title: Environmental assessment and modification to prevent falls in older people.
abstract: To assess the effectiveness of an environmental falls prevention intervention delivered by qualified occupational therapists or unqualified trained assessors.
  
  
  METHODS
  A pilot three-armed randomized controlled trial.
  
  
  METHODS
  Airedale National Health Service Trust catchment, North and West Yorkshire, England.
  
  
  METHODS
  Two hundred thirty-eight community-dwelling adults aged 70 and older with a history of falls in the previous year.
  
  
  METHODS
  Assessment and modification of the home environment of people at greater risk of falls.
  
  
  METHODS
  Fear of falling was the primary outcome measure, and an analysis of covariance was conducted on the area under the curve at 12 months. As a secondary outcome, falls were analysed using negative binomial regression. Quality of life and independence in activities of daily living (ADLs) were also measured.
  
  
  RESULTS
  The intervention had no effect on fear of falling (P=.63). The occupational therapy group had significantly fewer falls than controls 12 months after the assessment (incidence rate ratio (IRR)=0.54, 95% confidence interval (CI)=0.36-0.83, P=.005). There was no significant effect on falls in the trained assessor group (IRR=0.78, 95% CI=0.51-1.21, P=.34).
  
  
  CONCLUSIONS
  Environmental assessment had no effect on fear of falling. Environmental assessment prescribed by an occupational therapist significantly reduced the number of falls in high-risk individuals whereas that prescribed by a trained assessor did not. Further research in other settings is needed to confirm this, to explore the mechanisms, and to estimate cost-effectiveness.
authors.affiliation: Department of Health Sciences, Queens Medical Centre, Nottingham, UK. Alison_pighills@health.qld.gov.au
authors.forename: Alison C
authors.initials: AC
authors.lastname: Pighills
authors.forename: David J
authors.initials: DJ
authors.lastname: Torgerson
authors.forename: Trevor A
authors.initials: TA
authors.lastname: Sheldon
authors.forename: Avril E
authors.initials: AE
authors.lastname: Drummond
authors.forename: J Martin
authors.initials: JM
authors.lastname: Bland
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004739:England; D004779:Environment Design; D005239:Fear; D005260:Female; D006801:Humans; D007318:Inservice Training; D008297:Male; D009788:Occupational Therapy / Q000193:education / Q000379:methods*; D010865:Pilot Projects; D011788:Quality of Life; D012111:Residence Characteristics; D018570:Risk Assessment