Effectiveness of autonomous home hazard reduction on fear of falling in community‐dwelling older women
Journal of The American Geriatrics Society
Many falls in older people occur at home, and home hazards (HOHA) are often involved. Fear of falling (FOF) is a frequent and serious consequence of falls. This study aimed to analyze the effectiveness of an autonomous reduction of HOHA on FOF. In this single-blinded, prospective cohort study design, the inclusion criteria were female sex, age ≥60 years, no known dementia, community-dwelling, and written informed consent. Using a 54-item room-by-room checklist, the participants identified and
... tonomously reduced as many HOHA as possible, within 14 days. The FOF was measured using a dichotomous scale (D-FOF) and the Falls Efficacy Scale International (FES-I). Logistic regression models were used to identify the predictors of a substantial reduction of HOHA (≥50%) and FOF (≥25%). A total of 782 women fulfilled the inclusion criteria, and 431 (60.5%) returned the complete checklist on time. The mean age was 72.5 [SD 7.1] years. 43.8% of participants reduced ≥50% of the HOHA. The D-FOF (odds ratio 22.4 [95% confidence interval 11.0-45.3]), age ≥ 75 years (14.1 [7.5-26.4]), polypharmacy (3.0 [1.4-6.5]), and assumed improvability of housing conditions (2.4 [1.3-4.3]) were identified as predictors for substantially reducing HOHA with an area under the curve of 0.91. The initial FES-I score decreased from 24.5 to 19.5. Prior to the intervention, 53.1% showed a high FOF (>22 FES-I scores). Of these, 70.7% participants reduced their high FOF to low FOF. 29.2% of all participants reduced FOF ≥25% postinterventionally, associated with a substantial reduction in HOHA (3.5 [2.2-5.7]) as the strongest independent factor in the multiple logistic regression analysis. The use of a self-administered checklist led to a substantial reduction of HOHA and subsequently to a clinically relevant reduction of FOF in older community-dwelling women. Autonomous competence of older people should be considered when developing fall prevention strategies.