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Abstract

The Home Falls and Accidents Screening Tool (HOME FAST) was developed as a screening instrument for use in a community preventive care trial for older people. This paper describes the first stage of the development of this screening tool. The objectives of the study were (i) to review existing home safety measures, (ii) to field test an instrument containing a pool of home safety items with the goal of identifying those hazards associated with falls in the home and (iii) to select the items for inclusion in a 25-item tool using an expert panel. The field testing took place in a rural area of Australia, where the pooled checklist was used to evaluate hazards within the homes of 83 older people. No individual hazards were associated with the risk of falls at home and, although participants who had experienced falls had a higher mean number of home hazards (mean = 13.7, SD 8.2), the differences between fallers and non-fallers was not significant. Items relevant to a rural population were indicated through field testing. Further psychometric testing of the HOME FAST and a meaningful method of scoring the checklist are now warranted.
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... The Home Falls and Accidents Screening Tool (HOME FAST) is a suitable instrument for the task as it has extensive evidence of validity and reliability [18]. The HOME FAST was created in Australia and has been used in fall prevention services, and it is aimed at identifying older persons living at home who have a risk of falling due to environmental conditions in and around their home [22]. The HOME FAST has been validated among the older population in several countries and has fair to excellent interrater and test-retest reliability [20,23,24]. ...
... The HOME FAST is a screening instrument that examines home hazards through the interaction of individuals and their home environment when performing activities that could put them at risk of falls [22]. The HOME FAST assesses hazards via 25 items on seven domains consisting of flooring, furniture, lighting, bathroom, storage, stairways/steps, and mobility. ...
... The score is calculated by counting and totalling the "no" response, in which each response contributed 1 mark. The range of the score is from 0 to 25, and higher scores indicate more hazards at home, therefore a higher risk of falls [22]. The HOME FAST is administered via observation and interview of how the individual functions within their home environment [24]. ...
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Objective: This study is aimed at translating the Home Falls and Accidents Screening Tool (HOME FAST) into the three main languages spoken in Malaysia and investigating its reliability through an alternative technology-based evaluation. Methods: Translation into three languages and cross-cultural adaptation of the HOME FAST was conducted via the five steps adopted from the Mapi Institute. For interrater reliability, occupational therapists who attended a face-to-face home hazard workshop were recruited. Each therapist rated the HOME FAST by using the provided combination of videos and photographs of stroke survivors manoeuvring in their home. For test-retest reliability, the same occupational therapists were invited to rate the same combination of photographs and videos again. Reliability was analysed using Gwet's AC1 and Bland and Altman's plot to describe agreement. Results: The translation challenges were minimal and rectifiable. A Bahasa Melayu, Mandarin, and Tamil versions of the HOME FAST were developed. Overall interrater reliability for both video (AC1 = 0.91) and photograph (AC1 = 0.91) were good. The test-retest reliability yielded similar outcome (video: overall AC1 = 0.92 and photograph: overall AC1 = 0.93). Conclusion: Using alternative technology (video and photograph) to do a home hazard assessment was feasible. However, the asynchronous nature of these methods has limitations in clarifying certain aspects in the home. Moving forward, potential investigation on other technologies such as telehealth for synchronous and real-time interaction is warranted.
... A study found that among the standardized instruments developed to assess the residential risks of falls in the older adults, the Home Fall and Accidents Screening Tool (HOME FAST) (12) is one of the instruments with high potential for evaluating home hazards associated with falls (13). This instrument was translated and culturally adapted to Brazilian Portuguese (14), however, the need for home visits for its application is a limiting factor (15,16). ...
... According to the present study, the older adults who reported difficulty in getting up from bed or from armchairs/ sofas, requiring more than one attempt in order to stand up, suffered more falls in their own homes. Not managing to get up from the bed or from armchairs/ sofas on the first attempt is as much related to a possible inadequacy of the furniture as to mobility alterations in the older person (12). Aging is associated with a reduction in skeletal muscle mass and in muscle strength and power, especially that of the knee extensor muscles, in which a 20 to 40% reduction in strength and power up to the seventh decade of life has been found. ...
... Apart from these, 14.2% of the falls occurring in the person's own home were caused by attitudes such as getting up onto a stool or portable steps when carrying out domestic chores. Risky behavior includes attitudes adopted by the community-dwelling older adults which expose them to a greater chance of falling (12,38). The items in the HOME FAST BRAZIL-SR cover risk categories such as environmental factors, functional factors and behavioral factors (17). ...
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Objective: Verify the intra- and inter-rater reliability of the HOME FAST BRAZIL—Self-reported version and correlate household environmental risks with the history of falls by community-dwelling older adults. Method: Cross sectional study with 50 community-dwelling older adults who were screened by the cut-off point of the Mini Mental State Exam and replied to the HOME FAST BRAZIL—Self-reported version using two evaluators, on three occasions. The reliability analysis was determined by the Intra-class Correlation Coefficient (ICC), considering ICC > 0.70 as adequate. To test the correlations, the Spearman test was used. Results: The mean age of the participants was 73.2 ± 5.8 years. The inter- rater reliability of HOME FAST BRAZIL—Self-reported version was ICC 0.83 (IC95%, 0.70–0.90) and the Intra- reliability ICC 0.85 (IC95%, 0.74–0.91). A risk of falls was verified in 88% of the sample and four environmental risks presented significant correlations with the history of falls. Conclusions: The HOME FAST BRAZIL—Self-reported version presented adequate reliability for the evaluation of household environmental risks for community-dwelling older adults. Risks such as inadequate armchairs/ sofas, the absence of anti-slip mats in the shower recess, the presence of pets and inadequate beds require attention in the evaluation of household risks, due to their correlation with the occurrence of falls.
... The Greek version of the Falls Self-efficacy International Scale (FES-I_GREEK) [8] was used for the evaluation of "fear-of-falling" (FOF), defined as ongoing concern about falling that ultimately limits the performance of activities of daily living (ADL) [22]. The home falls and accidents screening tool (HOMEFAST) [23] was used to identify hazards in older people's home. The description and procedures of the used outcome measures are presented below: ...
... The score ranges from 0 to 25 points. The maximum score of 25 corresponds to a higher risk of falling within the home environment [23]. ...
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Objectives Physical exercise is a key intervention for improving functional ability and preventing falls in older people. However, the implemented interventions targeted balance, gait, and muscle strength, while little is known regarding motor control exercises in this population. Therefore, this study aimed to investigate the effects of a 12-week home-based motor control exercise program combined with an ergonomic home modification (the McHeELP program). Patients and methods Fifty-two older people (aged ≥65 years), who had experienced at least one fall incident in the past 12 months, were randomly assigned into two groups; the McHeELP group (McHeELP-G) (n=26) that received the McHeELP program and the control group (CG) (n=26). Physical performance measures (PPMs) and patient-reported outcomes (PROs) were used to evaluate participants. At baseline, 3rd month (post-intervention), and again at 6th month (follow up), balance control was assessed using the Tandem stance test (Tandem) and the Functional Reach Test (FRT). Functionality was assessed by the 4 meters walking test (4MWT), Timed Up and Go (TUG) test, 30 seconds-Sit to stand test and the Greek version of Lower Extremity Functional Scale (LEFS-Greek). The Greek version of the Falls Self-efficacy International scale (FES-I_GREEK) was used for the evaluation of "fear-of-falling" (FOF). The home falls and accidents screening tool (HOMEFAST) is used to identify home hazards. Two-way mixed ANOVA model, independent samples t-test, One-factor Repeated Measures ANOVA model and ANCOVA model were used for the statistical analysis of the data. Results Homogeneity was found between McHeELP-G and CG regarding the demographic and clinical characteristics, and no statistically significant difference was found at baseline measurements of PROs andPPMs, except HOMEFAST (p=0.031). Post-intervention (3rd month), the comparison of the absolute values between groups revealed that the McHeELP-G achieved statistically significant better balance control (longer Tandem stance test and higher values of FRT), better functionality [faster gait speed (4MWT), shorterTUG performance time, and a higher number of repetitions at 30 seconds-Sit to stand] (all p-values <0.05), while no difference was found for LEFS-Greek score (p=0.095), compared to CG. In addition, McHeELP-G reported lesser FOF than CG [lower FES-I_GREEK score (p=0.041)], and fewer home-hazards [lower HOMEFAST score (p=0.041)]. At follow up measurement (6th month), all PPMs scores of McHeELP-G, regarding balance control and functionality, were remained statistically significant (all p-values <0.005), and the FES-I_GREEK score (p=0.034), while no difference was found between groups for LEFS-Greek score (p=0.146) and HOMEFAST score (p=0.185). Sensitivity analysis (from baseline to 3rd and 6th month) revealed similar findings to the "comparison of the absolute values between groups" analysis. The within-group changes from baseline to 3rd month of McHeELP-G were statistically significant improved for all PPMs and PROs (all p-values <0.05), while in CG, statistical significant difference was found for TUG, FRT-right, and HOMEFAST (p<0.05). Those within-group changes were also preserved until 6th month. Conclusions The study's findings provide encouraging evidence that McHeELP program may increase functional ability and decrease FOF of older people. However, further research is required for a thorough understanding of the effect of McHeELP program.
Article
Background People older than 65 years tend to have traumatic brain injuries (TBIs) more frequently and have a higher mortality rate after TBI than younger individuals. The aim of this study was to determine the effects of age on in-hospital mortality among patients who had fall-related TBIs at home, emphasizing the effect of specific locations in the house on the outcome. Methods This cross-sectional study was conducted using the Emergency Department-based Injury In-Depth Surveillance (EDIIS) database in South Korea. Patients aged 65 years or older with a slip or fall injury, accidental injury at home, and no major diagnosis other than TBI were included. The primary outcome was in-hospital mortality. Subgroup analysis was conducted to determine the effect of locations on the relationship between age and in-hospital mortality. Results Of the 2,571,442 patients in the EDIIS database, 9,747 were included in this study. The most common injury location was room or bedroom (29.1%), followed by living room or kitchen (23.0%), bathroom (20.2%), stairs (15.8%), and outdoor spaces of the house (11.9%). There was a significant association between increased in-hospital mortality and oldest old age. The stairs or outdoor spaces of the house was significantly associated with in-hospital mortality compared to rooms inside the house. The oldest age group showed a higher association with in-hospital mortality than the young-old group, especially in the bathroom, stairs, and outdoor spaces of the house. Conclusions Elderly individuals over the age of 85 are the most vulnerable to fall-related TBI mortality at home. A fall prevention strategy for the oldest-old is needed, especially for the bathroom, stairs, and the ancillary space outside the house.
Article
Many middle aged and older people will need to adapt or modify their home in order to age in place. Arming older people and their families with the knowledge and tools to assess their home and plan simple modifications ahead of time will decrease reliance on professional assessment. The objective of this project was to co-design a tool which enables people to assess their own home environment and make future plans for ageing in the home. We recruited members of the public who were aged 60 or older to attend a series of two co-design workshops. Thirteen participants worked through a series of discussions and activities including appraising different types of tools available and mapping what a digital health tool might look like. Participants had a good understanding of the main types of home hazards in their own homes and the types of modifications which may be useful. Participants believed the concept of the tool would be worthwhile and identified a number of features which were important including a checklist, examples of good design which was both accessible and aesthetically pleasing and links to other resources such as websites which provide advice about to make basic home improvements. Some also wanted to share the results of their assessment with family or friends. Participants highlighted that features of the neighbourhood, such as safety and proximity to shops and cafes, were also important when considering the suitability of their home for ageing in place. Findings will be used to develop a prototype for usability testing.
Article
Introdução: A identificação dos fatores de risco ambientais de quedas é determinante para a prevenção deste evento em idosos da comunidade. Objetivo: Apresentar as principais diretrizes para a avaliação dos riscos ambientais de quedas em idosos da comunidade. Método: Revisão narrativa de literatura com pesquisa bibliográfica realizada por meio de busca nas bases de dados LILACS, MEDLINE, SciELO e PubMed no período de agosto a novembro de 2018. Resultados: As diretrizes sobre riscos de quedas em idosos da comunidade recomendam a realização de avaliação multifatorial, incluindo fatores de risco intrínsecos e extrínsecos, com destaque para os fatores domiciliares. Diversas abordagens e ferramentas têm sido utilizadas para a avaliação do risco de quedas em idosos da comunidade. Entre os instrumentos validados para a avaliação de riscos ambientais residenciais, a maioria requer visita domiciliar pelo profissional de saúde para ser aplicado. Conclusão: Avaliação multifatorial é fundamental para identificar os principais fatores de risco para quedas em idosos da comunidade. A identificação de perigos no domicílio é um dos requisitos fundamentais para uma avaliação eficiente.Palavras-chave: Acidentes por Quedas. Idosos. Avaliação de Risco. Riscos Ambientais. AbstractIntroduction: The identification of environmental risk factors for falls is crucial for the prevention of this event in the elderly in the community. Objective: To present the main guidelines for the assessment of the environmental risks of falls among elderly people in the community. Method: Narrative review of literature with bibliographic research carried out by searching the LILACS, MEDLINE, SciELO and PubMed databases from August to November 2018. Results: The guidelines on the risks of falls in the elderly in the community recommend carrying out multifactorial assessment, including intrinsic and extrinsic risk factors, with emphasis on household factors. Several approaches and tools have been used to assess the risk of falls in the elderly in the community. Among the validated instruments for assessing residential environmental risks, most require home visits by health professionals to be applied. Conclusion: Multifactorial assessment is essential to identify the main risk factors for falls in the elderly in the community. The identification of hazards at home is one of the fundamental requirements for an efficient assessment.Keywords: Accidental Falls. Aged, Risk Assessment. Environmental Risks. ResumenIntroducción: La identificación de los factores de riesgo ambientales para las caídas es crucial para la prevención de este evento en los ancianos de la comunidad. Objetivo: Presentar las principales pautas para la evaluación de los riesgos ambientales de caídas entre las personas mayores en la comunidad. Método: revisión narrativa de la literatura con investigación bibliográfica realizada mediante la búsqueda en las bases de datos LILACS, MEDLINE, SciELO y PubMed de agosto a noviembre de 2018. Resultados: las pautas sobre los riesgos de caídas en los ancianos en la comunidad recomiendan llevar a cabo evaluación multifactorial, incluidos los factores de riesgo intrínsecos y extrínsecos, con énfasis en los factores del hogar. Se han utilizado varios enfoques y herramientas para evaluar el riesgo de caídas en los ancianos de la comunidad. Entre los instrumentos validados para evaluar los riesgos ambientales residenciales, la mayoría requiere que se apliquen visitas domiciliarias de profesionales de la salud. Conclusión: la evaluación multifactorial es esencial para identificar los principales factores de riesgo de caídas en los ancianos de la comunidad. La identificación de los peligros en el hogar es uno de los requisitos fundamentales para una evaluación eficiente.Palabras clave: Accidentes por Caídas. Personas Mayores. Evaluación de Riesgos. Riesgos Ambientales.
Chapter
This third edition of a trusted resource brings together the latest literature across multiple fields to facilitate the understanding and prevention of falls in older adults. Thoroughly revised by a multidisciplinary team of authors, it features a new three-part structure covering epidemiology and risk factors for falls, strategies for prevention and implications for practice. The book reviews and incorporates new research in an additional thirteen chapters covering the biomechanics of balance and falling, fall risk screening and assessment with new technologies, volitional and reactive step training, cognitive-motor interventions, fall injury prevention, promoting uptake and adherence to fall prevention programs and translating fall prevention research into practice. This edition is an invaluable update for clinicians, physiotherapists, occupational therapists, nurses, researchers, and all those working in community, hospital and residential or rehabilitation aged care settings.
Chapter
This third edition of a trusted resource brings together the latest literature across multiple fields to facilitate the understanding and prevention of falls in older adults. Thoroughly revised by a multidisciplinary team of authors, it features a new three-part structure covering epidemiology and risk factors for falls, strategies for prevention and implications for practice. The book reviews and incorporates new research in an additional thirteen chapters covering the biomechanics of balance and falling, fall risk screening and assessment with new technologies, volitional and reactive step training, cognitive-motor interventions, fall injury prevention, promoting uptake and adherence to fall prevention programs and translating fall prevention research into practice. This edition is an invaluable update for clinicians, physiotherapists, occupational therapists, nurses, researchers, and all those working in community, hospital and residential or rehabilitation aged care settings.
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Background: Falls are recognized globally as a major public health problem. Although the elderly are the most affected population, it should be noted that the pediatric population is also very susceptible to the risk of falling. The fall risk approach is the assessment tool. There are different types of tools used in both clinical and territorial settings. Material and methods: In the month of January 2021, a literature search was undertaken of MEDLINE, CINHAL and The Cochrane Database, adopting as limits: last 10 years, abstract available, and English and Italian language. The search terms used were "Accidental Falls" AND "Risk Assessment" and "Fall Risk Assessment Tool" or "Fall Risk Assessment Tools". Results: From the 115 selected articles, 38 different fall risk assessment tools were identified, divided into two groups: the first with the main tools present in the literature, and the second represented by tools of some specific areas, of lesser use and with less supporting literature. Most of these articles are prospective cohort or cross-sectional studies. All articles focus on presenting, creating or validating fall risk assessment tools. Conclusion: Due to the multidimensional nature of falling risk, there is no "ideal" tool that can be used in any context or that performs a perfect risk assessment. For this reason, a simultaneous application of multiple tools is recommended, and a direct and in-depth analysis by the healthcare professional is essential.
Article
The purpose of this research was to examine environmental hazards related to falling risk by using two different approaches and to discuss older adults’ adaptive coping strategies. Environmental hazards were identified by a researcher and residents in 88 older adults’ independent living units at a senior retirement community. This research employed two statistical analyses including a dependent sample t-test and pair-wise Kappa statistics in order to identify a significant difference in environmental hazards from two assessment tools as well as examine the inter-rater reliability on each item. Research findings show that older adults could hardly identify as many environmental hazards as the objective measurement did because of their different coping strategies, knowledge, experience, and health status. The residents' perception is a necessary component in that it could provide new insights about hazards. This research provides empirical evidence of how older adults negotiate their environmental hazards.
Chapter
The central theoretical perspective of this book has been provided by the contingency theory developed by Miles and Snow. According to Miles and Snow, not only is it important to achieve alignment between the internal characteristics of organizations, but a fit between those characteristics and the environment is also critical to organizational success. Miles and Snow (1978, 3) note the demands that this places on organizations at the outset of the book: ‘For most organizations, the dynamic process of adjusting to environmental change and uncertainty — of maintaining an effective alignment with the environment while efficiently managing internal interdependencies — is enormously complex.’ In the introduction to the Classic Edition (as published in the 2003 reprint, xviii) they argue that they were ‘less certain about how consistency across strategy, structure and process contributed to firm success. Eventually, we decided that the concept of fit could be used to explain the dynamics of organizational adaptation and effectiveness.’ In view of the need for fit, in Chapters 4–6, we examined how strategy interacts with key internal characteristics to influence performance. In this chapter, we explore how strategy content, formulation and implementation interact with the technical and institutional environment confronted by public organizations to affect organizational outcomes.
Article
This study describes the type and range of hazards found in the homes of elderly persons (n=257) referred to the occupational therapy department of a city teaching hospital. Homes were assessed using an abbreviated version of the Westmead Home Safety Assessment. The most commonly found hazards were in internal traffic ways (48%), the bathroom (40%), and access areas to and from the home (38%). Hazardous mats, pathways, and bathroom and toilet floor surfaces were the most commonly found individual hazards. Mildly cognitively impaired persons were found to have increased exposure to hazards in traffic ways; women were found to have more bed light hazards and people living with others were more likely to have a pet that may pose a risk of the elderly person falling. Otherwise, characteristics of people were generally not found to be associated with increased exposure to any particular type of hazard. We recommend further and more detailed investigation of home hazards, including in the homes of the well elderly.
This article defines the environment's potential to "support competence, provide appropriate stimulation, and promote safety" by using examples and case data. The author fosters a great appreciation of the home as a medium for enhancing functional independence. This information is of vital importance to the home care professional who relates to the geriatric patient in the home setting.
Article
Falls are the commonest cause of accidents in the home, affecting onethird of those over 65 years of age every year. Thirty-seven patients who had fallen took part in a quasi-experimental study with a pretest post-test design. Group A received a group education programme and an information booklet, and group B received just the booklet. Results showed that patients who participated in a group programme with the booklet were most likely to show a very high score when tested on their knowledge of falls prevention strategies, but had little change to their attitudes/behaviour towards risk-taking 1 month after discharge.