Home Fall-Hazard Reduction for Preventing Falls in Older People

Summary

A Cochrane review [Abstract] 1 included 22 studies from 10 countries involving a total of 8463 subjects, of which 14 studies with a total of 5830 subjects studied home fall-hazard interventions. Participants were community-residing people from several countries, on average 78 years old, and 65 % were women. These interventions aimed to reduce falls by assessing fall hazards and making environmental safety adaptations (e.g. non-slip strips on steps) or behavioural strategies (e.g. avoiding clutter). Home fall-hazard interventions appear to reduce the overall rate of falls by 26 % (rate ratio (RaR) 0.74, 95 % confidence interval (CI) 0.61 to 0.91; 12 studies, n=5293); based on a control group risk of 1319 falls per 1000 people a year, this was 343 (95 % CI 118 to 514) fewer falls. These interventions were more effective in people who were selected for higher risk of falling, with a reduction of 38 % (RaR 0.62, 95 % CI 0.56 to 0.70; 9 studies, n=1513; 702 (95 % CI 554 to 812) fewer falls based on a control risk of 1847 falls per 1000 people). There was no evidence of a reduction in rate of falls when people were not selected for fall risk (RaR 1.05, 95 % CI 0.96 to 1.16; 6 studies, n=3780).

Home fall-hazard interventions probably make little or no difference to health-related quality of life (HRQoL) (standardised mean difference 0.09, 95 % CI −0.10 to 0.27; 5 studies, n=1848). They may make little or no difference to the risk of fall-related fractures (RR 1.00, 95 % 0.98 to 1.02; 2 studies, n=1668), fall-related hospitalisations (RR 0.96, 95 % CI 0.87 to 1.06; 3 studies, n=325), or in the rate of falls requiring medical attention (RaR 0.91, 95 % CI 0.58 to 1.43; 3 studies, n=946).