Home falls are one of the most complex health care issues, and researchers have looked into the most efficient ways of reducing home falls. There are many ways of reducing the reported cases of home falls such as the development of home visit programs, home renovation and modification, and the development of the community-based programs, exercise program. This paper presents a review of the literature covering different approaches and solutions used to prevent falls at home as a well a rationale for the home fall prevention explaining why this issue is important and needs addressing.
Home Falls Prevention Importance
The American Nurse Today magazine defines falls as “an unplanned descent to the floor with or without injury to the patient” (Lunsford & Wilson, 2015, p. 29). There are many factors that may contribute to the occurrence of falls such as the inappropriate home environment (slippery floors, lack of support bars, stairs, poor lighting, and cluttered rooms), specificities of treatments (some medications that cause drowsiness) , health conditions (unstable gait, excessive weight, altered mental status, and frequent need for toileting (Lunsford & Wilson, 2015). Experiencing falls, older adults are exposed to serious health threats dealing with which they may spend a long time undergoing treatments; in many cases falls result in irreparable damage to the health of the older adults.
As emphasized by the CDC’s National Center for Injury Prevention (2015), falls represent on the of the biggest threats to the health of older adults and people with disabilities and produce a significant negative effect on health and independence. In fact CDC (2015) points out that annually, one-third of all people older than 65 years suffer from falls that affect their health; besides, the individuals who have experienced falls in the past are over 50% more likely to have more of such accidents in the future. Statistically, falls are recognized as one of the primary causes of injuries in elderly people; about 10% of the injuries resulted from falls may be rather serious (broken limbs, fractures, head trauma) and lead to hospitalization, restriction, loss of independence, emotional stress, and physical pain; moreover, they take older people a very long time to heal and most elderly patients never fully recover from the fall-related traumas (CDC, 2015).
NSW Department of Health (2015) adds that falls significantly increase the rates of morbidity and mortality among older adults; besides, even falls that do not result in physical trauma may produce negative effects on the affected people and lead to the loss of confidence, fears, and activity restrictions. Moreover, the frequency of falls in older adults has grown over the last decade, and so did the rates of hospitalization due to fall-related injuries (NSW Department of Health, 2015).
Home Visit Programs
The home visit programs are aimed at enhancing the provision of home fall prevention education to the victims and their relatives or caregivers. Home visits are viewed as the ways to provide necessary knowledge and support to the individuals exposed to the risk of falling at home. Luck, Motzek, Luppa, Matschinger, Fleischer, Sesselmann and Reidel-Heller (2013) developed a study that revealed that preventive home fall visits are effective in eliminating the reported cases of falls by the elderly. The main reason for the effectiveness of the preventive home visits is that they provide the victims with personalized preventive measures. General training on health care providers and family members does not place the personal requirements of the patients into perspective; hence, it is not as effective as the home visits.
Corrieri, Heider, Riedel-Heller, Matschinger, and König, (2011) specify that professional home visits conducted specifically in order to prevent falling in the home settings are recognized are a promising type of approach used to achieve the increased level of independence in the older adults thus improving their quality of life and reducing health care costs. Their study targeted cost-effectiveness of home visits in particular by means of a randomized controlled trial of such interventions. The research found that home visits are to be planned individually based on the unique features of each case that need to be evaluated in relation to patient needs and the potential savings (Corrieri et al., 2011).
Clemson, Donaldson, Hill and Day (2014) note that compared to the substantial amount of information and research in fall prevention in the clinical settings that of the community-based environment is rather limited. Having interviewed several professionals involved in the coordination and therapies conducted during home visits, the researchers found that all of the specialists were supporting of this type of intervention (Clemson et al., 2014). The authors also emphasized that the success of home visit intervention is determined by many factors such as individual approaches and practices used by the therapists, congruence of the therapy with the organizational processes, and the patient expectations (Clemson et al., 2014). The interviewees also admitted that the fact that the nature of the intervention outcomes was practically invisible its assessment was a challenge. In order to increase the sustainability of home visits as a way to prevent falls more substantial body of research in this sphere is required.
The researchers who promote the use of physical exercise programs as the interventions for falls in the home settings propose the use of the latest technologies such as virtual reality devices; in the opinion of the researchers, such methods may be rather costly, and also they are likely to face challenges when implemented with older adult users (Kiselev, Haesner, Gövercin, & Steinhagen-Thiessen, 2015). Searching for a way to improve the effectiveness of the technology-based intervention, the authors propose an alternative method that involved the development of a setup, software, and interface. All in all, the users were to wear the VR device and be connected to the Internet while exercising and that would allow their physicians to observe the training in real time and also see which groups of muscles are trained and how well (Kiselev et al., 2015). This approach would enable the supervising physicians to monitor the training process and provide feedback and comments right away but also to update the exercise program, add new exercises, and adjust the level of difficulty (Kiselev et al., 2015). While this approach sounds extremely convenient for the doctors, it may be rather challenging for the patients because many older adults would find it extremely challenging to handle the contemporary devices, learn how to use them, and wear them every time they exercise.
As to the conventional form of exercise, Haines et al. (2016) found that the primary challenge to this type of fall prevention strategy is the reluctance of the older population to participate. In the study, the researchers evaluated the rates of intention and the rates of participation in the physical exercises for the elderly population under the risk of falling and compared to the percentage of compliance with the exercise program based at home and that held elsewhere as a group activity (Haines et al., 2016). Among the groups of people who did not have the intention to take part in these activities more agreed to exercise at home while the group form of exercising was less popular among people who were not willing to exercise (Haines, 2016).
Also, Duckham et al. (2015) reviewed the exercise programs for fall prevention in terms of their impact on bone mineral density and found that no significant effect was produced. That way, it is possible that the exercises strengthen the muscles and add confidence to the older people when walking. However, if a fall occurs due to some reason (slippery floor, clutter, insufficient lighting) – the amount of damage is likely to be just as high as in people who did not engage in exercise.
Chase, Mann, Wase, and Arbesman (2012) developed a study that highlighted the effectiveness of home modification and other interventional programs in reducing cases of home falls. The findings of the study revealed that the application of different preventive measures alongside home modification can effectively eliminate the number of falls. Some of the alternative approaches include providing exercising programs, enhancing vision through regular tests, and providing assistive technology to evaluate risks of falling in the home setting. The study revealed that exercising and providing education to the caregivers and the patients about their safety in the homes can effectively reduce cases of home falls. The growth in technology has provided the ability to detect potential risks to falls in the home setting, and the relevant modifications can be applied on a timely basis depending on the requirements of the patients. The researchers also proposed the development of continuous studies to look into the best alternatives to enhance safety for the respective patients.
Sadasivam et al. (2013) evaluated the usefulness of a remotely operated robot as a means for the evolution of home-based hazards that may cause an elderly person to fall. The assessments using the robot and an in-person screening were compared, and the researchers found that there was a significant difference in the assessment results provided by the screening and the robot. Namely, approximately 4.2 home based hazards per person were found during the in-person evaluation of the patients’ homes; at the same time, the same homes assessed by the robot showed to have 7.0 hazards per person (Sadasivam et al., 2013). That way, the effectiveness of the robot is higher and allows eliminating more threats to the patients’ health while at home. The researchers are convinced that the further development of the robot technologies for the assessment of home hazards could significantly improve the quality of life and safety of the elderly population and people with disabilities (Sadasivam et al., 2013).
Keall, Nevil, Howden-Chapman, Cunningham, & Cunningham (2015) researched the benefits of all the safety measures present in the homes proofed from falls. The researchers make a conclusion that the home modification means (even the cheaper ones) produce a significant positive effect on the level of safety of the dwellers. Overall, home modifications are some of the most common and effective measures used to prevent falls at home; while the other approaches such as exercises and home visits are optional and can be disregarded by some patients, home modifications are widely embraced by the elderly population as helpful and effective support.
Another valuable piece of the research literature selected for this review is the Supplemental Table 1. Summary of Evidence on Home Modification and Fall Prevention Programs (2012), the table provides a comprehensive list of the reviewed sources assessing the effectiveness of home modifications in terms of the prevention of falls. The studies mentioned in the table present the data from the end of the 1990s, the beginning of the 2000s, and the beginning of the 2010s. Based on the results of assessments, the safety measures and additions installed in the patients’ homes show increasingly better results in recent studies compared to those of a couple decades ago. This tendency indicates that more hazards are addressed today and in a more effective way so that the quality of life of the persons exposed to the risk of falling is significantly higher today than at the end of the 1990s.
The best quality prevention programs for falls have been proposed by various researchers, but it is apparent that the most important aspect of the programs is educating the caregivers and the patients. Vigilance on the part of the caregivers is the main contributing factor to the elimination of falls in the home setting. According to Jackson (2016), the development of a program that entails mobilizing caregivers to enhance vigilance is one of the most effective ways of preventing falls. Additionally, patients need to exercise on a daily basis to enhance their physical agility. Caregivers are advised to ensure their patients take part in outdoor activities to build on their physical energy. It is apparent that the development of regular checks on the patients improves their safety because the nurses and caregivers can identify the risks around the home environment. Additionally, the caregivers should focus on ensuring that every patient receives personalized care. By evaluating the respective needs of the patients, it is possible to provide the most appropriate multi-interventional protocol. For instance, there are patients who need physical exercises to reduce the number of monthly falls, whereas there are those who need to be assisted through the modification of the home setting because their eyesight is the main issue. The caregivers are obliged to acquaint themselves with the requirements of their patients to ensure that the relevant programs are applied to enhance positive health outcomes.
Fall prevention has been an important subject of discussion and a field of research for many decades. Falls are recognized as a serious threat to the health of the elderly population and people with disabilities. They increase the rates of morbidity and mortality, cause loss of confidence, emotional and physical pain, fears, and the limitation of independence. As a result, the experts identify various interventions for the prevention of falls. Some of them are quite traditional (such as muscle strengthening exercises and the installation of hand rails and other home modifications) and the others are very recent and innovative (such as the training programs based on VR). Each of them has advantages and weaknesses, but most prove to be significantly effective.
Chase, C. A., Mann, K., Wasek, S., & Arbesman, M. (2012). Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults. American Journal of Occupational Therapy, 66(3), 284-291.
Clemson, L., Donaldson, A., Hill, K., & Day, L. (2014). Implementing person-environment approaches to prevent falls: A qualitative inquiry in applying the Westmead approach to occupational therapy home visits. Australian Occupational Therapy Journal, 61, 325–334.
Corrieri,S., Heider, D., Riedel-Heller, S. G., Matschinger, H., & König, H., (2011). Cost-effectiveness of fall prevention programs based on home visits for seniors aged over 65 years: a systematic review. International Psychogeriatrics 23(5), 711-723.
Duckham, R., Masud, T., Taylor, R., Kendrick, D., Carpenter, H., Iliffe, S.,… Brooke-Wavel, K. (2015). Randomised controlled trial of the effectiveness of community group and home-based falls prevention exercise programmes on bone health in older people: the ProAct65+ bone study. Age and Ageing, 44(4), 573-579.
Haines, T., Hill, K., Vu, T., Clemson, L., Finch, C., & Day, L. (2016). Does action follow intention with participation in home and group-based falls prevention exercise programs? An exploratory, prospective, observational study. Archives of Gerontology and Geriatrics, 64, 151–161.
Jackson, K. M. (2016). Improving nursing home falls management program by enhancing standard of care with collaborative care multi-interventional protocol focused on fall prevention. Journal of Nursing Education and Practice, 6(6), p84.
Keall, M., Pierse, N., Howden-Chapman, P., Cunningham, C., Cunningham, M., Guria, J., & Baker, M. (2015). Home modifications to reduce injuries from falls in the Home Injury Prevention Intervention (HIPI) study: a cluster-randomised controlled trial. The Lancet, 385(9964), 231-238.
Kiselev, J., Haesner, M., Gövercin, M., & Steinhagen-Thiessen, E. (2015). Implementation of a Home-Based Interactive Training System for Fall Prevention: Requirements and Challenges. Journal of Gerontological Nursing, 41(1), 14-19.
Luck, T., Motzek, T., Luppa, M., Matschinger, H., Fleischer, S., Sesselmann, Y., & Riedel-Heller, S. G. (2013). Effectiveness of preventive home visits in reducing the risk of falls in old age: a randomized controlled trial. Clin Interv Aging, 8, 697-702.
Lunsford, B. & Wilson, L. D. (2015). Assessing your patients’ risk for falling. American Nurse Today, 10(7), 29-31.
NSW Department of Health. (2015). Falls – Prevention of Falls and Harm from Falls among Older People: 2011-2015. Web.
Sadasivam, R., Luger, T., Coley, H., Taylor, B., Padir, T., Ritchie, C., & Houston, T. (2013). Robot-assisted home hazard assessment for fall prevention: a feasibility study. Journal of Telemedicine and Telecare, 20(1), 3-10.
Supplemental Table 1. Summary of Evidence on Home Modification and Fall Prevention Programs (N = 33). (2012). American Journal of Occupational Therapy, 66, 1.