title: Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomized trial of falls prevention.
abstract: OBJECTIVE
  To determine whether occupational therapist home visits targeted at environmental hazards reduce the risk of falls.
  
  
  METHODS
  A randomized controlled trial.
  
  
  METHODS
  Private dwellings in the community in Sydney, Australia.
  
  
  METHODS
  A total of 530 subjects (mean age 77 years), recruited primarily before discharge from selected hospital wards.
  
  
  METHODS
  A home visit by an experienced occupational therapist, who assessed the home for environmental hazards and facilitated any necessary home modifications.
  
  
  METHODS
  The primary study outcome was falls, ascertained over a 12-month follow-up period using a monthly falls calendar.
  
  
  RESULTS
  Thirty six percent of subjects in the intervention group had at least one fall during follow-up, compared with 45% of controls (P = .050). The intervention was effective only among subjects (n = 206) who reported having had one or more falls during the year before recruitment into the study; in this group, the relative risk of at least one fall during follow-up was 0.64 (95% confidence interval, 0.50-0.83). Similar results were obtained when falls data were analyzed using survival analysis techniques (proportional and multiplicative hazards models) and fall rates (mean number of falls per person per year). About 50% of the recommended home modifications were in place at a 12-month follow-up visit.
  
  
  CONCLUSIONS
  Home visits by occupational therapists can prevent falls among older people who are at increased risk of falling. However, the effect may not be caused by home modifications alone. Home visits by occupational therapists may also lead to changes in behavior that enable older people to live more safely in both the home and the external environment.
authors.affiliation: Department of Public Health and Community Medicine, University of Sydney, NSW, Australia.
authors.forename: R G
authors.initials: RG
authors.lastname: Cumming
authors.forename: M
authors.initials: M
authors.lastname: Thomas
authors.forename: G
authors.initials: G
authors.lastname: Szonyi
authors.forename: G
authors.initials: G
authors.lastname: Salkeld
authors.forename: E
authors.initials: E
authors.lastname: O'Neill
authors.forename: C
authors.initials: C
authors.lastname: Westbury
authors.forename: G
authors.initials: G
authors.lastname: Frampton
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000061:Accidents, Home / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D004779:Environment Design; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D009788:Occupational Therapy; D016016:Proportional Hazards Models; D012307:Risk Factors; D017751:Safety Management; D016019:Survival Analysis