Reducing the number of environmental hazards in the homes of community dwelling elderly: A comparison of approaches to fall prevention via environmental assessment and modification

Purpose. To investigate the effectiveness, reliability and concurrent validity of a self- administered home safety assessment designed to decrease environmental fall hazards in the homes of community dwelling elderly. Outcomes from the non-expert self-assessment were compared to those of an expert professional assessment, considered to be the "gold standard". Additionally, a tandem approach, combining the expert and non-expert assessments, was investigated and compared to the single approaches.;Null hypothesis. Method of delivery has no significant effect on the identification of fall hazards, generation of safety recommendations, or implementation of recommended changes.;Method. Ninety-six elderly volunteers were randomly assigned to receive one of three approaches. Group I used a self-administered, non-expert, home safety assessment to evaluate their homes and develop a plan to remediate identified hazards. Group II received a visit from a licensed health care professional (LHCP) who performed an expert home safety assessment and made recommendations on hazard remediation. Group III received both the professional and self administered assessments within a tandem approach. Subjects received their completed assessment, recommendations for action, and additional information on fall prevention. After 10 weeks, subjects reported on actions taken to implement recommended changes.;Results. Concurrent validity of the self-assessment tool was excellent compared to the gold standard from which it was developed (kappa=0.95). Expert versus non-expert, inter rater reliability for hazard identification was moderate for the self-assessment tool (kappa=0.46) with the expert consistently identifying more hazards than non-experts. Non-experts using the self-assessment tool generated appropriate safety recommendations for 3 out of 4 (75%) of identified hazards. Implementation of recommendations tended to be lower for fixed structural items. The proportion of recommendations implemented was approximately 50% for all three approaches but the self-assessment and tandem groups implemented a significantly higher proportion than the LHCP group (p=0.003 and p=0.02 respectively). The tandem approach resulted in the largest number of hazards corrected while the self-assessment produced the least.;Conclusion. The effectiveness of an intervention to assess and remediate environmental fall hazards is increased by using a delivery method that includes a self-assessment component.