, and nativity status), number of comorbidities (diabetes, Parkinsons, Alzheimers, heart attack, stroke, hip fracture), and SPPB score.
RESULTS: In the sample, 334 (35.84%) participants reported a fall; 64 (6.87%) participants performed home repairs. An unadjusted logistic regression model showed home repairs to be significantly associated with lower odds of a fall (OR 0.43, 95% CI: 0.43–0.81). This relationship remained after adjusting for socio-demographics (OR 0.43, CI: 0.23–0.81). However, home repair was no longer significant after adjusting for socio-demographics, comorbidities, and SPPB (OR 0.61, CI: 0.97–1.17). In this fully adjusted model, higher SPPB scores were significantly associated with lower odds of experiencing a fall (OR 0.94, CI: 0.90–0.98).
CONCLUSION: Engagement in home repairs was associated with lower odds of experiencing a fall, but this relationship was mediated by the inclusion of comorbidities. Increasing physical activity and preventing chronic diseases may reduce the risk of falls in this population.
IMPACT STATEMENT: These findings will exert a powerful influence on occupational therapy because this research provides evidence that active participation in home repairs may be protective against falls; occupational therapists can play a vital role by encouraging safe participation.
References
National Council on Aging (NCOA). Falls prevention facts. Website: https://www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/ Accessed June 2, 2019.
Burns, E., Stevens J., & Lee, R. (Sept 2016). The direct costs of fatal and non-fatal falls among older adults—United States. J Safety Res, 58:99-103. doi:10.1016/j.jsr.2016.05.001.
Bergen, G., Chen, L.H., Warner, M., Fingerhut, L.A., 2008. Injury in the United States: 2007 Chartbook. National Center for Health Statistics, Hyattsville, MD.
