title: Relationship between pre-discharge occupational therapy home assessment and prevalence of post-discharge falls.
abstract: OBJECTIVE
  Pre-discharge occupational therapy home assessments are common practice, and considered important for falls prevention in older people. This prospective, observational cohort study describes the association between pre-discharge home assessment and falls in the first month post-discharge from a rehabilitation hospital.
  
  
  METHODS
  342 inpatients were recruited and followed up 1 month post-discharge. Patients were classified into diagnostic groups (cardiac, orthopaedic trauma, spinal, peripheral joint surgery, neurological and deconditioned). Age, gender, falls risk [Falls Risk Assessment Scoring System (FRASS)], functional independence scores (FIM™) and receipt (or not) of a home assessment were recorded. Patients completed a diary to document post-discharge falls. Logistic regression analysis tested the effect on falling of receiving a home assessment, age, gender, diagnostic group, FRASS and FIM™.
  
  
  RESULTS
  Considering all subjects, not receiving a home assessment increased the risk of falling 1 month post-discharge [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.4-4.7, P=0.003]. Neurological and orthopaedic trauma patients had significantly elevated risks of falling [OR (95% CI), respectively, 12.5 (4.7-33.2), 3.4 (1.4-8.4)] relative to the orthopaedic joint group. For all diagnostic groups except neurological, falls risk was mitigated by a home assessment. In non-neurological patients, adjusting for the effect of diagnostic group, FRASS and FIM™ scores indicated a significant association between not receiving a home assessment and falling (OR 4.2, 95% CI 2.1-8.2, P<0.001).
  
  
  CONCLUSIONS
  Pre-discharge occupational therapy home assessments are sound post-discharge falls-prevention strategies in non-neurological patients. The decision to conduct a home assessment should consider diagnosis, falls risk and functional independence.
authors.affiliation: Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia. kylie.johnston@unisa.edu.au
authors.forename: Kylie
authors.initials: K
authors.lastname: Johnston
authors.forename: Sarah
authors.initials: S
authors.lastname: Barras
authors.forename: Karen
authors.initials: K
authors.lastname: Grimmer-Somers
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006792:House Calls; D006801:Humans; D016015:Logistic Models; D008297:Male; D009788:Occupational Therapy; D010351:Patient Discharge; D011446:Prospective Studies; D018570:Risk Assessment