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Modification of the home environment for the reduction of injuries

  1. Samantha Turner1,*,
  2. Geri Arthur2,
  3. Ronan A Lyons1,
  4. Alison L Weightman3,
  5. Mala K Mann3,
  6. Sarah J Jones4,
  7. Ann John2,
  8. Simon Lannon5

Editorial Group: Cochrane Injuries Group

Published Online: 16 FEB 2011

Assessed as up-to-date: 30 NOV 2009

DOI: 10.1002/14651858.CD003600.pub3


How to Cite

Turner S, Arthur G, Lyons RA, Weightman AL, Mann MK, Jones SJ, John A, Lannon S. Modification of the home environment for the reduction of injuries. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD003600. DOI: 10.1002/14651858.CD003600.pub3.

Author Information

  1. 1

    Swansea University, School of Medicine, Swansea, UK

  2. 2

    School of Medicine, Public Health Wales; Swansea University, Swansea, UK

  3. 3

    Information Services, Cardiff University, Support Unit for Research Evidence (SURE), Cardiff, Wales, UK

  4. 4

    Cardiff University, Public Health Wales; Department of Primary Care and Public Health, Cardiff, UK

  5. 5

    Cardiff University, Welsh School of Architecture, Cardiff, UK

*Samantha Turner, School of Medicine, Swansea University, Grove Building, Singleton Park, Swansea, SA2 8PP, UK. s.turner@swansea.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 16 FEB 2011

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Characteristics of included studies [ordered by study ID]
Babul 2007

Methods3 armed parallel, non-blinded, RCT.


ParticipantsParents of newborn infants, recruited from single public health unit, with 82% of the population living in urban communities or suburban neighbourhoods and the balance in the rural hillsides and farming areas.

n = 202 (I1).

n = 206 (I2);

n = 192 (C).


Interventions(I1) A home visit and home safety kit. A 41-item checklist was used to identify potential hazards in the home, and when identified parents were taught how to remove or modify these hazards. The nine home safety kit items included a smoke alarm, a coupon for 50% savings on a safety gate and cabinet locks.

(I2) Home safety kit alone.

(C) The control group received standard services provided by the community health unit for families with newborn infants.


OutcomesParent reported use of safety measures, attitudes toward safety and parent reported injury rates assessed by questionnaire. Outcomes evaluated using questionnaire completed at 2-month (baseline), 6-month and 12-month immunisation visits with community health nurse.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low risk

Becker 2003

MethodsCluster RCT.


ParticipantsLong-stay residents ≥ 60 from 6 community nursing homes. Mean age 85; 79% female.

n = 509 (I).

n = 472 (C).


InterventionsStaff and resident education on fall prevention, advice on environmental adaptations, balance and resistance training, hip protectors. Participants could participate in any possible combination of intervention options for any time they wanted.


OutcomesFalls, injuries and fracture rates were documented for all facilities for 365 consecutive days from the same index date.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Campbell 2005

MethodsRCT.


ParticipantsStudy set in Dunedin and Auckland, New Zealand. Men and women aged ≥ 75 with visual acuity of 6/24 or worse who were living in the community.

n = 100 (I1).

n = 97 (I2).

n = 98 (I3).

n = 96 (C).


InterventionsRecruitment took place over a 12-month period beginning in October 2002, and participants were followed up for 12 months. The study included 3 interventions:

(I1) A home safety assessment and modification programme delivered by an occupational therapist.

(I2) An exercise programme prescribed at home by a physiotherapist plus vitamin D supplementation.

(I3) Both interventions.

(C) Social visits.

Environmental hazards were identified using the Westmead home safety assessment checklist to identify hazards and to initiate discussion with the participant about any items, behaviour or lack of equipment that could lead to falls. The therapist and participant agreed on which recommendations to implement, and the therapist facilitated the provision of equipment and evaluated adherence to the home safety programme.


OutcomesCompliance to home safety recommendations measured by a 6-month follow-up telephone call. Falls and fall related injuries were monitored for 12 months.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Carter unpublished

MethodsRCT.


ParticipantsPatients > 70 years of age identified from patient lists of 37 family physicians.
n = 163 (I1).
n = 133 (I2).
n = 161 (C).


InterventionsBrief intervention - Home visit assessment of house/garden for hazards. Post-home visit - summary of hazards found and given pamphlet on home safety and use of medications. Intensive intervention - Home assessment as above. Post-assessment participant joint development of action plan including actions to be taken to modify hazards found. Phone prompts for action plan were provided after 3 and 6 months. 6-month follow-up advised to see family physician for medication review. Home hazards not specifically reported. Control group received no intervention.


OutcomesFalls and falls resulting in medical attention, hazard reduction. Fall related data was collected via phone interviews at 3, 6 and 12 months, and hazard reduction data was collected during the 12-month interview.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Clamp 1998

MethodsRCT.


ParticipantsFamilies with children < 5 years registered with a single-handed general practice.
n = 83 (I).
n = 82 (C).


InterventionsIntervention group families received GP safety advice and leaflets to promote the use of smoke alarms, stair gates, fireguards, cupboard locks, covers for electric sockets and door slam devices. Access to low-cost safety equipment was made available for families receiving means tested state benefits. Control group families received usual care.


OutcomesPrevalence of safety devices and practices, collected 6 weeks after the intervention via a questionnaire.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Close 1999

MethodsRCT.


ParticipantsAll patients > 65 years living in the local community who attended A & E department with a primary diagnosis of a fall between Dec 1995 and June 1996.
n = 184 (I).
n = 213 (C).


InterventionsIntervention group participants received a single home visit by an occupational therapist after medical assessment. Environmental hazards were identified using a checklist. Safety advice and education was given on completion of the assessment, and modifications such as removal of loose rugs were made with the patient's consent. Minor equipment was supplied directly by the occupational therapist and additional support was referred to social or hospital services. Control group patients received usual care.


OutcomesPrimary diagnosis of a fall & hospital admissions, collected via postal questionnaire every 4 months for 1 year after the fall.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Cumming 1999

MethodsRCT.


ParticipantsInpatients, > 65 years of age, in 2 hospitals. Also recruitment from outpatient clinics at study hospitals and local day care centres for older people.
n = 264 (I).
n = 266 (C).


InterventionsIntervention group participants received home visit by an occupational therapist who conducted a 1-hour home assessment using a standardised form to record hazards and facilitated necessary home modifications. Modifications included: removal of mats and electrical cords, installation of non-slip mats, night-lights and stair rails and advice on footwear and activities. Control group participants received usual care.


OutcomesFalls, and modifications to the home. Fall data was collected over a 12-month follow-up period using monthly fall calendars and compliance with home modifications was recorded during a 12-month follow-up home visit.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Day 2002

MethodsRCT.


ParticipantsIndependent community-dwelling elderly > 70 years of age registered on the Australian electoral roll for the area.
n = 395 (I).
n = 47 (C).


InterventionsFactorial intervention trial of group-based exercise including a balance component, home hazard management and vision improvement delivered separately or combined. Control participants received no intervention until after study end.

Home hazards intervention consisted of a walk-through checklist for rooms used in a normal week to review steps/stairs, floor surfaces, lighting, bathroom fittings and furniture and the removal/modification of home hazards either by participants or via the City's home maintenance staff. The control group received a home visit by a research nurse for baseline questionnaire and risk factor measurements before randomisation took place (as did intervention group), a falls calendar for monthly falls recording and other variables (as did intervention group), phone call if their calendar was more than 7-10 days late in being returned each month (as did intervention group), a phone call if fall reported and a telephone interview regarding circumstances of the fall (as did intervention group), promise of being given most effective intervention at study end. About 50% of control group were re-visited at study end for risk factor measurements & questionnaire (as did intervention group). There was, however, no placebo intervention for the control group, so they did not for example receive visits by a social worker etc.


OutcomesFalls and hazard reduction. Fall data collected over 18-month follow-up period using monthly fall calendars and hazard data collected at 18 months also.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Elley 2008

MethodsRCT.


Participants312 community-living people aged 75 and older who had fallen in the previous year.

n = 155 (I).

n = 157 (C).


InterventionsMulticomponent intervention: Home-based nurse assessment of falls-and-fracture risk factors and home hazards, referral to appropriate community interventions, and strength and balance exercise programme.


OutcomesFall data collected over a 12-month follow-up period using monthly fall calendars.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low risk

Gielen 2002

MethodsRCT.


ParticipantsPaediatric residents in a large, urban teaching hospital in Maryland. Parents/guardians of infants 6 months of age.
n = 19 (I1).
n = 94 (I2).
n = 20 (C1).
n = 93 (C2).


InterventionsIntervention group parents received safety counselling and referral to Children's Safety Centre (providing safety products such as, safety gates, smoke alarms, and hot water thermometers) from paediatric residents plus a home safety visit by community health worker between patient's 6- and 9-month well-infant clinic visit. Paediatric residents received 2-part training programme. (Physical hazards assessed during home visit unspecified.) Control group families received the same as above without the home visit.


OutcomesPrevalence of safety practices collected at 12-18 months follow-up during home visit.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Gitlin 2006

MethodsTwo-group randomised design with survivorship followed for 14 months.


ParticipantsUrban community living adults aged 70 and older, who reported having difficulty with one or more activities of daily living.

n = 160 (I).

n = 159 (C).


InterventionsMulticomponent intervention. Occupational and physical therapy sessions involving home modifications and training in their use, instruction in strategies of problem solving, energy conservation, safe performance, and fall recovery techniques; and balance and muscle strength training.

The six-month intervention consisted of five occupational therapy contacts and one physical therapy visit. OT's identified and prioritised priority areas, and for each targeted area an OT observed participants' performance for safety, efficiency and difficulty and presence of environmental barriers. Before the sixth contact, home modifications were ordered and installed (grab bars, rails, raised toilet seats) which were paid for through grant funds. Over the following six months OTs conducted three telephone calls to reinforce use of intervention derived strategies.


OutcomesPresence of 106 potential tripping and falling hazards (torn carpets, glare, lack of grab rails). The home hazard index represented the total number of potentially unsafe conditions. Data collected at 6 and 12 months follow-up.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low risk

Hendrickson 2005

MethodsRCT: Pre- and post-test experimental design


ParticipantsMothers of 1-4 year old children, English- or Spanish-speaking and agency qualified at or below 185% of the US Federal poverty level, were recruited from a non-urban area in Texas where migrant Hispanics represent the majority of residents.

n = 41 (I).

n = 41 (C).


InterventionsThe intervention was carried out 1 week after the baseline visit and included counselling, assessment of maternal safety practices and provision of safety items. A researcher counselled mothers regarding hazards reported during the first visit based on Health Belief Model (HBM) constructs. One construct - behaviour accomplishment - involved mothers placing free safety items and correcting hazards such as putting a working battery in a smoke detector. Mothers were also offered the option of having a photograph taken as they corrected a hazard. Another construct - persuasion - was targeted towards individuals, but built around a SafeKids brochure to stress the prevention of injuries.


OutcomesMaternal childhood injury health beliefs (MCIHB) and observed controllable safety hazards (CSH) scores collected 6 weeks after baseline visit via a home visit.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low risk

Hendriks 2008

MethodsTwo group RCT.


Participants333 community dwelling Dutch people aged 65 and over who were seen in an emergency department after a fall. Participants were also recruited from the GP Cooperative.

n = 166 (I).

n = 167 (C).


InterventionsMultidisciplinary fall prevention programme. Intervention participants underwent a detailed medical and occupational therapy assessment to evaluate and address risk factors for recurrent falls, followed by recommendations and referral if indicated. Environmental hazards were identified and recorded using a home safety checklist, and modifications were referred to and delivered by social and community services.


OutcomesFalls and injurious falls collected over a 12-month follow-up period using monthly fall calendars.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low risk

Hogan 2001

MethodsRCT.


ParticipantsAmbulatory, community-dwelling residents, > 65 years of age, of Calgary, Alberta.
n = 79 (I).
n = 84 (C).


InterventionsIntervention subjects received in-home assessments to identify both host and environmental risk factors in conjunction with the development of an individualised treatment plan, including an exercise programme for those deemed likely to benefit.
Environmental risk factors identified by example only. Examples include: no grab bars on bath/shower and the removal of floor rugs. Control group participants received a home visit from a recreational therapist who performed a leisure assessment following which a letter was sent to each participant's GP.


OutcomesFalls collected over a 12-month follow-up period via monthly fall calendars, 3- and 6-month home visits and telephone contact at 12 months.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Jenson 2002

MethodsCluster RCT.


ParticipantsLiving in residential care facilities, > 65 years.

n = 194 (I).

n = 208 (C).


InterventionsStaff education, environmental adjustment, exercise, drug review, aids, hip protectors, post-fall problem-solving conferences, guiding staff.


OutcomesFalls and injuries collected over a 34-week follow-up period using a structured report form.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Kendrick 1999

MethodsCluster RCT.


ParticipantsAll children aged 3-12 months registered with 36 participating general practices in Nottingham. All health visitors in Nottingham.
n = 1100 (I).
n = 1019 (C).


InterventionsIntervention group participants received: age-specific safety advice at child health surveillance consultations at 6-9, 12-15 and 18-24 months, provision of low-cost safety equipment (stair gates, fireguards, cupboard locks and smoke alarms) to families on means tested state benefits and home safety checks by a health visitor. Physical hazards checked during home visit unspecified. Control group participants received usual care.


OutcomesFrequency and severity of medically attended injuries, ascertained from a search of the secondary and primary care records, at 25 months follow-up.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

King 2005

MethodsRCT.


ParticipantsParticipants < 8 years old presenting to the Emergency Departments at 5 hospitals in 4 urban centres.
n = 601 (I).
n = 571 (C).


InterventionsStudy research assistant conducted home visits to observe home safety hazards for both control and intervention groups. Intervention group participants received an information package on injury prevention, discount coupons for safety devices, specific instruction regarding home safety measures and a letter from site project directors on need to maintain preventive behaviours. Hazards measured were: access to small and dangerous objects, absence of child resistant medicine containers, tap water greater than 54oC, functioning smoke detectors, fire extinguishers, stair gates, infant walkers, ease of opening basement door, absence of bicycle helmets and car restraints. Control group participants received a general pamphlet on safety and notification if a non-functioning smoke detector was found. All participants were contacted at 4 and 8 months after the initial visit to reinforce the intervention.


OutcomesInjuries and hazard reduction recorded at 4, 8 and 12 months.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Mahoney 2007

MethodsRCT.


Participants65 years and older, with two falls in the previous year or one fall in the previous 2 years with injury or balance problems.

n = 174 (I).

n = 175 (C).


InterventionsThe intervention used an algorithm based on the University of Wisconsin Falls Prevention Clinic, designed to identify predisposing factors for falls; induce risk reduction changes in medical conditions, medications, behaviour, physical status, and home environment through recommendations to participants and their physicians, referrals to physical therapy and other providers, 11 monthly telephone calls, and a balance exercise plan. Control subjects received a home safety assessment.


OutcomesFalls were followed for 12 months using monthly fall calendars and telephone contact. All hospitalisation and nursing home reports were verified using medical records.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low risk

Nikolaus 2003

MethodsRCT with follow-up of subjects for 1 year.


ParticipantsPatients with functional decline, admitted from home to a geriatric clinic in southern Germany.

n = 181 assigned to geriatric assessment and home intervention team (I).

n = 179 assigned to geriatric assessment and usual care (C).


InterventionsGeriatric assessment and home intervention. Home intervention included an assessment of the home for environmental hazards, advice about possible changes, offer of facilities to modify the home environment, and training in the use of mobility and technical aids.


OutcomesFalls and compliance with home safety recommendations, measured at 12-month follow-up.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Pardessus 2002

MethodsRCT.


ParticipantsPatients admitted to a geriatric hospital following a fall. Study set in Lille, France and mean age 83.5 years.

n = 30 (I).

n = 30 (C).


InterventionsA home visit to assess environmental hazards and recommend modifications. Environmental hazards were identified using a check list and where possible modifications such as the removal of loose carpets were made with the patient's consent. When a hazard could not be removed the occupational therapist provided safety advice instead.


OutcomesFalls collected by contacting each patient every month during 6-month follow-up and at 12 months.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Posner 2004

MethodsRCT.


ParticipantsCaregivers of < 5 year olds who presented to casualty with acute unintentional injury sustained at home.

n = 69 (I).

n = 67 (C).


InterventionsComprehensive home safety education and free home safety kit which included: cabinet latches, drawer latches, electrical outlet covers, tub spout covers, non-slip bath decals, bath water thermometer, small parts tester (choking tube), poison control telephone number stickers, and literature related to fire and window safety.


OutcomesDegree of improvement in safety practices assessed by improvement in safety scores, collected by telephone contact at 6-8 weeks after the initial ED visit.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Salminen 2009

MethodsRCT.


Participants591 community dwelling 65+ year olds, self selected between 2003 and 2005, via news articles and mail-shots.

n = 293 (I).

n = 298 (C).


Interventions12-month fall prevention programme based on individual risk analysis; geriatric assessment, counselling and guidance in fall prevention, home hazard assessment, group physical exercise, home exercise, lectures in groups and psychosocial groups.


OutcomesFalls were followed for 12 months using monthly fall calendars.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low risk

Sangvai 2007

MethodsProspective RCT.


ParticipantsTrial conducted at 3 paediatric sites. Recruitment occurred from December 2002 to January 2004 and included parents of children aged 0 to 5 years who were with their child at a health maintenance visit.

n = 160 (I).

n = 159 (C).


InterventionsMulticomponent intervention including focused counselling from a physician and health assistant, educational handouts, phone follow-up, and access to free safety devices and automobile restraint evaluations. Intervention focused on 5 safety issues: use of automobile restraints, use of smoke detectors, safe storage of hazardous materials (household cleaners and medications), setting of appropriate tap water temperature (< 120oF), and safe storage of guns.


OutcomesPrevalence of safety features collected by home visit and medically attended injuries collected by chart review, both at 6-month follow-up.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low risk

Shaw 2003

MethodsProspective single centre RCT.


ParticipantsOlder people aged ≥ 65 years, cognitively impaired and dementia, presenting to casualty following a fall. Study set in Newcatle upon Tyne.

n = 130 (I).

n = 144 (C).


InterventionsMultifactorial intervention involving a medical, cardiovascular, physiotherapy and occupational therapy assessment and intervention. Occupational therapy assessment identified environmental fall hazards using a standard checklist, and home hazard modification was carried out using a standard protocol.


OutcomesFalls, injury rates, objective effect on environmental risk factors. Fall and injury data collected over a 12-month follow-up period, using weekly diaries and A&E department records. Environmental risk factor data collected at 3 months' follow-up.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Stevens 2001

MethodsRCT.


ParticipantsResidents, aged ≥ 70 years of age, living independently in the Perth metropolitan area and listed on the State Electoral Roll and the White Pages telephone directory.
n = 570 (I).
n = 1167 (C).
Recruited and randomly allocated by household.


InterventionsAll members of both the intervention and the control groups received a home visit from a nurse. Intervention consisted of 3 strategies: a home hazard assessment, the installation of free safety devices and an educational strategy to empower seniors to remove or modify home hazards. Modifications included: installation of grab bars, removal of obstacles, removal/stabilisation of rugs and mats, repair of damaged flooring, improving the height of chairs and improving poor lighting. Control subjects received no safety devices or information on home hazard reduction.


OutcomesFalls, injurious falls, hazard reduction. Fall and injury data collected over a 12-month follow-up period using daily calendars and hazard reduction data was collected at 11 months' follow-up by postal questionnaire (51 homes received a second home hazard assessment to evaluate change in hazard prevalence).


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Tinetti 1994

MethodsRCT.


Participants≥ 70 years of age, members of a Health Maintenance Organisation (HMO) with one of the following risk factors for falling: postural hypotension; use of sedatives; use at least four prescription medications; and impairment in arm or leg strength or range of motion, balance, ability to move safely from bed to chair or to the bathtub or toilet, or gait.
n = 153 (I).
n = 148 (C).


InterventionsMultifactorial intervention. Intervention group received home assessment visit by a nurse followed 1-week later by physical therapist. Nurse assessment included: postural hypotension, medication review and use, transfer and gait training skills, balance exercises and exercises with resistive tools. Appropriate changes to environmental hazards for falls or tripping were made such as removal of hazards, safer furniture (correct height, more stable), installation of structures such as grab bars or handrails on stairs determined by room-by-room assessment. Control group received home visits from social-work students where structured interviews were conducted.


OutcomesFalls, collected over a 12-month follow-up period.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Van Haastregt 2000b

MethodsRCT.


ParticipantsParticipants, ≥ 70 years of age, from 6 general practices in Hoensbroek, who had reported two or more falls in the previous 6 months or had scored 3 or more on the mobility control scale of the short version of the sickness impact profile.
n = 159 (I).
(n = 138 received standard intervention programme; n = 21 did not receive standard intervention programme).
n = 157 (C).


InterventionsMultifactorial intervention. Intervention group received 5 home visits by community nurse over a period of 1 year. During home visits participants were screened for medical, environmental and behavioural factors potentially influencing falls and mobility and followed by advice, referrals and other actions aimed at dealing with observed hazards. The control group did not receive any special attention or intervention on prevention of falls and impairments in mobility. No details of any home modification given.


OutcomesFalls & injurious falls, collected at 12 and 18 months' follow-up.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Vetter 1992

MethodsRCT.


Participants70 years of age patients registered at a group practice of 5 general practitioners in a Welsh market town.
n = 350 (I).
n = 324 (C).


InterventionsIntervention participants received intensive health visiting, over 4 years, to provide nutrition advice and make medical and environmental checks environmental hazards included: trailing wires, loose carpets, outside toilets, lighting levels and slippery slopes. Muscle tone and fitness levels were addressed at physiotherapist-led classes. Health visitor visited as often as believed to be necessary, carrying out referrals. Details concerning the control group are not available.


OutcomesChange in fracture rates, falls over a 4-year follow-up period.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low riskAdequate.

Watson 2005

MethodsRCT.


ParticipantsFamilies with one or more children younger than 5 years, from the caseloads of participating health visitors. Health visitors were recruited from working practices located in deprived areas in the Nottingham Health Authority.

n = 1711 families (I).

n = 1717 families (C).


InterventionsStandardised safety consultation and provision of free safety equipment.

Intervention comprised of a standard consultation on safety that had been adapted to conform to educational principles to increase the effectiveness. Consultation was individualised and specific to children's ages in each family and took about 20 minutes. The health visitor offered stair gates, fire guards, smoke alarms, cupboard locks and window locks free of charge to low income families and these were fitted free of charge. Families not on a low income were offered equipment at cost price and a delivery service to their home.


OutcomesMedically attended injury over a two year follow-up period, and possession of safety equipment collected at 12 and 24 months by postal questionnaire.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment (selection bias)Low risk

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Assantachai 2002Community based with no home hazard intervention.

Barnes 2004Trials of Improved Practices (TIPs) methodology.

Binns 2004Study focused on reducing injuries related to chronic exposures.

Boreland 2006Study focused on reducing injuries related to chronic exposures.

Bouwen 2008No intervention that met inclusion criteria.

Caplan 2004No intervention that met inclusion criteria.

Carman 2006Evaluation study.

Casteel 2004Controlled clinical trial. Allocation concealment unclear.

Ciaschini 2009No intervention that met inclusion criteria.

Clemson 1996Case-control study.

Colver 1982Controlled clinical trial. Allocation concealment unclear.

Conn 2005Non-controlled before and after study. Allocation concealment not used.

Dershewitz 1979Controlled clinical trial. Allocation concealment unclear.

Diener 2005Controlled clinical trial. Allocation concealment unclear.

Dixon 2009Controlled clinical trial. Allocation concealment unclear.

Duff 2002Undefined access to home equipment with no measure of change to physical hazards.

Durongritichai 2003PRECEDE-PROCEED methodology with randomisation not described.

Fergusson 2005No intervention that met inclusion criteria.

Filiatrault 2007Controlled clinical trial. Allocation concealment unclear.

Gerson 2005Controlled clinical trial. Allocation concealment unclear.

Gillespie-Bennett 2008Study focused on reducing injuries related to chronic exposures.

Ginnelly 2005Installation of smoke alarm sole intervention.

Haynes 2003No intervention that met inclusion criteria.

Hermann 1999German-language paper translated does not meet inclusion criteria.

Hornbrook 1994Controlled clinical trial. Allocation concealment unclear.

Huang 2003No intervention to meet inclusion criteria.

Huang 2004Controlled clinical trial. Allocation concealment unclear.

Iwarsson 2009Survey study.

Johnston 2000Controlled clinical trial. Allocation concealment unclear.

Katcher 1989Controlled clinical trial. Allocation concealment unclear.

Kelly 1987Controlled clinical trial. Allocation concealment unclear.

Kendrick 2008Study protocol.

Kerse 2004No intervention that met inclusion criteria.

Laffoy 1997Case-control.

Lamb 2008Survey study.

Lannin 2007No intervention that met inclusion criteria.

Lightbody 2002Controlled clinical trial. Allocation concealment unclear.

Lin 2007Controlled clinical trial. Allocation concealment unclear.

Llewellyn 2003No intervention that met inclusion criteria.

McLean 1996Case-control.

McMurdo 2000Environmental intervention was not undertaken.

Minkovitz 2010No intervention that met inclusion criteria.

Morgan 2005Evaluation study.

Morgenstern 2000Stage 1: cohort. Stage 2: case-control.

Nelson 2005No intervention that met inclusion criteria.

Neno 2008No intervention that met inclusion criteria.

Neyens 2009No intervention that met inclusion criteria.

Northridge 1995Cohort.

Odendaal 2009Controlled clinical trial. Allocation concealment unclear.

Ozanne-Smith 2002Ecological study. Changes to hazards not reported at a household level.

Paul 1994Controlled clinical trial. Allocation concealment unclear.

Peel 2000Controlled clinical trial. Allocation concealment unclear.

Peeters 2007Study protocol.

Petridou 1996Case-control.

Petridou 1997Controlled clinical trial. Allocation concealment not used.

Plautz 1996Interrupted time-series. Insufficient data gathering points.

Poulstrop 2000Controlled before and after study.

Pressley 2009No outcome that met inclusion criteria.

Ramsey 2003No intervention that meets inclusion criteria.

Rizawati 2008Cross-sectional study.

Roberts 2004Installation of smoke alarm sole intervention.

Robertson 2005Evaluation study.

Robson 2003Controlled clinical trial. Allocation concealment unclear.

Runyan 1992Case-control.

Sattin 1998Case-control study.

Schwarz 1993Controlled clinical trial. Allocation concealment not used.

Schwebel 2009Observational study.

Spiegel 1977Interrupted time-series. Insufficient data gathering points.

Steinberg 2000Controlled clinical trial. Allocation concealment unclear.

Stone 2007Controlled before and after study. Allocation concealment not used.

Studenski 1994Cohort study.

Swart 2008Housing was not architect-designed or subject to housing regulations.

Sznajder 2003Controlled clinical trial. Allocation concealment unclear.

Tanner 2003No outcome that met inclusion criteria.

Thomas 1984Controlled clinical trial. Allocation concealment unclear.

Thompson 1996Interrupted time series. Insufficient data gathering points.

Tideiksaar 1990Interrupted time-series. No control group.

Van Rijn 1991Case-control.

Vind 2009No intervention that meets inclusion criteria.

Wagner 1994Controlled clinical trial. Allocation concealment not used.

Waller 1993Controlled clinical trial. Allocation concealment unclear.

Weatherall 2004No intervention that meets inclusion criteria.

Wyman 2007No intervention that meets inclusion criteria.

Xia 2009Controlled clinical trial. Allocation concealment not used.

Yang 2008Installation of smoke alarm sole intervention.

Yates 2001Controlled clinical trial. Allocation concealment not used.

Ytterstad 1996Controlled before and after study. Allocation concealment not used.

 
Comparison 1. Multifactorial fall prevention intervention including: home hazard assessment and modification; medication review, bone and health assessment and exercise program, versus control

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Falls2901Risk Ratio (M-H, Random, 95% CI)1.09 [0.97, 1.23]

 
Table 1. Children

Study IDStudy TypeInterventionResultsReduction

Babul 2007RCTHome visit plus safety kit or safety kit alone or control groupParents in both intervention groups were more likely than those in the control group to report having their home hot water temperature adjusted to a safe level (safety kit alone (OR 2.21, 95% CI 1.32 to 3.69) & safety kit plus home visit (OR 2.6, 95% CI 1.57 to 4.46), both adjusted for income and baseline measure of dependent variable)).

Parents receiving a safety kit plus home visit were more likely to report having used the hot water temperature-testing card than those receiving the safety kit alone (OR 2.38, 95% CI 1.42-3.97), adjusted for income)).

Parents receiving a safety kit plus home visit were also more likely than those in the control group to report having plants placed out of reach of infants (OR 1.90, 95% CI 1.03 to 3.52), adjusted for income and baseline measure of dependent variable)).

However, no differences were found in the levels of parent-reported infant injuries.

Difference in injury rates between kit group and control group was OR = 1.03, (95% CI 0.49 to 2.18), and difference between the kit plus home visit group compared to control group OR =1.05, (95% CI 0.50 to 2.21).
Injury N
Falls NA
Hazards Y

Clamp 1998RCTGP safety advicePost intervention, intervention group families used fireguards (RR 1.89, 95% CI 1.18 to 2.94), smoke alarms (RR1.14, 95% CI 1.04 to 1.25), socket covers (RR 1.27, 95% CI 1.10 to 1.48), locks on cupboards for storing cleaning materials (RR 1.38, 95% CI 1.02 to 1.88), and door slam devices (RR 3.60, 95% CI 2.17 to 5.97). Intervention group families showed safe practice for: window (RR 1.30, 95% CI 1.06 to 1.58), fireplace (RR 1.84, 95% CI 1.34 to 2.54), socket (RR 1.77, 95% CI 1.37 to 2.28), smoke alarm (RR 1.11, 95% CI 1.01 to 1.22) and door slam safety (RR 7.00, 95% CI 3.15 to 15.6).

Unadjusted results.
Injury NA
Falls NA
Hazards Y

Gielen 2002RCTSafety counselling by paediatric residents, referral to children's safety centre, plus home visitNo significant differences in safety practices were found observed between study groups.

However, a sub-analysis, independent of study group, found that families who visited the safety centre were significantly more likely to have 3 or more home safety practices observed compared to families who di not (34% vs 17% ≥3, 95% CI 1.30 to 8.82). Although this analysis was adjusted for exposure to safety councelling and a home visit, and the authors found no socio-demographic confounders; it was based on non-randomised participants and is therefore susceptible to confounders and self selection bias.
Injury NA
Falls NA
Hazards N

Hendrickson 2005RCTCounselling, assessment of maternal safety practices and provision of safety items. A researcher counselled mothers regarding hazards reported during the first visit based on Health Belief Model (HBM) constructs.A statistically significant difference was found in controllable safety hazard (CHS) scores between groups F (1.77) = 99.6, P = 0.00. As well as having fewer observed hazards, mothers receiving the intervention indicated improved self efficacy for home safety behaviours. All significant ANCOVA findings occurred after the intervention.

Unadjusted results.
Injury NA
Falls NA
Hazards Y

Kendrick 1999RCTSafety advice, low-cost safety equipment and home visitNo significant difference was found in frequency of at least one medically attended injury (OR 0.97, 95% CI 0.72 to 1.30), at least one attendance at an accident and emergency department for injury (OR 1.02, 95% CI 0.76 to 1.37), at least one primary care attendance for injury (OR 0.75, 95% CI 0.48 to 1.17) or at least one hospital admission for injury (OR 0.69, 95% CI 0.42 to 1.12).

Unadjusted results.
Injury N
Falls NA
Hazards NA

King 2005RCTHome hazards assessment, discount coupons for safety devices and information packageSignificant reduction in injury visits per patient was shown in the intervention group at 12 months (RR 0.69, 95% CI 0.54 to 0.88). However between 12 and 36 months the effect appeared to diminish (RR 0.8, 95% CI 0.64 to 1.00).

Significant reduction in the observed prevalence of homes without hot water (> 54%; OR 1.31, 95% CI 1.14 to 1.50) and the presence of a fire extinguisher (OR 0.81, 95% CI 0.67 to 0.97). Other changes were small and non-significant.

Self reported home safety modifications were reported in 62% of intervention and 23% of control homes (P < 0.05).

Unadjusted results.
Injury Y
Falls NA
Hazards Y

Posner 2004RCTHome visit with structured home safety questionnaire caregivers of those < 5 years given comprehensive home safety education and free safety devicesAt 2 months follow-up the IG demonstrated significantly higher average overall safety scores than the CG (73.3%, SD 8.4%, P ≦ 0.002), and significant improvements in poison (74.4%, SD 19.5, P ≦ 0.02), cut/piercing (81%, SD18.2, P ≦ 0.001) and burn category scores (76.0%, SD 14.9, P = 0.03). Caregivers in the intervention group also demonstrated greater improvement in reported use of the distributed safety devices (65.4%, SD 20.5, P ≦ 0.001).

Unadjusted results.
Injury NA
Falls NA
Hazard reduction Y

Sangvai 2007RCTMulticomponent intervention including focused counselling from a physician and health assistant, educational handouts, phone follow-up, and access to free safety devices and automobile restraint evaluations.At 6 months follow-up smoke detectors were present and functional in 16/17 intervention households and 5/10 control (P = 0.015); hazardous substances not found in low cupboards in 13/16 intervention and 3/10 controls (P = 0.015). However the study was extremely underpowered with only 27 home assessments.

No significant difference in medically attended injuries, 19/160 intervention, 22/159 control.

Unadjusted results.
Injury N
Falls NA
Hazards Y

Watson 2005RCTStandardised safety consultation and provision of free safety equipmentAt 24 months follow up the attendance rate for injury in primary care was higher (37%) for children in intervention than in the control arm (IRR 1.37, 95% CI 1.11 to 1.70, P = 0.003). Treatment arms did not differ significantly for other injury outcomes.

At both one and two years’ follow up, families in the intervention arm were significantly more likely to have a range of safety practices.

The intervention arm were significantly more likely to be safe in terms of stairs (OR 1.46, 95% CI 1.19 to 1.80, P = 0.0004), smoke alarms (OR 1.83, 95% CI 1.33 to 2.52, P = 0.0002), windows (OR 1.28, 95% CI 1.02 to 1.59, P = 0.03), and storage of cleaning products (OR 1.34, 95% CI 1.09 to 1.66, P = 0.006) and sharp objects (OR 1.34, 95% CI 1.09 to 1.65, P = 0.005) in the kitchen than families in the control arm.

At two years, families in the intervention arm were significantly more likely to be safe in terms of smoke alarms (OD 1.67, 95% CI 1.21 to 2.32, P = 0.002), storage of medicines (OR1.55, CI 1.00 to 2.40, P = 0.05), and cleaning products (OR 1.31, 95% CI 1.07 to 1.60, P = 0.008) in the kitchen than families in the control arm.

Absolute differences in the percentages of families with safety practices were, however,
small.

Unadjusted results.
Injury N
Falls NA
Hazards Y

 
Table 2. Older people

Study IDStudy TypeInterventionResultsReduction

Becker 2003RCTStaff and resident education on fall prevention, advice on environmental adaptations, progressive balance and resistance training and hip protectors.Incidence density rate of falls was reduced (RR 0.55, 95% CI 0.41 to 0.73). No significant difference was seen for hip fractures. Lack of validated scoring meant no hazard reduction was recorded.

Unadjusted results.
Injury N
Falls Y
Hazards NA

Campbell 2005RCTHome safety assessment and modification programme, home exercise programme plus vitamin D supplementation, both interventions, or social visits.90% of the home safety group participants (152/169) reported as complying partially or completely with one or more recommendations made by the occupational therapist.

Fewer falls occurred in the group randomised to receive the home safety programme only, compared to the social visits group (IRR 0.39, 95% CI 0.24 to 0.62).

Although a conservative analysis showed neither intervention was effective in reducing injuries from falls, when the home safety programme group was analysed in a single comparison against the social visit group, the home safety programme was shown to significantly reduce injurious falls (IRR 0.56, 95% CI 0.36 to 0.87).

*Although a reduction in hazards was observed in the intervention group, no statistical significance test was reported.

Unadjusted results.
Injury Y
Falls Y
Hazards N*

Carter (unpublished)RCTHome visit to assess hazards followed by action plan.The proportion of participants who reported falling did not differ significantly between control group (CG) and either of the intervention groups (IG): brief intervention (OR 0.6, 95%CI 0.3 to 1.1) and intensive intervention (OR 0.8, 95% CI 0.4 to 1.4).

The proportion of participants who reported one or more falls resulting in medical attention did not differ significantly between control group (CG) and either of the intervention groups (IG): brief intervention, (OR 0.7, 95%CI 0.2 to 2.2) and intensive intervention (OR 0.7, 95% CI 0.2 to 2.4).

The proportion of older people falling in and around their homes was not significantly different between the control group and either of the intervention groups.

A significant association was found between intervention and control groups to improve home safety with the brief (35%) and the intensive intervention (49%) groups compared to the control group (28%) over a 12-month follow-up.

*Although a significant reduction in hazards is reported, no statistical significance test was reported.

Unadjusted results.
Injury N
Falls N
Hazards Y*

Close 1999RCTHome visit to identify hazards.Risk of falling was significantly reduced in the intervention group (OR 0.39; 95% CI 0.23 to 0.66), as was risk of recurrent falls (OR 0.33; 95% CI 0.16 to 0.68).

No significant reductions in the percentage of patients reporting serious injury from falls was found (CG 8% versus IG 4%, P = 0.26).

Unadjusted results.
Injury N
Falls Y
Hazards NA

Cumming 1999RCTHome visit to record hazards and facilitate modifications.Hazard percentage of homes with modifications recommended; compliance at 12 months:
Remove mats/rugs: 48%; 49%
Change footwear: 24%; 54%
Non-slip mats: 21%; 75%
Change behaviour: 15%; 60%
Night light: 13%; 58%
Stair rails: 12%; 19%
Remove electrical cords: 12%; 67%

Falls were reduced in the intervention subgroup with a history of falls (RR 0.64, 95% CI 0.50 to 0.83).

*Although a reduction in hazards was observed in the intervention group, no statistical significance test was reported.

Unadjusted results.
Injury NA
Falls Y
Hazards N*

Day 2002RCTMultifactorial intervention including home hazards management.The percentage estimated reduction in annual fall rate attributed to home hazard management was not significant (3.1%, 95% CI -2.0 to 9.7). There was a significant effect when combined with exercise (9.9%, 95% CI 2.4 to 17.9) and the strongest effect was observed when all three interventions; exercise, home hazard management, vision correction, were combined together (14.0%, 95% CI 3.7 to 22.6) (RR 0.67, 95% CI 0.51 to 0.88).

543 participants receiving the home hazard management intervention 478 were advised to have modifications to their homes. 363 received help to do these modifications which included 275 hand rails fitted, 72 modifications to floor coverings and 72 homes receiving contrast edging to steps.

Unadjusted results.

* Although hazards were reduced in the intervention homes, no statistical significance test was reported.
Injury NA
Falls Y
Hazards N*

Elley, 2008RCTMulticomponent intervention. Home-based nurse assessment of falls and fracture risk factors and home hazards, referral to appropriate community interventions, and strength and balance exercise programme.The incidence rate ratio for falls for intervention group compared with the control group, over the 12 month follow-up period, was 0.96 (95% CI 0.7-1.34).

There was no significant difference in secondary outcomes between the two groups.

Unadjusted results.
Injury N
Falls N
Hazards NA

Gitlin 2006RCTMulticomponent intervention involving home modifications and training in their use, instruction in strategies of problem solving, energy conservation, safe performance, and fall recovery techniques; and balance and muscle strength training.Fewer home hazards were observed in the intervention group than in the control group.

The difference of adjusted means for environmental hazards at 6 months was -1.53 (P = 0.05) which appears non-effective.

The difference of adjusted means for environmental hazards at 12 months was -1.38, (95% CI -3.17 to 0.41, P = 0.13) which was non-significant.

In both, the difference of adjusted means were adjusted for race, living arrangements, number of recent fallers and near falls, and perceived ability to manage fall risks and control falling and health conditions.
Injury NA
Falls NA
Hazards N

Hendricks 2008RCT333 community dwelling Dutch people aged 65 and over who were seen in an emergency department after a fall. Participants were also recruited from the GP Cooperative.No significant differences between the two groups were observed in terms of falls.

At least one fall: 4 months (OR 1.36, 95% CI 0.77 to 2.41, (P = 0.29)), 12 months (OR 0.86 (0.50 to 1.49) P = 0.59).

More than 1 fall: 4 months (OR 0.91, 95% CI 0.39 to 2.11 (P = 0.83)), 12 months (OR 0.95, 95% CI 0.51 to 1.78 (P = 0.87)).

injurious falls: 4 months (OR 0.79, 95% CI 0.31-2.0, (P = 0.62)), 12 months (OR 0.77, 95% CI 0.35-1.73, (P = 0.53)).

Unadjusted results.
Injury N

Falls N

Hazards NA

Hogan 2001RCTHome visit to assess environmental risk factors followed by treatment plan.No significant differences between the control and intervention groups in the cumulative number of falls (311 versus 241, P = 0.34), having one or more falls (79.2% versus 72.0%, P = 0.30) or in the mean number of falls (4.0 versus 3.2, P = 0.43).

Unadjusted results.
Injury NA
Falls N
Hazards NA

Jensen 2002RCTMultifactorial fall prevention programme comparing staff education, environmental adjustment, exercise, drug reviews, aids, hip protectors and post fall problem solving conferences.An interdisciplinary and multifactorial prevention programme targeting residents, staff and the environment may reduce falls and femoral fractures.

During the 34-week follow-up period, 44% of residents in the intervention group sustained a fall compared with 56% in the control group (RR 0.78, 95% CI, 0.64 to 0.96). The odds ratio adjusted for baseline factors was 0.49 (95% CI 0.37 to 0.65), and the incidence rate ratio of falls adjusted for baseline factors was 0.60 (95% CI 0.50 to 0.73). Three people in the intervention group and 12 people in the control group had a fracture to the femur (adjusted odds ratio, 0.23 (CI 0.06 to 0.94)).

In a later report (Jensen 2003) the effect of this intervention in older people with differing levels of cognitive function was investigated. 59 minor, moderate or serious injuries occurred in the higher cognitive group (IRR 0.9, 95% CI 0.5 to 1.5) compared with the control group and similarly in the lower cognitive group (IRR 0.9, 95% CI 0.5 to 1.3). However in the lower cognitive group the 171 participants sustained 10 femoral fractures, all of which were in the control group (P = 0.006).
Injury Y
Falls Y
Hazard NA

Mahoney 2007RCTHome visits to assess falls risk factors, recommendations to participant and physician, exercise plan, and 11 monthly telephone calls.There was no difference in rate of falls between the intervention and control groups (RR 0.81, P = 0.27).

Nursing home days were fewer in the intervention group (10.3 vs 20.5 days, P = 0.04).

Intervention subjects with a Mini-Mental State Examination (MMSE) score of 27 or less had a lower rate of falls (RR 0.55; P = 0.05) and, if they lived with someone, had fewer hospitalisations (RR 0.44, P = 0.05), nursing home admissions (RR 0.15, P = .003), and nursing home days (7.5 vs 58.2, P = .008).

Unadjusted results.
Injury NA
Falls N
Hazard NA

Nikolaus 2003RCTHome visit with advice about environmental hazards, offer of facilities to change them and training in the use of mobility and technical aids.Intervention group had 31% fewer falls than control group (IRR 0.69, 95% CI 0.51 to 0.97).
Study not designed to examine fall related injuries.
Compliance rate of 75.7% with at least one recommended hazard change.
Participants who made at least one recommendation experienced a significant reduction in the rate of falls (IRR 0.64; 95% CI 0.37 to 0.99).
The number of falls in those in the intervention group with no modifications was not significantly different from those in the control group (IRR, 1.05, 95% CI 0.82 to 1.41).

Unadjusted results.

* Although hazards were reduced in the intervention homes, no statistical significance test was reported.
Injury NA
Falls Y
Hazards N*

Pardessus 2002RCTHome visit that assessed environmental hazards and recommended modifications.Rate of falls, hospitalisation for falls were not significantly different between the two groups.

Unadjusted results.
Injury N
Falls N
Hazards NA

Salminen 2009RCT12-month fall prevention programme based on individual risk analysis; geriatric assessment, counselling and guidance in fall prevention, home hazard assessment, group physical exercise, home exercise, lectures in groups and psychosocial groups.The intervention did not reduce the incidence of falls overall (IRR for I vs C 0.92, 95% CI = 0.72 to 1.19) or the incidence of falls requiring medical treatment (IRR 0.87, 95% CI 0.63 to 1.21). However in subgroup analysis, significant interactions between subgroups and groups (I and C) were found for depressive symptoms (P = .006), number of falls during previous 12 months (P = .003), and self-perceived risk of falling (P = .045).

Unadjusted results.
Injury N
Falls N
Hazards NA

Shaw 2003RCTMultifactorial intervention including medication review, vision, blood pressure, mobility, footwear and an assessment of home environmental fall hazards and modification using standard checklists.No significant differences between two groups in proportion who fell after 1 year or in injuries sustained.
Compliance with hazard advice was 41/105 in intervention group and 8/111 in control.

Unadjusted results.

* Although hazards were reduced in the intervention homes, no statistical significance test was reported.
Injury N
Falls N
Hazards N*

Stevens 2001RCTHome visit to assess hazards, installation of free safety devices and educational strategy.No significant reduction in the intervention group in the incidence rate of falls involving environmental hazards inside the home (adjusted rate ratio 1.11; 95% CI 0.82 to 1.50), or the rate of falls inside the home (adjusted rate ratio 1.17; 95% CI 0.85 to 1.60). There was no significant reduction in the rate of injurious falls in intervention subjects (adjusted rate ratio 0.92; 95% CI 0.73 to 1.14). Rate ratios were adjusted for the covariates of age, sex, history of falling, sole participation, recruitment method and use of walking aid.

Two-thirds of falls that occurred inside the home involved an environmental hazard - most frequently implicated falls were caused by furniture (25%), steps (19%), wet and slippery floors (13%), objects on the floor (9%) and mats and rugs (7%).

Statistically significant improvements in a sample (n = 51) of the larger study were reported in: unsafe steps (mean 0.61, 95% CI 0.28 to 0.94), stabilisation of rugs and mats (mean 1.27, 95% CI 0.91 to 2.24), rooms with trailing cords (mean 0.43, 95% CI 0.10 to 0.76) and rooms with an unsafe favourite chair (mean 0.10 95% CI 0.02 to 0.18). Whilst the authors reported other results as significant, no statistical significance test was reported.
Injury N
Falls N
Hazards Y

Tinetti 1994RCTHome visit assessment and changes made to environmental hazards.The adjusted incidence ratio for falling in the intervention group as compared with the control group was 0.69; 95% CI 0.52 to 0.90. The incidence rate ratio was adjusted for the number of previous falls (0,1,2 or > 3) during the follow-up and for the week of follow-up in order to account for non-independence of recurrent falls. Changes in physical hazards were not reported.Injury NA
Falls Y
Hazards NA

van Haastregt 2000bRCTHome visit screening for environmental & behavioural factors.Odds ratios for the intervention group for at least one fall was 1.3, 95% CI 0.7 to 2.1 and for an injurious fall 1.4, 95% CI 0.8 to 2.6. Changes in physical hazards were not reported.

Unadjusted results.
Injury N
Falls N
Hazards NA

Vetter 1992RCTHome visit to provide environmental hazards check.Similar proportions of fractures were observed in both groups (5% (I) versus 4% (C)). More falls without fracture occurred in the intervention group (23% (I) versus 16% (C)). Stratifying by disability there were more falls for all disability levels in the intervention group participants.
No results reported related to changes in environmental hazards and no indication of uptake/self reported falls and injurious falls implementation.

Unadjusted results.
Injury N
Falls N
Hazards NA