Nikolaus, et al.
This intervention provided home visits to identify environmental hazards that can increase the risk of falling, provided advice about possible changes, offered assistance with home modifications, and provided training in using safety devices and mobility aids. The fall rate for participants was reduced 31 percent. The intervention was most effective among those who had experienced 2 or more falls in the previous year; the fall rate for these participants was reduced 37 percent.
Participants were frail community-dwelling older adults who had been hospitalized for conditions unrelated to a fall, and then discharged to home. Participants showed functional decline, especially in mobility. All were 65 or older and lived in the community. Three-quarters were female.
Mid-sized town, Southern Germany
Assess and reduce fall hazards in participants’ homes.
Intervention team members contacted patients once or twice while they were hospitalized to explain the program. The program took place in participants’ homes.
The first home visit was conducted while the participant was still hospitalized. Two team members, an occupational therapist with either a nurse or a physical therapist, depending on patient’s anticipated needs, conducted a home assessment. They identified home hazards using a standardized home safety checklist and determined what safety equipment a participant needed.
During 2 to 3 subsequent home visits, an occupational therapist or nurse met with the participant to:
- Discuss home hazards
- Recommend home modifications
- Facilitate necessary modifications
- Teach participants how to use safety devices and mobility aids when necessary
The program consisted of 2 or more home visits, each lasting about 11/2 hours. After the participant was discharged from the hospital, 3 home visits typically were needed to provide advice on recommended home modifications and to teach the participant how to use safety devices and mobility aids. On average, the total individual contact time was 8 hours.
The home intervention team was composed of a physical therapist, occupational therapist, 3 nurses, a social worker, and a secretary. Occupational therapists generally worked with all participants. Depending on individual need, either a physical therapist or nurse also helped the participant. The social worker was available to provide information about ambulatory services and to help participants complete applications for additional money from the mandatory care insurance.
Information was not provided by the principal investigator.
Participants met all intervention team members at the hospital before they were discharged, which facilitated follow-up.
A standardized home safety checklist is available in German only.
Nikolaus T, Bach M. Preventing falls in community-dwelling frail older people using a home intervention team (HIT): Results from the randomized falls-HIT trial. Journal of the American Geriatrics Society. 2003 Mar;51(3):300-5.
Practitioners interested in using this intervention may contact the principal investigator for more information:
Thorsten Nikolaus, MD
Bethesda Geriatric Clinic and Professor of Geriatric Medicine
University of Ulm
Zollernring 26, 89073 Ulm, Germany
Tel: +49 731 187 185
Fax: +49 731 187 389
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