A Comparison of Home Safety Education Methods to Prevent Falls

A Comparison of Home Safety Education Methods to Prevent Falls: Healthcare Professional
and Self-Directed Learning
Sumandeep Saharan (Investigator), Machiko R Tomita, Ph.D. (Advisor)
Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo
Objectives: Home safety education by healthcare professionals (HP) to prevent falls has
evidence to be effective, but that of self-directed learning (SDL) by older adults,
themselves, is unknown1.
Methods: This study compared effects of these two educational approaches through a twogroup pretest-posttest design. Both groups used a Home Safety Self-Assessment Tool
booklet that helps users identify fall risk factors in the home, find local resources for home
modifications and useful products, and keep a log for home hazard reduction activities.
The HP intervention provided detailed education for fall prevention in participants’ home
while the SDL group was provided an instruction sheet regarding use of the booklet.
Procedure for Analysis
1. Chi-Square and t-test statistics for sample characteristics.
2. Paired t-test , Wilcoxon signed-rank test, and Independent t-test for pre-test and post-test,
and between SDL and HP.
3. ANCOVA for differences between SDL and HP.
Demographics and other background information, Falls Efficacy Scale, Level of Stages of
Change (Transtheoretical Model), Home Safety Self Assessment Tool (HSSAT) v3.
Mean (SD) or
Frequency (%)
74.5 (8.79)
79.3 (9.55)
t = 2.049
Male =9 (75.0%)
Female=27 (54.0%)
Male=3 (25.0%)
Female=23 (46.0%)
χ² = 1.753
Black= 8, White= 28,
Native American= 0,
Hispanic= 0, Others= 0
Black= 10, White= 12,
Native American= 1,
Hispanic= 2, Others= 1
χ² = 9.250
dwelling older adults with and without history of falls.
Living Status
The Transtheoretical Model of Behavior Change2
No= 15, Yes= 21
Research Questions
Alone= 13
With Someone= 23
Medication List
No= 12, Yes= 24
Mean (SD) or
Frequency (%)
The purpose of this study is to identify and compare the effectiveness of home safety
education through SDL and home safety education provided by HP in community
Figure 3: Home Hazard Reduction
Table 1: Demographics
Conclusions: Within SDL, those with previous falls removed home hazards more than nonfallers (p<.014). Therefore, SDL using the booklet was effective in raising awareness of
home hazards, in general and effective for people with previous falls in actual home
hazard reduction.
Results: At follow-up, HP group reduced fear of falling (p<.01), and both groups moved up a
stage in the Transtheoretical Model (p<.001). Using analysis of covariance, the two groups
were similar in changes for both outcomes (p>.05). However, the HP intervention resulted
in more home hazard reductions (M=8.4, SD=6.3) than SDL (M=4.1, SD=6.2) (p=.005).
Figure 2: Stage in Transtheoretical Model
Alone= 19
With Someone= 7
No= 7, Yes= 19
No= 7, Yes= 19
1. Is there a difference between the two methods of home safety education (SDL and
χ² = 8.260
Table 2: Ten Most Home Hazards Removal Made
χ² = 1.433
1. Removed Clutter (Living Room)
6. Installed nightlight (Bedroom)
χ² = .292
2. Removed Clutter (Bedroom)
7. Removed/rearranged furniture
3. Removed Clutter (Hallway)
8. Wearing shoes with non-skid sole
4. Removed scatter rug (Kitchen)
9. Secured rug to floor (Living Room)
5. Added bathmat (Bathroom)
10. Removed Clutter (Bathroom)
education provided by HP) in reducing the fear of falling among community-dwelling
older adults with and without history of falls?
Figure 1: Change in the Level of Fear of Falling
2. Is there a difference between HPs home safety education and SDL in bringing about
change of stage in Transtheoretical Model among community dwelling older adults with
and without history of falls?
3. Is there a difference between the two methods of home safety education (SDL and
education provided by HP) in the number of home hazard reduction in communitydwelling older adults with and without history of falls?
Study Design
A two-group pretest-posttest design was used to compare two different home safety
educational approaches. The time interval between pre-test and post-test was one month.
Data for 62 community-dwelling older adults aged 60 and above from Western New York
were analyzed. Participants with cognitive impairments were not included for the study.
The most common hazards that were recognized in the home environment included the
presence of clutter in various areas, inadequate lighting, slippery bathtub, inadequate
footwear, and loose rugs. At follow-up the average number of hazards were reduced to 6.8
from 9.4 in each home. At the end of the follow-up visit most of the participants
significantly reduced their home hazards. But this indicates that hazards still exist.
1. Cumming, R. G., Thomas, M., Szonyi, G., Salkeld, G., O'Neill, E., Westbury, C., &
Frampton, G. (1999). Home visits by an occupational therapist for assessment and
modification of environmental hazards: a randomized trial of falls prevention. Journal of
the American Geriatrics Society, 47(12), 1397-1402.
2. Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people
change. Applications to addictive behaviors. American Psychologist, 47(9), 1102-1114.
The type of hazards removed by the participants suggest that cost of modifications and the
ease of making the changes are important factors for their decision to make a change. It is
also evident that history of falls has an impact on the home hazards reduction. It was
found that HSSAT v.3 is an effective tool for creating awareness about the home hazards
and motivating older adults even when it is used by themselves without healthcare
professionals. However, it was useful for actual home hazard reduction only for older
adults with previous falls. Healthcare providers intervention was effective for home
hazard reduction for older adults, in general, regardless their fall history.
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