Campbell, et al.
This study looked at the effectiveness of 2 interventions to reduce falls and fall injuries in older people with poor vision. The home safety program consisted of a home hazard assessment by an occupational therapist followed by home modifications and recommendations for behavior change. The home exercise program consisted of a combination of strength and balance exercises (the Otago Exercise Programme modified for people with poor vision) plus vitamin D supplements.
Only the home safety program was effective in reducing falls. The home safety group had 61 percent fewer falls and 44 percent fewer injuries compared to those who received social visits.
Participants were community-dwelling seniors aged 75 or older with poor vision. Two-thirds of the participants were female.
Dunedin and Auckland, New Zealand
Assess and reduce home hazards and encourage changes in behavior.
The program took place in participants’ homes.
An occupational therapist conducted a home safety assessment and made suggestions for modifications. The assessment consisted of a walk-through of the participant’s home using a checklist to identify hazards as well as a discussion about items, behavior, or lack of equipment that could lead to falls. The occupational therapist and participant then agreed on which recommendations to implement.
The occupational therapist helped the participant obtain any necessary equipment and oversaw payment for the home modifications. Home modifications and equipment costing more than NZ$200 were funded by the local Board of Health and items costing less than this were funded by the participant or from research funds. The occupational therapist made a follow-up visit if equipment needed to be installed.
The intervention consisted of 1 or 2 home visits. The first visit lasted about 2 hours. If the occupational therapist needed to approve new equipment, they made a second visit 2 to 3 weeks later. The second visit lasted about 45 minutes.
Occupational therapists who attended a 2-day training course.
One half-day training is necessary for occupational therapists to become familiar with the specific focus on falls prevention in people with poor vision.
- The occupational therapist’s advice rather than the environmental changes was key.
- A trained and experienced occupational therapist is critical to the success of this intervention.
The Westmead Home Safety Assessment checklist is available but not the modified version used in the VIP trial.
Clemson L. Home fall hazards: A guide to identifying fall hazards in the homes of elderly people and an accompaniment to the assessment tool, the Westmead Home Safety Assessment (WeHSA). West Brunswick, Victoria: Co-ordinates Publications, 1997.
Campbell AJ, Robertson MC, La Grow SJ, Kerse NM, Sanderson GF, Jacobs RJ. Randomised controlled trial of prevention of falls in people aged ≥75 with severe visual impairment: The VIP trial. British Medical Journal. 2005 Oct 8;331(7520):817-25.
La Grow SJ, Robertson MC, Campbell AJ, Clarke GA, Kerse NM. Reducing hazard related falls in people 75 years and older with significant visual impairment: How did a successful program work? Injury Prevention. 2006 Oct;12(5):296-301.
Practitioners interested in using this intervention may contact the principal investigator for more information:
A. John Campbell, MD
Department of Medical and Surgical Sciences
Dunedin School of Medicine
Dunedin, New Zealand
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