Home Modification Education IN Community-Based Older Adults to Prevent Falls OT Geriatric Group University at Buffalo February 25th, 2010 Buffalo, New York Community Health Foundation of Western & Central New York Falls Learning Section 4

Home Safety Self Assessment Tool (HSSAT) Table of Contents Goals and Aims Aim 1 Research and findings Aim 2 Accomplishment and Future Plan Aim 3 Accomplishment and Future Plan Home Safety Self Assessment Tool (HSSAT)

Aims 1. Develop and test an educational method for home safety to reduce falls. (HSSAT) 2. Educate older adults how to prevent falls through home hazard removal 3. Educate OT and other healthcare providers about importance of home hazard removal to prevent falls among older adults

1. Development and test of an educational method HSSAT was developed with input from 24 older adults and revised several times. Current version is 2.0 (Simple and interesting to use) Sketches The number coinciding with a hazard item, a sketch, and a solution List of local resources Log pages

1. Development and test of an educational method 40 participating older adults who had a fall in the past year were educated on home safety using the HSSAT. The home assessments and education were conducted by occupational therapists at baseline, three months (n=40) and six months follow-up (n=25) in the participants’ home. Monthly phone calls were made for reminder to make modifications as discussed.

Results 1: Reduction in number of home hazards Number of participants (n=42) Baseline Total (mean) 3 month (sum) 6 month Difference (Improvement) (t, p) (n=40) 465 (11.63) 202 (5.05) (56.7%) in 3 months (t=10.767, p=.001) (n=25) 279 (11.16) 99 (3.96) 180(64.5%) in 6 months (t= 8.626, p< .001)

Results 1: Reduction in number of home hazards Removal of clutter: 55 Made a safe flooring including removal of a throw rag and electrical codes: 50 cases Improved lighting: 22 Removal of ice/snow in driveway/walkway: 16 Reduction in the use of a stool/chair to reach things in kitchen: 12 Repaired pavement of front door entrance: 9 Moved a telephone to the bedside: 9 Moved things in higher shelves in a cabinet to lower shelves: 9 Used shower in stead of a claw foot bathtub : 7

Results 1: Reduction in number of home hazards Bathroom was identified as the most hazardous place and its improvements were identified as most difficult. Of the 40 participants only one participant installed grab bars in the bathroom. In addition to the cost factor, the majority of the participants did not install grab bars in their bathrooms as they considered it as being “institutional”

Result 2: Reduction in number of falls Number of participants (n=42) 3 month prior to baseline (mean, SD) 3 month (t, p value) 6 month t (p) (n=40) Total=15 M=.38 (p= .586) Total=3 M=.08, (p=.267) t=.972 p=.001 (n=25) Total =12 M=48 (p=.510) Total = 0 t=3.361 p=.003

Falls occurred during the 3 months Bathroom Bedroom Kitchen

Result 3: Decrease in level of fear Number of participants (n=42) Baseline (mean/SD) 3 month p value, t value 6 month (n=40) 18.6 (9.4) 17.4 (7.6) (t=3.151, p=.003) (n=25) 18.8 ( 9.9) 16.6 ( 10.3) t= .853 p=.402

Result 4 Evaluation of the method 100% said it was useful, were satisfied, and would recommend to other people. “The HSSAT made me more conscious of what things in my home could be troublesome. I am now more aware of being sure to look at things around my home that I should be more careful of”. “The home modification education helped in making me aware of objects and situations that can cause falls and how to remediate them”. “ Home builder suppliers should be more educated for the items such as nonskid tapes”.

Conclusion The method (OT assessment and education using the HSSAT and monthly phone calls for reminder) was effective in reducing the number of home hazards, the number of falls, and the level of fear of falls in 3 months. This was the first study to isolate participant’s education of home hazard reduction from . Since the HSSAT was found to be easy to use and useful, this can be utilized beyond research. Education that includes caregivers and home improvement stores may be necessary.

2. Educate older adults how to prevent falls through home hazard removal As of 2/25/2010 40 through research 90 through workshops in senior centers Some (?) through Erie County Senior Services (ECSS) Future Plans 20 in 3/12/2010 Autumn wood senior center 50 in March-May Parkside Community Association 10 in March- April Skills Nursing Facility 250 through ECSS (?) in VNA

3. Educate OTs and other healthcare providers about importance of home hazard removal to prevent falls among older adults As of 2/25/2010 Completed online HSSAT in www.agingresearch.buffalo.edu Provided 50 HSSAT for ECSS Future Plans 3/1/10 New York State Occupational Therapy Association: 100 OTs 3/10 Network in Aging meeting: 25 members 6/10 Online module for fall prevention for OT students. 8/10 Online CEU module for fall prevention for health care professionals

Online HSSAT http://www.agingresearch.buffalo.edu/

Thank You!