Do Home Adaptations Prevent Falls for Older People?

Abstract

Introduction
Around a third of people aged 65+, and around half of people aged 80+ fall at least once a year in the United Kingdom. Homes may be adapted to try to prevent falls, but evidence on the effectiveness of home adaptations is limited.

Objectives and Approach
Our objective was to determine if proactive (Care&Repair service) and reactive (rapid response) home adaptations provided by Care&Repair Cymru resulted in a reduced risk of a fall for older people aged 60+ in Wales.

We constructed a longitudinal dataset from the Secure Anonymised Information Linkage Databank. We created quarterly intervals for 5-years pre and post the date a home adaptation was received, or a randomly assigned date for the comparator. Per quarter, we created a binary indicator of whether someone had a fall at home that was recorded in either the emergency department or hospital admission data sources for Wales. We included key demographic variables as covariates. We analysed the data using logistic regression and a difference-in-difference approach.

Results
We analysed 634,046 individuals, of whom 60,794 received the proactive Care&Repair service, and 47,244 received the reactive rapid response service. People receiving proactive or reactive home adaptations from Care & Repair were at around a two-fold increased risk of falling, compared to those who did not receive home adaptation with Odds Ratios (ORs) of 2.13 [95%CI: 2.07, 2.20] and 2.73 [2.64,2.81] respectively. Falls risk increased per quarter for all individuals, but after intervention delivery, the rate of increase fell in the intervention groups.

Conclusion
People receiving home adaptations from Care&Repair had a higher chance of a fall, indicating the service was successfully identifying those in need. Falls risk increased for everyone over time, but this was counteracted for people receiving an intervention.