According to recent Cochrane research, reducing home hazards such as clutter, stairs and poor lighting can reduce older people’s risk of falling by around a quarter.
The review did not find that there was conclusive evidence to support other fall prevention techniques, such as ensuring older people have the correct prescription glasses, special footwear or fall prevention training.
It also found that de-cluttering and reducing hazards had the greatest benefit for older people who are at risk of falling, for example because they have recently fallen and been hospitalized or need support with daily activities such as dressing or using stairs.
Nearly a third of people age 65 and older fall each year. Most falls occur in the home.
Lindy Clemson, Emeritus Professor at the University of Sydney, Australia was the lead author of the review. She said: “Falls are very common in older people. They can cause serious injury or even death, but they are preventable. In this review, we wanted to explore which interventions could have the greatest impact on reducing falls in older people living at home.’
Professor Clemson and her colleagues analyzed the results of 22 studies including data on 8,463 older people living in the community.
They found that taking steps to reduce fall hazards around the home reduced the overall fall rate by 26%. This usually involves assessing the risk of falling in and around the home and making recommendations to reduce the risk, for example by removing clutter and adding handrails and anti-slip strips to stairs. These measures have the greatest effect (38% fewer falls) in people who are at higher risk of falling. Based on their analysis, the reviewers found that if 1,000 people who had fallen before followed these measures for about a year, the total number of falls would have decreased from 1,847 to 1,145.
The Clemson professor said: “Falling or needing help with daily activities are markers of underlying risk factors such as restless legs, poor judgment or weak muscles. These risk factors make it difficult to negotiate the environment and in some situations increase the risk of tripping or slipping.
“Research shows that for those at risk of falling, being aware of fall hazards in and around the home, eliminating hazards and adopting safe behaviors can significantly reduce the risk of falling. Interventions to reduce the risk of falling around the home seem to require some elements of assessment and support for work, not just a short checklist of things to tick. So while everyone can take more care of their home environment and should exercise for balance and lower limb strength, professional support from an occupational therapist is an important intervention for many people living at home.
“We encourage all people to reduce their risk of falling as they age. Often these are simple things like removing or replacing slippery carpets, improving the lighting on the stairs, or de-cluttering the home. It seems that this is not always “common sense”. People tend to overlook the clutter around their home or realize that climbing ladders the way they always have is a potential fall risk, especially if their mobility or balance isn’t what it used to be.
While the review showed fewer falls with a reduction in risk, there was not enough data from the trials to determine whether there were fewer falls hospitalizations. The authors found limited evidence for the other fall prevention approaches they examined—assistive technology and education. They also found a lack of research on the impact of providing equipment or modifications to help older people carry out daily activities, such as showering or cooking, on reducing falls.
Professor Clemson added: “Fall prevention is a really important way to help people stay healthy and independent as they age, and our review also highlights the need for more research in this area.”
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