This paper describes the design of a project evaluating the effects of using a research-based strategy for managing housing adaptations (HAs); the evaluation targets clients’ perspectives in terms of activity, participation, usability, fear of falling, fall incidence, use of mobility devices, and health-related quality of life, and determines the societal effects of HAs in terms of costs.
This article summarizes seventy-seven studies from 16 countries to examine how home modifications evidence is measured.
This 2013 document of the Department of Justice and the Department of Housing and Urban Development provides guidelines regarding the persons and structures that are covered by the accessible design and construction requirements of the Fair Housing Act.
This guide is a comprehensive, one-stop encyclopedia of products and solutions that make homes safer and more livable for Seniors. Those who can benefit most from this resource include healthcare professionals, social workers, caregivers, family members and, most importantly, those who intend to age in place.
Aging and Accessible Homes Infographic includes statistics showing that 79% of adults above the age of 65 have difficulty using the bathroom when reported living in a home without accessible bathroom features, only 2% of the 21.5 million homes with an adult age 65 and over have accessible ramps and that 1 in every 3 adults age 65 and over have trouble using some feature of their home.
Cost – benefit analysis of fall injuries prevented by a programme of home modifications: a cluster randomised controlled trial. Injury prevention – Keall, M. D., Pierse, N., Howden-Chapman, P., Guria, J., Cunningham, C. W., & Baker, M. G. (2016).
This paper presents the rationale and design for a clinical trial of a new interdisciplinary program aimed to reduce disability among low income older adults; the outcomes included decreased disability in self-care (ADL), improvement in instrumental ADLS, strength, balance, walking speed, and health care utilization.
This article targets occupational therapists and discusses a useful clinical reasoning tool for them to deliver complex interventions.
This paper determines the effect size and acceptability of a multicomponent behavior and home repair intervention for low-income disabled older adults. The results found that the Community Aging in Place Better Living for Elders (CAPABLE) intervention was acceptable to participants and feasible to provide and showed promising results.
This document provides a description of complex environmental modifications (CEMs) and highlights the role of occupational therapy practitioners as providers of service within this area
EHLS recieved two Small Business Innovation Grants from the National Institute on Aging to develop the Comprehensive Assessment and Solution Process for Aging Residents (CASPAR). CASPAR enables practitioners to identify a client’s aging in place needs by collecting information that can be used by building professionals and occupational therapists to specify the right modifications. This assessment considers the home environment, the resident’s abilities and preferences, and the interaction between the two, combining the specific concerns of consumers, building professionals, and occupational therapists in performing home modifications assessments.
This paper estimates the cost benefit of the modifications from construction costs and published reports of effectiveness and cost of treating falls in Hawaii. The average cost of home modifications was $800 and the average annual averted medical cost of falling was $1728.
This article outlines cost-effective fall prevention interventions.
This is the first randomized controlled trial to examine the benefits of home modification for reducing fall injury costs in the general population. The results show a convincing economic justification for undertaking relatively low-cost home repairs and installing safety features to prevent falls.
The results of the study indicated that the rate of decline in the frail elderly can be slowed through certain in-home personnel costs, reduced through a systematic approach to providing Assistive Technology and Environmental Interventions.
A multifactorial fall prevention program with exercise intervention may reduce the risk of falls in the short-term but not necessarily in the long-term. Awareness is key to reduce falls.
This article investigated the role of environmental and behavioral factors surrounding fall incidents in a senior living community. Falls occurring in the bathroom can cause severe damage; three types of activities and five behavioral factors related to falls are identified.
This paper assesses the effectiveness of an environmental falls prevention intervention delivered by qualified occupational therapists or unqualified trained assessors. The study found that an environmental assessment prescribed by an occupational therapist significantly reduced the number of falls in high-risk individuals whereas that prescribed by a trained assessor did not.
This article aims to provide reliable and consistent practice guidelines to help prevent secondary falls in elderly adults. The guidelines include home and institutional assessment guidelines as well as recommended interventions.
The University of Southern California Leonard Davis School of Gerontology/homemods.org partnered with the National Council on Aging (NCOA) to compile and feature home modification and home safety programs falling in the categories of evidence-based, best practices, and innovative. Over 150 organizations from the aging, disability, housing, and health care sectors nationwide contributed to this inventory of home modification programs and practices
This study focuses on the best practices and tools used by Occupational Therapists on Prince Edward Island, Canada to develop an interdisciplinary, multifactorial falls prevention program.
Home FAST is a home assessment tool designed to identify older people at risk of falling because of hazards within their home environment. The tool consists of 25 items that include a range of indoor and outdoor environmental and functional concerns. A dichotomous assessment, the user marks whether or not a hazard is present. A higher score indicates a higher risk of falling.
This study tested the safety benefits of home modifications such as handrails, grab rails, outside lighting, edging and more. The findings suggest that low-cost home modifications and repairs can be a means to reduce injury in the general population.
This 2008 report from the US Department of Health and Human Services outlines the use of home modifications by older adults.
This article determines the health gain, cost-utility and health equity impacts from home safety assessment and modification (HSAM) for reducing falls in older people. Findings include: the provision of a HSAM intervention produces considerable health gain, is highly cost-effective, and provides a promising initial approach among older people.
With the aim of reducing falls among older adults, this self-assessment consists of a home safety assesment checklist and solutions, illustrations of common fall hazards and solutions in ten indoor and outdoor areas of the home, assistive devices and other recommended products to prevent falls, and “how to” home improvement instructions. In addition to assessing for risk factors, the HSSAT aims to raise awareness. For example, some users may not be aware that clutter is a fall risk until they see it on the list. By reviewing each risk item, users may be able to match the risks listed with identified risks in their own home environment. The HSSAT has been translated into several languages.
This evidence based study illustrates the effect of home visits by Occupational Therapists on the prevention of falls. It shows that home modification and behavioral changes involving OTs can improve safety in the living environments by reducing the risk of falls.
This report focuses on the housing needs of the elderly population. Most seniors wish to age in place but have to face the consequences of aging, and thus are restricted in their housing choices. The report examines the housing needs of America’s senior population, and urges the housing industry and public policy makers to respond with home modifications, supportive services, and housing alternatives. It also projects the demographic and economic profiles of the next generation of seniors and examines their likely housing choices, labor force participation, and lifestyles.
This study explores the ways in which people with dementia and their carers adapt their homes, including the barriers and use of available information. The most significant barriers to making home adaptations were lack of knowledge and maintaining familiarity. Having more information and making home modifications earlier might enable individuals with dementia to adjust to their adapted environment.
Impact of Home Modification Services on Ability in Everyday Life for People Aging with Disabilities. Petersson, Ingela; Lilja, Margareta; Hammel, Joy; Kottorp, Anders. This study examines the impact of home modifications on self-rated ability in everyday life from various aspects for people aging with disabilities.
This document, created by the Joint Center for Housing Studies at Harvard, features recent remodeling trends and includes discussions and data about the potential for growth in the accessibility remodeling market for older persons and persons with disabilities.
The In-Home Occupational Performance Evaluation (I-HOPE) targets activities performed in the home that are essential for aging in place. The purpose is to measure the effects of an incompatibility between a person’s abilities and the environment or the “person-environment misfit” of older adults and their homes. The I-HOPE helps therapists measure client’s in-home activity performance and observe changes in person-environment fit before and after home modification interventions. It considers the client’s perspective and satisfaction while recognizing the role of the environment on performance. It is a multistep assessment that is conducted in the home of an individual. It takes approximately 60 minutes to conduct. A kit includes all necessary materials to conduct the assessment’s three steps: 1) An assessment of current in-home activities is conducted using a set of 44 cards of images depicting older adults participating in daily activities. An overall score for activity performance is then calculated; 2) Priority activities are identified for intervention and given a subjective performance and satisfaction score; 3) Performance-based rating of barriers’ influence on performance. The I-HOPE yields four sub-scores that can be used individually or as a profile of performance (activity, performance, satisfaction, total barrier severity).
This paper assesses the effects of interventions designed to reduce the incidence of falls in older people living in the community and finds that group and home-based exercise programs as well as home safety interventions (and more) reduce rate of falls and risk of falling.
A series of booklets on lighting written in collaboration between AARP and the Lighting Research Center at Rensselaer Polytechnic Institute.
The LRC developed three guidelines that address the needs of health care professionals, designers and builders, and the general public, including older adults and their families.
This paper investigates the longitudinal impacts of home modifications on the difficulty of performing everyday life tasks for people aging with disabilities, and whether other factors had any additional impacts. The results found that home modifications are effective in decreasing difficulty in performing everyday life tasks up to six months after the installation and to be effective they need to be installed in a timely fashion.
This newly updated and revised guide offers practical tips and useful illustration to help persons with vision impairment live independently.
The new CDC publication, “The Potential to Reduce Falls and Avert Costs by Clinically Managing Fall Risk”, in the American Journal of Preventive Medicine is the first to show that evidence-based fall prevention interventions delivered by U.S. healthcare providers have the ability to prevent thousands of falls, thereby improving the health and well-being of older Americans.
This article presents preliminary data from Community Aging in Place, Advancing Better Living for Elders (CAPABLE), a model funded by the CMS Innovation Center and designed to overcome the functional and home environmental barriers of older adults.
Home interventions, such as assessing environmental hazards and suggesting potential modifications, alongside technical trainings were found to be effective in reducing the risk of falls among seniors with a fall history.
Exercise or physical therapy and vitamin D supplementation are suggested by the USPSTF to reduce falls for seniors who live in community settings
Shows data from Community Aging in place, Advancing Better Living for Elders (CAPABLE), a model designed to overcome the functional and home environmental barriers of older adults. Initial findings demonstrated that daily living limitations improved in 79% of the first 100 people who completed the intervention.
This study explores the effectiveness of three interventions (group based exercise, home hazard management, and vision improvement) on decreasing the risk of falls in older adults living at home.